Moving the HME Industry Forward

General Healthcare

Road to Medtrade

August 18, 2014

ATLANTA – The upcoming Medtrade (Oct 20-23, 2014 in Atlanta) has an excellent line-up of speakers who will present programs addressing the most important topics faced by DME suppliers today. Every issue of Medtrade Monday, leading up to Medtrade, will highlight a Medtrade program.

Integrating Modern Therapeutic Footwear into a Comprehensive Treatment Plan for Patients with Diabetes
It used to be that therapeutic footwear was frowned upon by patients because they didn’t wish to wear ugly, orthopedic shoes. Well, many modern therapeutic footwear manufacturers now produce shoes that, based on appearance, are indistinguishable from “normal” shoes. Also, in years past, some physicians doubted the effectiveness of prescribing special shoes for their patients with diabetes.

There has been quite a bit of research performed and published in recent years on the efficacy of therapeutic shoes in the care of people with diabetes. Due to Medicare’s Therapeutic Shoes for Persons with Diabetes (TSD) benefit, access to prescription footwear has expanded dramatically in the two decades since the legislation’s passage. Medicare’s TSD benefit provides coverage for shoes, shoe modifications and custom shoe inserts (arch supports) for people with diabetes. Incorporating therapeutic footwear into a treatment plan and into your business plan can be beneficial for all parties concerned: patients, physicians and your business’ bottom line.

The “Frankenstein” shoes of the past have been replaced with normal looking therapeutic footwear. Also gone is the stigma attached to having to wear attention-grabbing “orthopedic” shoes. The category of therapeutic footwear, once only the domain of clunky leather oxfords, now includes cute Mary Janes, sneakers, hiking boots, and innumerable examples of casual walking and European-styled comfort shoes. Cosmesis is one reason often cited for patients’ resistance to therapeutic footwear (Breur. 1994). Other considerations which impact compliance include differences in the age of the patient, a patient’s perception of their foot abnormalities and their health status.

Some argue, however, that a patient’s perception of the value of the shoe plays a bigger role than the aesthetics of the shoe (Macfarlane DJ, Jensen JL. 2003). That is to say that until the patient understands the true importance and value of wearing proper footwear, he/she will not do so. This is why patient education, good communication and the team approach to diabetic foot care are so critical.

The use of proper footwear, when combined with the education and support provided by a team approach to foot care, has been demonstrated to dramatically reduce the incidence and recurrence of foot ulcers and subsequent amputations (Edmonds ME, Blundell MP, Morris ME, et al. 1986). There have also been several studies which concluded that, generally speaking, patients do better when wearing shoes selected and fit by a trained specialist than when choosing and fitting shoes on their own (Albert SF, Christensen LC. 1994; Chantelau E, Haage P. 1994; Uccioli L, Faglia E, Monticone G, et al. 1995; Harrison SJ, Cochrane L, Abboud RJ, Leese GP. 2007).

Many of the commercially available modern therapeutic shoes use a technology known as “hidden depth”, which means that the footbed is set deeper within the sole of the shoe instead of on top of it. This allows for extra depth inside the shoe to accommodate custom arch supports, braces and/or deformities like hammertoes and bunions.

Many of these shoes are also constructed with a built-in rocker sole which helps to reduce weightbearing pressures under the ball of the foot which could cause diabetic ulcers. It has been shown that in many cases this standard factory rocker sole is adequate enough that the patient does not need to have the shoe further customized or modified by increasing the thickness rocker sole (Kästenbauer T, Sokol G, Auinger M, Irsigler K. 1998). This means that many of these shoes offer a comparatively affordable and immediately available therapeutic shoe option for the patient.

There are myriad other studies which prove the efficacy of therapeutic footwear (shoes, foot orthoses and shoe modifications like rocker soles) when used in patients with diabetes to prevent foot complications. This Medtrade session will review this material and demonstrate how these shoes can be easily and effectively become part of any comprehensive diabetic foot care plan.

Q&A with the Presenter
Medtrade Monday: Why is this topic important?
Dennis Janisse, president and CEO, National Pedorthic Services Inc: “This topic is important because we now have evidence/research that shows we can enhance people’s lives that live with diabetes and help prevent complications, even amputations, with proper footwear.”

Medtrade Monday: Why should people attend this presentation?
Janisse: People should attend so they can better understand the properties of appropriate footwear for patients with diabetes as well as how to fit and evaluate the diabetic foot.

On Tuesday, October 21, 2014, Dennis Janisse, president and CEO, National Pedorthic Services Inc, will present an in-depth program entitled Integrating Modern Therapeutic Shoes into a Comprehensive Treatment Plan for Patients with Diabetes.

• Providers who wish to register for Medtrade should CLICK HERE.    
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• Pricing for events can be found at
• All sessions at Medtrade and their descriptions can be found here:
Exhibitors have already bought 96% of the floor space at the Georgia World Congress Center in anticipation of what could be the most important Medtrade in the event’s long history. For a complete list of exhibitors and/or additional information about the show, visit