In The News

This appeared in the The Plain Dealer newspaper in Cleveland Ohio On July 2, 2001 Medicare provides special shoes for diabetics by JOHN O'NEIL
	When Arthur Winslow, an 85 year-old man with diabetes, told a neighbor In Tamarac, Fla. that he was having trouble keeping his balance when he bent over, he was surprised by the advice he received. Go see a podiatrist, the neighbor said, and get a pair of specially measured or molded shoes, courtesy of Medicare. I didn’t know the program existed, "Winslow said. Neither did his daughter, Joyce Winslow, even though she is a spokeswoman for the branch of the federal government that runs Medicare. (It was just renamed from the Health Care Financing Administration to the Center for Medicare and Medicaid Services.) The Therapeutic Shoe Program, which gave away 1.25 million pairs of shoes last year at a total cost of $54 million, seems an unlikely candidate for best kept secret. Still, the Medicare agency is taking several steps to raise its profile and expand its reach. More than 16 million Americans of all ages now have diabetes. That number of cases is expected to triple over the next 30 years as the population ages, Winslow said.
More diabetes means more foot problems, including amputations, because the disease can interfere with blood flow to the extremities and damage the nerves. As a result, scrapes or cuts on the foot can sometimes go unnoticed and become more difficult to heal.Dr. Sean Tunis, the director of the agency’s coverage and analysis group, said, "The No. 1 reason people go to the hospital for diabetes is foot related complications." From 1993 to 1995, there were 67,000-foot amputations among Medicare patients with diabetes, he said. In 1993, at the direction of Congress, the agency established the program for people with conditions that threatened their feet. Under the Therapeutic Shoe Program, patients are entitled to one pair of special shoes, molded or depth, each year, along with a custom fitting by a podiatrist or a shoe specialist known as a Pedorthist, and two sets of inserts. For molded shoes, an actual cast of the foot is taken, and a shoe is poured to fit snugly. Depth shoes have an arch shaped to match detailed measurements of each foot In each case, the shoe is designed to minimize pressure on the ball of the foot other spots — rubbed raw. Winslow said his depth shoes were "the most comfortable pair of shoes I’ve had in quite a while." Somewhat to his surprise, the shoes made a big difference in balance. "I do a lot more walking now, he said. Dr. Michael King, a podiatrist in Fall River, Mass., who is chairman of a national panel that advises Medicare on foot-care issues, said he considered the program underused. "All my patients have beard of molded shoes", he said, "but very few have beard of this benefit through Medicare" At the same time, King does not consider customized shoes to be the only route to healthy feet. "Sneakers today are so much better made than they used to be," he said, "in terms of support and fit." He added, "I've had very Good experience with people just purchasing sneakers or walking shoes like Rockport’s." Preventive care, in his view, depends as much or more on vigilance. "Diabetics should inspect their feet daily or have someone help them," King said. Tunis said Medicare had come to a similar conclusion and was preparing new regulations that would expand coverage for those with diabetes who had lost some feeling in their hands or feet. They are now eligible for two-foot exams per year, even when there is no obvious problem, he said. The agency also stepped up efforts last month to work through health-care providers of all kinds to increase the awareness of diabetes and the need for early detection and preventive care. "This will probably have some effect in terms of making primary-care physicians more aware of this service," Tunis said, "and the agency as a whole has quite a strong interest in promoting coordinated care for people with chronic disease.