This document outlines InCare DME's diabetic footcare program. It discusses Medicare coverage of therapeutic shoes and inserts, risks factors for diabetic foot complications, proper foot assessment and care, the fitting process for therapeutic shoes, and follow up with patients. Key points include that Medicare covers one pair of therapeutic shoes and 3 pairs of inserts per year to help prevent foot complications for diabetics, which can include ulcers, infection, and amputation. A proper fitting process assesses foot risks and ensures shoes and inserts are properly fitted to support high-risk feet.

1. InCare DME
DIABETIC FOOTCARE PROGRAM
InCareInCare DMEDME
DIABETIC FOOTCARE PROGRAMDIABETIC FOOTCARE PROGRAM
Implementation PresentationImplementation Presentation
Nancy Cummings, RN, Clinical DirectorNancy Cummings, RN, Clinical Director
Greg Wolfe, Pres., C.Greg Wolfe, Pres., C.PedPed..
Bob Schwartz,Bob Schwartz, CPedCPed., C.O.F.., C.O.F.
Lori Schwartz, C.Lori Schwartz, C.PedPed., C.O.F.., C.O.F.

2. •• http://www.incaredme.comhttp://www.incaredme.com
•• Phone (866) 936Phone (866) 936--74637463
•• Fax (818) 991Fax (818) 991--49514951
•• sales@sales@incaredmeincaredme.com.com
•• Nancy Cummings (443) 786Nancy Cummings (443) 786--21672167
•• Customer Service & Applications StaffCustomer Service & Applications Staff

3. InCare Therapeutic Shoe ProgramInCareInCare Therapeutic Shoe ProgramTherapeutic Shoe Program
•• Medicare Therapeutic Shoe BillMedicare Therapeutic Shoe Bill
•• The Diabetic FootThe Diabetic Foot
•• InterventionIntervention
•• Diabetic Shoes and InsertsDiabetic Shoes and Inserts
•• The Sizing ProcessThe Sizing Process
•• The Fitting ProcessThe Fitting Process
•• The Ordering ProcessThe Ordering Process
•• DeliveryDelivery
•• GauntletsGauntlets
•• ConclusionConclusion

4. The Medicare Therapeutic Shoe BillThe Medicare Therapeutic Shoe BillThe Medicare Therapeutic Shoe Bill
•• Created by Medicare in June 1993. This is aCreated by Medicare in June 1993. This is a
Medicare Part B program.Medicare Part B program.
•• Preventative Measure.Preventative Measure.
•• RenewableRenewable everyevery calendar year.calendar year.
•• 1 pair Therapeutic Shoes1 pair Therapeutic Shoes
•• 3 Pair:3 Pair:
–– Custom Molded InsertsCustom Molded Inserts
–– Heat Moldable InsertsHeat Moldable Inserts

5. The Diabetic FootThe Diabetic FootThe Diabetic Foot
•• The Diabetic Patients feet are at RISK.The Diabetic Patients feet are at RISK.
•• More than 25% of all Diabetic hospitalizations are foot related.More than 25% of all Diabetic hospitalizations are foot related.
•• ADA states that there are 20.8 million people with Diabetes.ADA states that there are 20.8 million people with Diabetes.
•• Every 21 seconds someone in the USA is diagnosed with DM.Every 21 seconds someone in the USA is diagnosed with DM.
•• Every 30 seconds, a lower limb is lost to diabetes somewhere inEvery 30 seconds, a lower limb is lost to diabetes somewhere in
thethe worldworld....
•• More than 170 million people suffer from diabetes globally, andMore than 170 million people suffer from diabetes globally, and
the World Health Organization expects that number to doublethe World Health Organization expects that number to double
by 2030.by 2030.
•• MoreMore ½½ of those cases are of Medicare age.of those cases are of Medicare age.
•• This is your most seen groupThis is your most seen group..

