Medicare Coverage

Diabetic Education

Socks/Hosery

Shoes

Inserts

Foot inspection

Foot hygiene

Skin care

Toenails

Exercise

 
 
Medicare Coverage
Medicare may cover some of the cost of "high risk" routine foot care for people with certain conditions. You must be under the active care of a MD or DO who documents your condition. Additionally, care from a non-professional would be hazardous because of the underlying systemic disease. Ask your podiatrist, NP, or PA if you qualify for coverage for routine foot care.
Medicare may also cover the cost of therapeutic shoes  as well as inserts for individuals with diabetes. A podiatrist can work with your MD/DO if you have qualifying medical conditions that allow for Medicare coverage for therapeutic shoes and/or inserts. Your NP/PA can work with (incident to) the supervising MD/DO to create an order for therapeutic shoes. Your NP can work independently to order therapeutic shoes if he/she is enrolled in Medicare's Primary Care First Initiative.
Diabetic Education
There are many places to look for diabetic education. In a 2019 review about diabetic education, Smith et al. found that people turn to Facebook, Google, and YouTube to find answers. In their search for relevant material offered through YouTube, they found that of the first 100 videos that came up with the search diabetic foot care, over a third of them were classified as misleading. Smith et al. (2019) further identified the following topics as relevant to diabetic foot care.

 

Blood sugar: Target ranges, foods, exercise

Foot inspection: areas of friction, pressure, or injury

Exercise: fitness programs

Foot hygiene: daily washing and thorough drying

Skin care: lotions (emollients) and ointments (humectants), over the counter anti fungals

Toenails: proper length, width, and thickness

Foot protection: wearing shoes while walking

Socks: material, size, length, and form fitting to reduce wrinkles (pressure) or slack (friction)

Shoes: length, depth, width, sole, upper - breathability and give

Temperature protection: avoiding frozen toes or burnt feet

Circulation: things that help or inhibit blood flow to your toes

Seeing a podiatrist: pain, injury, balance

Over the course of time, I will add information about each topic. Please revisit for additional information.

Socks/Hosery

The goals of an ideal sock are to:

1) Reduce friction.

2) Reduce pressure by providing padding for boney areas like joints or metatarsal heads on the ball of your foot.

3) Assist with moisture wicking to keep your feet dry, which prevents maceration and skin breakdown.

Socks are just as important as shoes and inserts and should be chosen with the same care. Thin material as seen with thin anklets, nylon stockings, and trouser socks retain moisture and do not protect against friction/pressure.

The features of an ideal sock are:

1) Thick enough to protect the skin.

2) Made with a synthetic material that will wick away moisture.

3) Seamless or have minimal seaming (allowable if the seam is on the outside of the sock and above the toenails).

4) Light in color to identify if there is a break in the skin (most often the plantar surface/bottom of the foot for those with peripheral neuropathy/loss of protective sensation).

5) Appropriate fit to avoid pressure (if too small) or friction/pressure (if too big, leading to slipping or folds).

Brands that are recommended by The Academy of Pedorthic Science are:

Thorlo

Dr. Specified

When choosing a sock style, make sure that your sock cuff is either just below the knee or at the ankle. The elastic cuff can further reduce circulation if pulled to the mid-calf.

References

Smith, P. E., McGuire, J., Falci, M., Poudel, D. R., Kaufman, R., Patterson, M. A., Pelleschi, B., Shin, E. (2019, March 1). Analysis of YouTube as a Source of Information for Diabetic Foot Care. Journal of American Podiatric Medical Association, 109(2), 122–126. doi: https://doi.org/10.7547/16-149

 

Diabetic Feet