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The challenging diabetic foot requires experienced and attentive care. Wright & Filippis is pleased to offer our Diabetic Foot Care Program:
The Diabetic Boot
An ankle foot orthotic (AFO) that is commonly used to treat diabetic ulcers or calluses is a bivalved AFO with a rocker sole. This device is also commonly referred to as a neuropathic AFO, Crow Walker or diabetic boot.
After a thorough gait evaluation, patients are casted below the knee to obtain a custom mold. This mold is then removed and modified to provide true pressure relief. Using lightweight plastics and pressure relieving foam, the fabrication process is complete. With the addition of a “rocker bottom” and Velcro straps, the boot is ready for the initial fitting procedure.
A diabetic sock is recommended for use with the boot, but a cotton knee high is also acceptable. The orthotist will carefully examine the boot to ensure that pressure relief is obtained and that bony prominences are allowed clearance. After checking the patient in full weight bearing, another gait evaluation is performed. If needed, the AFO is adjusted for height and gait allowance. The patient is then instructed in wear and care procedures. Follow-up care is very important. Patients are educated on skin assessment and are instructed to return to their orthotist immediately should redness or further skin breakdown occur. Otherwise, a weekly appointment is recommended to address potential problems before they occur.
 Other healing options may include: a double upright AFO. This brace includes double adjustable, dorsi-assist or free motion ankle joints to assist or resist dorsal and plantar flexion. T-straps are available on single or double upright. AFOs assist in controlling vargus or valgus conditions. A diabetic healing boot is fabricated with a multi-density removable insole can be modified as healing progresses. With its fully lined bivalve design, the reinforced ankle restricts movement and eliminates friction.
 Footwear Evaluation
As healing of the ulcer occurs, plans are made to provide a smooth transition into proper shoes. During a routine follow-up, evaluation and discussion of the patient’s footwear needs to take place. This is very important to maintain the gains made by wearing the boot. Also, the proper shoes and inserts can help prevent further complications.
Medicare Diabetic Foot Care Coverage
Items are covered for select patients with diabetes for the prevention or treatment of diabetic ulcers. A physician overseeing ulcer care, Charcot joint, unspecified joint deformity, or pain may prescribe diabetic foot care. The physician managing the treatment of diabetes has to sign a Certification Statement.
Medicare recognizes the importance of managing diabetic ulcers and conditions. Most insurances comply with Medicare guidelines. Patients may contact any Wright & Filippis facility to help interpret benefits.
Coverage includes:
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Custom molded shoes and four inserts or modifications
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Extra-depth shoes and six inserts or modifications
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Wide shank shoes
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Multi-density arch supports or insoles
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Shoe modifications
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Orthotics, which relieve pressure from