6. The Diabetic FootThe Diabetic FootThe Diabetic Foot
•• 72,000 amputations each year result from complications72,000 amputations each year result from complications
of diabetes.of diabetes.
•• ½½ of the patients who had a foot or leg amputated willof the patients who had a foot or leg amputated will
endure yet another amputation within five years .endure yet another amputation within five years .
•• The cost to Medicare for a (LEA) is approx. $54,000The cost to Medicare for a (LEA) is approx. $54,000
per patient for the life of the patient.per patient for the life of the patient.
•• The cost to the Patient IMMEASURABLE!The cost to the Patient IMMEASURABLE!
•• ““Prevention is keyPrevention is key””. Hence, the Medicare Therapeutic. Hence, the Medicare Therapeutic
Shoe Bill.Shoe Bill.

7. Risk Factors for AmputationRisk Factors for AmputationRisk Factors for Amputation
•• Peripheral NeuropathyPeripheral Neuropathy
•• Sensory DepravationSensory Depravation
•• Altered BiomechanicsAltered Biomechanics
•• Peripheral Vascular DiseasePeripheral Vascular Disease
•• Evidence of Increased Pressure,Evidence of Increased Pressure,
Callus and CornsCallus and Corns
•• History of UlcerationHistory of Ulceration
•• Previous AmputationPrevious Amputation
•• Severe Nail PathologySevere Nail Pathology

8. What else happens with a patient’s
foot?
What else happens with a patientWhat else happens with a patient’’ss
foot?foot?
•• Loss of feeling in the footLoss of feeling in the foot
•• Pain in legs while walkingPain in legs while walking
•• The shape of the foot changesThe shape of the foot changes
•• Loss or decrease blood flow to the extremitiesLoss or decrease blood flow to the extremities
•• Decreased resistance to infectionDecreased resistance to infection
•• Delayed wound healingDelayed wound healing
•• Impaired LeukocyteImpaired Leukocyte ChemotaxisChemotaxis (BG + 240mg/dl)(BG + 240mg/dl)
•• AmputationAmputation

9. Callus and CornsCallus and CornsCallus and Corns
•• Areas at Risk and Example of Hammer ToeAreas at Risk and Example of Hammer Toe

10. BunionsBunionsBunions
Bunion (HalluxBunion (Hallux AbductoAbducto Valgus)Valgus)
Taylor’s Bunion or Bunionette

11. The Diabetic FootThe Diabetic FootThe Diabetic Foot

12. The Foot AssessmentThe Foot AssessmentThe Foot Assessment
•• Objectives:Objectives:
–– Identify patients who are at risk for problemsIdentify patients who are at risk for problems
–– Know when NOT to fit and refer to Primary CareKnow when NOT to fit and refer to Primary Care
PhysicainPhysicain (PCP), or Podiatrist if appropriate.(PCP), or Podiatrist if appropriate.
–– Never size or fit therapeutic shoes if the patientNever size or fit therapeutic shoes if the patient
has open sores.has open sores.
–– Educate and reinforce proper foot careEducate and reinforce proper foot care
–– Categories of Risk (low or high)Categories of Risk (low or high)
–– Document findingsDocument findings
–– Note the shape of the foot and obvious footNote the shape of the foot and obvious foot
conditioncondition

13. InterventionInterventionIntervention
•• What can be done?What can be done?
•• Must work closely with Physician.Must work closely with Physician.
•• Encourage the patient to maintain tight controlEncourage the patient to maintain tight control
of blood glucose levels (A1c)of blood glucose levels (A1c)
•• See a Podiatrist on a regular basis (at leastSee a Podiatrist on a regular basis (at least
annually).annually).
•• Proper fitting therapeutic shoes and inserts.Proper fitting therapeutic shoes and inserts.
•• Personal education and lifestyle info. on DMPersonal education and lifestyle info. on DM
•• Improved foot hygiene and careImproved foot hygiene and care

