Nurse practitioners, physician assistants could sign off on therapeutic shoes under new bill

Medicare covers one pair of therapeutic shoes and two inserts for many people with diabetes each year. However, a doctor’s prescription is currently required to confirm coverage. A new bipartisan bill, the Promoting Access to Diabetic Shoes Act, could make it possible for nurse practitioners and physician assistants to also sign off on these prescriptions. Supporters hope this will help more people with diabetes access much-needed therapeutic shoes to prevent complications such as foot ulcers and calluses.

Nurse Practitioner at Canberra Hospital Walk-in Centre

Foot issues are a major concern for people with diabetes. That’s why Medicare and most major insurance companies cover the cost of custom-made diabetic shoes and inserts.

It sounds pretty great – but there’s a catch. To access coverage for these shoes, people need to go through a series of steps. This includes getting a prescription from a doctor and being professionally fitted for shoes.

While the shoe fitting remains critically important for a foot’s health, the prescription requirement has received some pushback. Not everyone who needs these therapeutic shoes has access to a doctor on a regular basis. Particularly in rural and underserved areas, many diabetics depending on nurse practitioners and physician assistants for regular health care support.

Two U.S. Senators, Maine Republican Sen. Susan Collins and Ohio Democratic Sen. Sherrod Brown, have decided to take action on this issue. They have introduced a bill entitled the Promoting Access to Diabetic Shoes Act.

The goals of this proposed legislation are:

  • Reduce cost for patients and/or insurance companies: Many patients incur expenses trying to get routine prescriptions for diabetic shoes from their doctors. By allowing more medical professionals to sign off for shoes and inserts, they will avoid these expenses.
  • Save patients and doctors time: Patients who wear therapeutic shoes often need a new prescription each year in order to get coverage from Medicare or insurance. This will cut out the annual back-and-forth by allowing an NP or assistant to provide the needed renewal. It will also help people who need therapeutic shoes to get them more quickly.
  • Increased access to therapeutic shoes: People in underserved or rural areas may not have access to a doctor. This bill would allow them to still access the shoes they need.
  • Encouraging use of therapeutic shoes for those who need them: By getting rid of some of the red tape, the bill aims to encourage those who truly need these shoes to go ahead and get them. Not using the correct shoes can lead to serious foot complications and loss of limbs for many diabetics, so this is a critical preventative tool for people trying to take care of themselves.

As L. Gail Curtis, MPAS, PA-C, DFAAPA, president and chair of the American foot pain preventionAcademy of Physician’s Assistants’ Board of Directors notes, “With the aging population and the increasing prevalence of this disease, removal of this barrier will make such a difference for patients everywhereAAPA appreciates Senators Collins and Brown for introducing this common sense legislation.” The bill has also been endorsed by the American Association of Nurse Practitioners and the American Podiatric Medical Association.

More than 100 million adults in the United States are now living with diabetes or prediabetes. At No Cost Shoes, we work to connect these people with therapeutic shoes covered by Medicare.  We try to make this as easy as possible by faxing a prescription to a family doctor to sign, but many still find that accessing a doctor is a challenge. For example, some patients do not have a family doctor, while others struggle to afford prescription renewal fees from an MD’s office.

As always, we will continue to keep you updated on any new and legislation that may affect your access to diabetic shoes and inserts. Those seeking support in accessing diabetic shoes can check their eligibility for coverage at nocostshoes.com.

11 Critical Reasons to Wear Your Doctor-Prescribed Orthotics and Custom Insoles

One of the most common misconceptions about orthotics is that they are prescribed for one specific reason. In reality, specialty shoe inserts support your physical health in many, many different ways. While your podiatrist might recommend this solution in response to something like foot pain, a broken arch, or diabetes complications, the use of custom shoe inserts or orthotics can have multiple benefits for wearers.

When your podiatrist tells you to wear custom insoles, there are plenty of reasons to listen. Here are the top 11 reasons to wear the custom orthotics or insoles prescribed to you by a medical professional.

1. Orthotics take pressure off your joints.

When you walk or run, multiple body parts are working together to get you from point A to point B. Orthotics help your feet to properly carry your weight, which has a positive influence on every other body part involved in your movement. In particular, it takes pressure off of important joints including your ankles, knees, and hips.  That means less pain and healthier movement all around!