14. Information for the PatientInformation for the PatientInformation for the Patient
•• Inspect the feet daily including between toesInspect the feet daily including between toes
•• Use mirrors if necessary to inspect all aspects of feetUse mirrors if necessary to inspect all aspects of feet
•• Inspect shoes daily prior to wearing. Run hand inside of shoesInspect shoes daily prior to wearing. Run hand inside of shoes
and feel for sharp areas or foreign objectsand feel for sharp areas or foreign objects
•• Once the patient has been fitted with diabetic shoes and insolesOnce the patient has been fitted with diabetic shoes and insoles,,
educate the patient to change the insoles every 4 monthseducate the patient to change the insoles every 4 months
•• DonDon’’t walk barefoot or wear sandalst walk barefoot or wear sandals
•• Do not soak feetDo not soak feet
•• Have either a DPM or healthcare professional trim nailsHave either a DPM or healthcare professional trim nails
•• Never us acid or chemicals to remove corns and callus.Never us acid or chemicals to remove corns and callus.
•• Education is crucial to good outcomes(Education is crucial to good outcomes(KramesKrames educationaleducational
pieces;pieces; ““Diabetes andDiabetes and FootcareFootcare, Foot owner manual, Foot owner manual””, LEAP, LEAP
info.)info.)

15. Therapeutic Shoes/InsertsTherapeutic Shoes/InsertsTherapeutic Shoes/Inserts
•• Extra Depth shoes,Extra Depth shoes,
•• Unique construction.Unique construction.
•• Deeper and wider reinforced toe boxes.Deeper and wider reinforced toe boxes.
•• Large variety of lengths/widths.Large variety of lengths/widths.
•• Ridged Shank, rocker bottom.Ridged Shank, rocker bottom.
•• Seamless or minimal seam construction.Seamless or minimal seam construction.
•• Inserts are total contact, multiple density,Inserts are total contact, multiple density,
made directly from a model of the patientmade directly from a model of the patient’’ss
foot or molded directly to the patientfoot or molded directly to the patient’’s foot.s foot.

16. The Assessment ProcessThe Assessment ProcessThe Assessment Process
•• Verify patientVerify patient’’s eligibilitys eligibility
•• Get signed Statement of Certifying Physician/RXGet signed Statement of Certifying Physician/RX
•• Remove patientRemove patient’’s socks or stockingss socks or stockings
•• Perform foot assessment and document findingsPerform foot assessment and document findings
•• Take digital images of that top and bottom of the feet.Take digital images of that top and bottom of the feet.
(Make sure to frame a piece of paper in shot with the(Make sure to frame a piece of paper in shot with the
patients name written so that itpatients name written so that it’’s clearly visible.s clearly visible.
•• Trace the foot with pen at a 90Trace the foot with pen at a 90ºº angle to floor.angle to floor.
•• Put the patientPut the patient’’s socks back on Before next steps socks back on Before next step
•• Measure patientMeasure patient’’s feet using the Ritz Sticks feet using the Ritz Stick
•• Inspect shoes the patient is currently wearing. Note wearInspect shoes the patient is currently wearing. Note wear
patternpattern

17. Assessment FormAssessment Form

18. Taking Foam ImpressionsTaking Foam Impressions
•• Have patient stand next to foam box while holdingHave patient stand next to foam box while holding
onto a chair or other assistive device(s).onto a chair or other assistive device(s).
•• Set the Foam Impression box next to person so thatSet the Foam Impression box next to person so that
you can maneuver each foot into the foam.you can maneuver each foot into the foam.
•• Place palm of your hand over the instep and pressPlace palm of your hand over the instep and press
foot into the foamfoot into the foam while the person steps into thewhile the person steps into the
foam.foam.
•• Without hurting the patient, make sure impressionWithout hurting the patient, make sure impression
cavitycavity is at least 2 inches deep.is at least 2 inches deep.
•• The deeper the better.The deeper the better.

19. The Ordering ProcessThe Ordering Process
•• Complete the order formComplete the order form (remember to include an(remember to include an
alternate shoe selection)alternate shoe selection)
•• Send tracing Outline with Order (do not fax outline, itSend tracing Outline with Order (do not fax outline, it
shrinks the image)shrinks the image)
•• Send Foam Impression boxSend Foam Impression box toto InCareInCare for processing.for processing.
•• Deliver and fit the shoes to patient, get necessaryDeliver and fit the shoes to patient, get necessary
documents signed by patientdocuments signed by patient
•• Return the signed delivery document toReturn the signed delivery document to
InCareInCare DME for claim processing.DME for claim processing.

20. Order FormOrder Form

21. ConsiderationsConsiderationsConsiderations
•• Time required to do sizing and fitting. If the patientTime required to do sizing and fitting. If the patient
has edema, size and fit about the same time of day.has edema, size and fit about the same time of day.
•• Obtaining the Physician signed CMN/RXObtaining the Physician signed CMN/RX
•• Turn around time for HMI or CMI and shoe deliveryTurn around time for HMI or CMI and shoe delivery
to the beneficiary.to the beneficiary.
•• Have the patient sign all Medicare required documentsHave the patient sign all Medicare required documents
•• Give the patient wearing instructions, warrantyGive the patient wearing instructions, warranty
information, HIPAA, Supplier Standards, satisfactioninformation, HIPAA, Supplier Standards, satisfaction
survey and complaint procedures.survey and complaint procedures.

22. Follow UpFollow UpFollow Up
•• Speak to beneficiary within the first five daysSpeak to beneficiary within the first five days
after delivery to see if there are any adverseafter delivery to see if there are any adverse
changes in their feet.changes in their feet.
•• Ask about red spots or other discomfort.Ask about red spots or other discomfort.
•• Confirm the break in process, wear shoes oneConfirm the break in process, wear shoes one
hour a day, increasing wear time one hour a dayhour a day, increasing wear time one hour a day
for five days.for five days.
•• Reassert the benefits of the footwear & insertsReassert the benefits of the footwear & inserts
for the beneficiary and the importance offor the beneficiary and the importance of
changing inserts as scheduled.changing inserts as scheduled.

23. Completion of FormsCompletion of FormsCompletion of Forms
•• Must have Dr.Must have Dr. (MD/DO),(MD/DO),
signature, date and UPINsignature, date and UPIN
•• MD must attest to DiabetesMD must attest to Diabetes
MellitusMellitus
•• MD must indicate secondaryMD must indicate secondary
conditions and add appropriateconditions and add appropriate
ICDICD--9 codes9 codes
•• Patient can deliver to Dr. forPatient can deliver to Dr. for
completion, ORcompletion, OR
•• Agent can FAX toAgent can FAX to InCareInCare
•• Keep Copies for Your Records.Keep Copies for Your Records.

24. Statement of Certifying Physician
with Prescription
Statement of Certifying PhysicianStatement of Certifying Physician
with Prescriptionwith Prescription

25. Helpful Sizing HintsHelpful Sizing HintsHelpful Sizing Hints
•• EveryoneEveryone’’s feet will vary in size and length from left foot to rights feet will vary in size and length from left foot to right
foot.foot. Always order shoes for the longest and widestAlways order shoes for the longest and widest
measurements of the two feet.measurements of the two feet.
•• If the patient wears an AFO (ankle foot orthoses) measure theIf the patient wears an AFO (ankle foot orthoses) measure the
patient wearing the AFO as the AFO will make the lengthpatient wearing the AFO as the AFO will make the length
measurement longer and in some cases the width measurementmeasurement longer and in some cases the width measurement
wider. You will receive 1 pair of shoes but only insoles for thwider. You will receive 1 pair of shoes but only insoles for thee
foot that does not have an AFO.foot that does not have an AFO.
•• In the case of AFO, you should order the extra depth shoes.In the case of AFO, you should order the extra depth shoes.
•• If the patient has had a leg amputated, measure not only theIf the patient has had a leg amputated, measure not only the
natural foot but also the prosthetic foot. You will receive 1 pnatural foot but also the prosthetic foot. You will receive 1 pairair
of shoes but only insoles for the natural foot.of shoes but only insoles for the natural foot.

26. How to Make a Foam ImpressionHow to Make a Foam ImpressionHow to Make a Foam Impression
•• Remove shoes andRemove shoes and
sockssocks
•• We recommend wearingWe recommend wearing
surgical gloves.surgical gloves.