2. Orthotics reduce back pain.

back pain xray why to wear orthoticsWhen your feet are not properly carrying weight while you walk, the pressure shifts to other body parts.

The chain reaction usually goes like this: Feet aren’t doing their job, so knees have to make up for it. The knees then turn inward (this is often referred to as “knock-knees”), shifting the angle where the thigh bone meets the pelvis and damaging a person’s posture. That unsteady posture is bad news, especially for the lower back.

Custom orthotics get to the source of these back issues, improving gait and posture by supporting the feet.

3. Orthotics help you move faster.

You might not be a professional athlete, but moving at a decent speed can make a big difference on a day to day basis. Orthotics absorb shock when walking or running. This better, easier foot movement makes a big difference in speed as well as stamina when moving.

4. Orthotics prevent injury.

dr with xray feet back joints why to wear orthoticsFoot injuries are a big concern for people with diabetes. Nerve damage can make it difficult to identify or respond to foot pain, which can lead to exacerbated injuries and even loss of limbs. Orthotics add support for feet, reducing the risk of rolling an ankle or sustaining another foot injury. Orthotics can also help those who already have injuries to walk in a way that doesn’t add to the issue.

5. They prevent calluses and corns.

When calluses and corns grow bigger, they can cause serious discomfort and walking problems. Abnormal weight distribution on the feet is often the cause of these issues, making orthotics a great choice for someone looking to reduce or prevent this issue.

6. They prevent the wearing down of skin from diabetic blisters.

For diabetics, there is no such thing as a minor foot wound. Every foot issue must be taken seriously – even the smallest blister can turn into an ulcer, which may require amputation in serious cases.

Orthotics are one way diabetics can prevent or properly care for blisters. Custom fitted inserts can reduce the friction between the foot and the shoe, preventing blisters from developing or worsening.

It’s important that those who are using orthotics for friction management use custom fitted inserts that aligns with their feet. These are often covered by Medicare or insurance for prescription-holding diabetics.

7. Orthotics can realign your feet and ankles, preventing future foot problems.

Orthotics aren’t just for people currently struggling with their feet – they can also be a great preventative measure. Many people push through issues like fallen arches and misaligned ankles, causing them to worsen over time. As soon as your podiatrist notices over-pronation and suggests orthotics, you should start using them (yes, even if you don’t have that much pain yet). This will improve your foot function for years to come.

8. Orthotics allow you to walk for longer periods.

Not only do orthotics help you walk faster, but they can give you more endurance to boot! By improving alignment and posture, the right inserts can make walking and running feel like a lot less work, so you can stay standing or moving for longer periods without fatiguing your body.

9. Orthotics reduce or eliminate foot pain.

foot pain preventionIt’s no surprise that orthotics can make walking more comfortable. After all, they are well-cushioned, shock absorbing, often custom-fitted inserts – what’s not to like?

Still, many people only use their inserts from time to time and forgo consistent use. When you do this, you’re not allowing the orthotics to properly repair your over-pronation and may still feel pain in your feet. Consistent use will allow the orthotics to really make an impact in how you walk, reducing foot pain and preventing injuries.

10. Orthotics can preserve your hips and knees.

As you age, your hips and knees can weaken. It is not uncommon for people to need surgery on these body parts. Whether you are caring for your joints after a surgery or are trying to prevent deterioration to begin with, orthotics are a great option.

11. Orthotics can stabilize any destruction or deformities in the foot.

Orthotics are great for preventing foot issues, but they can also be an important part of healing existing problems. People who have a foot challenge or deformity may struggle to walk in a way that protects their posture, joints, and other parts of their feet.  A podiatrist is an important person to work with to address these issues, and following their advice for care is critical to avoid future challenges.

How do I get custom insoles or orthotics?

There are several different types of shoe inserts, from generic over-the-counter brands to custom fitted insoles with a friction management design. Patients should medical professional to get personalized advice on what types of orthotics are best for their needs. Medicare covers three pairs of custom insoles each year for Americans with diabetes and a prescription, so it’s particularly important (and often free!) for diabetics to look into this option.