27. How to Make a Foam Impression - StandingHow to Make a Foam ImpressionHow to Make a Foam Impression -- StandingStanding
•• Place foam impression box on the floor next toPlace foam impression box on the floor next to
standing patient, while they are holding onto anstanding patient, while they are holding onto an
assistance device.assistance device.
•• Maneuver foot to center of foam area with hand onManeuver foot to center of foam area with hand on
top of the foottop of the foot
•• Have patient weight bear onto foot while you pressHave patient weight bear onto foot while you press
down, pushing foot at leastdown, pushing foot at least 2 inches2 inches into the foam.into the foam.
•• The deeper the better.The deeper the better. At same time, apply pressureAt same time, apply pressure
to lateral aspect of foot with the palm of the otherto lateral aspect of foot with the palm of the other
hand.hand.

28. How to Make a Foam Impression
(continued)
How to Make a Foam ImpressionHow to Make a Foam Impression
(continued)(continued)
•• Finish impression by pressingFinish impression by pressing
down each toe with yourdown each toe with your
finger.finger.
•• Lift foot straight up out ofLift foot straight up out of
the foam while holding thethe foam while holding the
ankle.ankle.
•• Repeat this procedure withRepeat this procedure with
other foot.other foot.
•• If the impression is not deepIf the impression is not deep
enough, discard and repeatenough, discard and repeat

29. Ritz Stick MeasurementsRitz Stick MeasurementsRitz Stick Measurements
•• Spray Ritz Stick with Antiseptic Spray prior toSpray Ritz Stick with Antiseptic Spray prior to
each useeach use
•• For length of a foot: Place the foot on theFor length of a foot: Place the foot on the
device with heel against stop. Move slide todevice with heel against stop. Move slide to
longest toe. Make sure your reading is forlongest toe. Make sure your reading is for
WomanWoman’’s or Mans or Man’’s length. Take note ofs length. Take note of
length measurement. Repeat with other foot.length measurement. Repeat with other foot.
•• For width of a foot: With the slide on theFor width of a foot: With the slide on the
outside of the foot, place ball of foot acrossoutside of the foot, place ball of foot across
the device Hold slide in place and release.the device Hold slide in place and release.
Take note of width. Repeat with the otherTake note of width. Repeat with the other
footfoot

30. Guidelines for Shoe SelectionGuidelines for Shoe SelectionGuidelines for Shoe Selection
•• You the technician should always select the proper shoe styleYou the technician should always select the proper shoe style
for the patient.for the patient.
•• You should never give the patient the catalog and ask them toYou should never give the patient the catalog and ask them to
select the shoes they would like.select the shoes they would like. If your patient has minimalIf your patient has minimal
foot deformities, you can select from a wider selection offoot deformities, you can select from a wider selection of
shoe.shoe.
•• The shape of the shoes must match the shape of the patientThe shape of the shoes must match the shape of the patient’’ss
feet.feet.
* Boxy square feet* Boxy square feet –– straight last likestraight last like OrthofeetOrthofeet
* Narrow curved foot* Narrow curved foot –– curved last like sneakers and some ofcurved last like sneakers and some of
the Drew shoesthe Drew shoes

31. Guidelines for Shoe Selection (cont)Guidelines for Shoe SelectionGuidelines for Shoe Selection (cont)(cont)
•• If the patient has edema, you should put the patient in a LycraIf the patient has edema, you should put the patient in a Lycra
shoe like theshoe like the OrthofeetOrthofeet 825, 830. Some Lycra shoes have825, 830. Some Lycra shoes have
more removable insoles and the Lycra material will bettermore removable insoles and the Lycra material will better
accommodate the edema.accommodate the edema.
•• If you do put a patient with edema in a leather shoe it must beIf you do put a patient with edema in a leather shoe it must be
a lace shoe (so you can open shoe sufficiently to put the foota lace shoe (so you can open shoe sufficiently to put the foot
in. A good leather shoe to get for this patient is thein. A good leather shoe to get for this patient is the PropetPropet
91089108
•• Patients with edema should never be put into a Mary JanePatients with edema should never be put into a Mary Jane
style shoestyle shoe
•• If the patient has a heel slippage problem, you should put theIf the patient has a heel slippage problem, you should put the
patient in a lace shoe with a fifth eyeholepatient in a lace shoe with a fifth eyehole
•• If the patient wears an AFO, put the patient in the deepestIf the patient wears an AFO, put the patient in the deepest
shoe possible, such asshoe possible, such as PropetPropet..

32. Toe Amputations and Toe Filler
Accommodations
Toe Amputations and Toe FillerToe Amputations and Toe Filler
AccommodationsAccommodations
•• For patients with an amputated toe, or toes, please contact theFor patients with an amputated toe, or toes, please contact the
Applications Department atApplications Department at InCareInCare DME, to help determine ifDME, to help determine if
your patient is eligible for additional modifications. They wilyour patient is eligible for additional modifications. They will letl let
you know if toe filler accommodations are necessary.you know if toe filler accommodations are necessary.
•• If they determine accommodations are appropriate, you will needIf they determine accommodations are appropriate, you will need
to get a Pressure Stat, foam impression and foot measurements,to get a Pressure Stat, foam impression and foot measurements,
as mentioned previously.as mentioned previously.
•• A specific prescription from an MD or DO for specificA specific prescription from an MD or DO for specific
modifications is required.modifications is required.
•• It is imperative you trace the foot on the pressure stat.It is imperative you trace the foot on the pressure stat.

33. How the Custom Molded Inserts
are Fabricated
How the Custom Molded InsertsHow the Custom Molded Inserts
are Fabricatedare Fabricated
•• Foam Impression BoxFoam Impression Box
•• Positive plaster mold of the patientPositive plaster mold of the patient’’s foot is createds foot is created
•• The material is Heated to 450/FThe material is Heated to 450/F
•• The material is molded over the cast.The material is molded over the cast.
•• Inserts are trimmed to fit the specific shoes orderedInserts are trimmed to fit the specific shoes ordered
•• A final finishing process smoothes all trim edges.A final finishing process smoothes all trim edges.

34. What to do With the Foam
Impression Box…
What to do With the FoamWhat to do With the Foam
Impression BoxImpression Box……
•• Put the Foot Tracing in thePut the Foot Tracing in the
boxbox
•• Tape the impression box closed.Tape the impression box closed.
•• Make sure the patientMake sure the patient’’s info ons info on
the box isthe box is fully completedfully completed
prior to mailing.prior to mailing. Be sure toBe sure to
indicate an alternate shoeindicate an alternate shoe
style/colorstyle/color
•• UnderUnder ““CommentsComments““: note: note
specific problems i.e.. Bunions,specific problems i.e.. Bunions,
hammered toe, edema, sores,hammered toe, edema, sores,
pain etcpain etc
•• Make a copy of the top of theMake a copy of the top of the
Impression. Box.Impression. Box.
..

35. How to Mail Foam ImpressionHow to Mail Foam ImpressionHow to Mail Foam Impression
•• Place the box and thePlace the box and the
Pressure Stat in thePressure Stat in the
postage paid, selfpostage paid, self--
addressed mailingaddressed mailing
envelope.envelope.
•• Please fax or callPlease fax or call
InCareInCare DME when yourDME when your
supplies need replenishing.supplies need replenishing.

36. Shoe DeliveryShoe DeliveryShoe Delivery
•• Shoes and Inserts will be shipped with patients name and aShoes and Inserts will be shipped with patients name and a
tracking number on each item.tracking number on each item.
•• Call patient to let them know shoes/inserts are available andCall patient to let them know shoes/inserts are available and
arrange time to do final fitting.arrange time to do final fitting. Request the patient wear orRequest the patient wear or
bring socks to the fitting.bring socks to the fitting.
•• Fully open shoes and remove packing materials andFully open shoes and remove packing materials and
inlays/insolesinlays/insoles
•• Place the custom molded insole on the floor and have the patientPlace the custom molded insole on the floor and have the patient
stand on the insole. You will be able to determine if the shoesstand on the insole. You will be able to determine if the shoes
are the correct length and width. The toes must not hang overare the correct length and width. The toes must not hang over
the edge of the insoles and the sides of the feet must not hangthe edge of the insoles and the sides of the feet must not hang
over the sides of the insoles. To ensure length is correct, youover the sides of the insoles. To ensure length is correct, you
must have no less thanmust have no less than ½½ inchinch –– ¾¾ inch from the tip of theinch from the tip of the
longest toe to the end of the insole.longest toe to the end of the insole.
•• Place custom insert in each shoePlace custom insert in each shoe
•• Place on patients feet using shoe horn if needed.Place on patients feet using shoe horn if needed.