If you’re a medical professional or diabetic patient looking for insoles and shoes with direct insurance billing, visit nocostshoes.com.

Going to the Gym with Diabetes? 10 Critical Tips about Exercise for Diabetics

Just like a healthy diet, exercise can help people to manage diabetes. Medical professionals tend to agree on this fact, but coming up with a fitness plan can be confusing; some experts encourage regular workouts while others caution against intense movement.

At No Cost Shoes, we get a lot of questions from diabetics hoping to get on their feet in a healthy, sustainable way. Here the six most critical tips to consider as you strive for a more active lifestyle.

Note: This article is a collection of general, helpful tips and should not replace professional medical advice. Talk to your doctor before starting any exercise plan.

1. Check your heart health first.

blood pressure testing diabetes

People who are diagnosed with Type 2 diabetes often have other co-existing health challenges, such as obesity, high blood pressure, or heart conditions. While exercise may help control diabetes, starting a rigorous fitness program without considering these other conditions would be a mistake.

For example, while exercise is generally a good move for heart health, working out too vigorously at first can cause issues. It is particularly important to chat with a doctor if you have blocked arteries or high blood pressure, as these conditions can be impacted by physical activity.

2. Always keep a 15 g carb snack with you – and don’t forget the water!

As a diabetic, it’s a good idea to stay hydrated and keep a low blood glucose treatment handy at all times. That advice is even more critical when you’re exercising. A 15g carb snack, like a granola bar, can serve as a necessary source of glucose in a pinch. This tip is particularly critical when you’re working out where food may not be readily available – for example, when you go on a wilderness hike.

3. Record your progress.

tracking fitness for diabeticsThe more information you can provide to your doctor, the better. A record of what you’re doing will help a medical professional understand the progress you’re making and how your fitness plan is affecting your overall health. If writing everything down seems tedious, consider investing in a fitness tracker. These high-tech watches can keep an eye on steps, heart rate, movement goals and more – all information your doctor might find useful at your next check-up.

4. See the right professional.

While your family doctor might be great at diagnosing issues and prescribing medication, he or she may not be particularly experienced with diabetic fitness (after all, no one is an expert in everything!). Consider working with an exercise physiologist or a personal trainer with diabetic knowledge to get started in the right direction. An expert can show you which exercises to focus on, how hard to work, and even how to make fitness fun! If you’re new to exercise, having someone by your side to help out can make a big difference.

5. Test your blood sugar regularly.

testing blood sugarHemoglobin A1C and blood glucose testing are important rituals for any diabetic. For those taking on an exercise plan, testing has an added perk – motivation! Exercise often keeps blood sugar under control, and good test results can bring a sense of encouragement for those taking their first steps into a healthier lifestyle.

6. Take care of your feet and wear the right shoes when exercising.

Diabetes is linked to foot problems for two reasons. First of all, diabetes can cause nerve damage that impacts a foot’s sensitivity to pain – imagine breaking a toe while working out and not even feeling it! Add to this poor circulation issues, and suddenly feet are at major risk for active diabetics.

When working out, take these steps to protect your feet:

  • Pick an exercise plan that is lower risk for your feet. Instead of running on rough terrain, for example, try using an exercise bike or a paved sidewalk.
  • Nerve damage could make it difficult to detect injuries, so be sure to inspect your feet during and after an exercise session. If you fall on, twist, or hit your foot, do not use pain as an indicator of damage. Instead, stay off of the foot for a few hours and have it inspected by a medical professional.
  • Get diabetic shoes that are optimized for activity. Medicare and major insurance companies cover one pair and two inserts per year, so it’s best to replace your shoes every 12 months (it’s free, so why not?). If you’re a resident of the United States and want to see if you’re covered for diabetic shoes, click here.

Staying healthy with diabetes

Staying healthy with diabetes is not a matter of just taking a pill and moving on – lifestyle changes and preventative measures are often a critical part of a treatment plan. Done correctly, exercise can and should be a part of this journey!

Keeping healthy with diabetes doesn’t have to be expensive – while gyms and trainers are amazing support, even a daily walk outside in the right pair of shoes can help support a healthy, happy life.