37. Checking the Fit with the
Shoes and Insoles on the Patient
Checking the Fit with theChecking the Fit with the
Shoes and Insoles on the PatientShoes and Insoles on the Patient
•• Check the width at the ball of the foot. The leather on the topCheck the width at the ball of the foot. The leather on the top
of the shoe should not be drum tight, nor should it be looseof the shoe should not be drum tight, nor should it be loose
enough to pinchenough to pinch--up a roll between thumb and finger. In generalup a roll between thumb and finger. In general
you should be able to run your thumb across the leather andyou should be able to run your thumb across the leather and
create a slight roll or wave of leather ahead of your thumb.create a slight roll or wave of leather ahead of your thumb.
•• Run your finger around the collar of the shoe at the ankle toRun your finger around the collar of the shoe at the ankle to
make sure it is not too tight or digs into the ankle.make sure it is not too tight or digs into the ankle.
•• Have the patient take a few steps on a hard surface like tile.Have the patient take a few steps on a hard surface like tile.
•• Ask the patient how the shoes feel. Remember to listen carefullAsk the patient how the shoes feel. Remember to listen carefullyy
to their description as it may contain important clues to aid yoto their description as it may contain important clues to aid youu
in understanding and rectifying any problems.in understanding and rectifying any problems.

38. Breaking in the ShoesBreaking in the ShoesBreaking in the Shoes
•• Advise patient to wear the shoes indoors on carpet if possibleAdvise patient to wear the shoes indoors on carpet if possible
for 1 hour the 1for 1 hour the 1stst. day, working up to 5 hours the 5. day, working up to 5 hours the 5thth. day. day
•• Advise the patient to change the custom insoles everyAdvise the patient to change the custom insoles every 4 months,4 months,
discarding the old insoles.discarding the old insoles.
•• Current return/replacement policy:Current return/replacement policy:
–– 5 days for fitting issues5 days for fitting issues
–– 30 days from shipping date for resizing.30 days from shipping date for resizing.
–– 1 year for materials and workmanship.1 year for materials and workmanship.
•• If fit is immediately problematic, notify customer service atIf fit is immediately problematic, notify customer service at
InCareInCare DME an arrange for replacement.DME an arrange for replacement.
•• Shoes returned for resizing must be in resalable condition. ShoeShoes returned for resizing must be in resalable condition. Shoess
that show signs of wear will not be replaced.that show signs of wear will not be replaced.

39. Break In InstructionsBreak In Instructions

40. Ankle & Foot
Gauntlet
Size determined
By shoe size

42. ConclusionConclusionConclusion
•• Can Therapeutic Shoes and Inserts help?Can Therapeutic Shoes and Inserts help?
•• Several large clinical centers have experienced a 44Several large clinical centers have experienced a 44--85%85%
reduction in Lower Extremity Amputations (LEA)reduction in Lower Extremity Amputations (LEA)
with the implementation of improved footwith the implementation of improved foot--carecare
programs for diabetic patients.programs for diabetic patients.
•• Implementation of theImplementation of the InCareInCare DME Therapeutic ShoeDME Therapeutic Shoe
Program can and will made a difference in the footProgram can and will made a difference in the foot
health of at risk Diabetic patients.health of at risk Diabetic patients.
•• Dramatic improvement in foot health and overallDramatic improvement in foot health and overall
benefit to the patient who avoids an amputation asbenefit to the patient who avoids an amputation as
result of this program is immeasurable.result of this program is immeasurable.

43. Thank You.
Please feel free to ask us
questions!!!!
Thank You.Thank You.
Please feel free to ask usPlease feel free to ask us
questions!!!!questions!!!!