How to Pick the Best Diabetic Walking Shoes

For people with diabetes, getting enough exercise is almost as important as a healthy diet. And when it comes to finding an easy and affordable form of exercise, it’s hard to beat good, old-fashioned walking.

But before you hit the pavement, you need to ensure you’re wearing the proper diabetic walking shoes. People with diabetes are at a high risk of developing impaired circulation in their feet and nerve damage, and wearing ill-fitting shoes can seriously increase your chances of developing a harmful condition. Since diabetes also affects the body’s ability to heal, even a minor skin irritation can lead to a lengthy recovery period.

woman walking in comfortable shoes

Here’s the good news: Medicare covers one pair of diabetic shoes and two pairs of customer inserts per year for adults with diabetes. All you need is a prescription from your doctor, size details from a qualified shoe fitter, and a supplier that is approved by Medicare (hey, that’s us!).  To learn whether you qualify for this coverage, click here.

Factors to Consider When Choosing Diabetic Walking Shoes

When choosing a diabetic walking shoe, you will want to ask yourself the following questions:

Are they comfortable?

Make sure that the toe box (front of the shoe) is wide enough for your toes to easily move around. You will also want to look for shoes with good insole cushioning and avoid shoes with interior stitching as they can cause friction that can lead to skin irritation. If you have any protrusions on your feet such as bone spurs or bunions, look for diabetic walking shoes that don’t put pressure on those areas. Another option is to look for high-quality shoes that can be stretched in those tighter spots.

Are they breathable?

Natural fabrics such as canvas, leather or suede are the best choices as they are the most breathable. Breathability is an important factor for people with diabetes to consider when picking a walking shoe as excess moisture can lead to blisters and fungal infections. Shoes with perforations or mesh inserts can also help with this.

Are they easily adjustable?

Diabetic walking shoes should be adjustable to accommodate swelling or the need for extra padding and inserts. Look for shoes with laces or buckles that can be easily loosened when needed. Velcro walking shoes usually provide the most flexibility in this area. On the other hand, open-toed shoes, thong sandals, flip-flops, and high heels are too rigid and don’t provide the necessary protection that people with diabetes require from their footwear.

The Best Walking Shoes for Diabetes

new balance women's walking shoes diabetes beige velcro

New Balance Women’s Diabetic Shoes
These shoes offer a padded interior for extra comfort and their velcro closure make them easily adjustable.

walking shoes diabetes men dr. comfort black

Dr Comfort Men’s Diabetic Shoes 
The mesh tongue adds breathability while the wide toe box offers ample room for movement.

orthofeet diabetic walking shoes

Orthofeet Men’s Diabetic Shoes
The perforations along the sides and toe box of this pair add much-needed breathability.

How to Pick the Best Diabetic Walking Shoes for You

The most important thing when picking diabetic walking shoes is to ensure the size is correct. This will allow for proper circulation. Your feet can change size and shape over time, so most insurance companies and Medicare require you to repeat this step each time you get new shoes. Set up an appointment with your podiatrist to have this done, or use No Cost Shoes’ easy and free service to have a trusted professional come to your home for a shoe fitting.

When you try on your shoes, make sure you’re wearing the type of sock or stocking you would typically wear. You will also want to bring any orthotics and inserts that you will be using with your shoes.

So You’ve Picked Your Shoe, Now What?

While picking a well-fitting shoe is a big part of proper foot care, there are not the only thing you should do to keep your feet healthy and happy. Try to reduce pressure on your feet by alternating your walking shoes every five hours or by giving your feet time to breath. You will also want to promote proper blood circulation by taking the time to extend your toes and move your ankles up and down ever three to four hours. If you notice any sores, blisters or swelling on your feet, alert your doctor immediately. Prompt treatment is critical to prevent minor injuries from developing into potentially life-threatening issues.

Finding your perfect pair of diabetic walking shoes doesn’t have to be a chore. As long as you keep the above recommendations in mind, you will be walking away in a comfortable pair in no time.

No Cost Shoes streamlines the process of getting a insurance and Medicare-covered shoes by sending a prescription to your physician, providing an in-home shoe fitting, and direct billing your insurance.