The challenging diabetic foot requires experienced and attentive care.  Wright & Filippis is pleased to offer our Diabetic Footcare Program:

• Orthotics which unload diabetic foot ulcers
• Custom fabrication of healing boots to off-load ulcers and promote early weight bearing
• Weekly follow-up to ensure pressure relief is maintained
• Upon healing, footwear evaluation is performed
• Custom molded shoes and orthotics
• Diabetic socks
• Functional arch supports
• Sports orthotics
• Accommodative arch supports
• Nutrition Tips when you need to HEAL (PDF, 192.85 Kb)

Bivalved AFO with Rocker Sole

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.

Fitting the Bivalved AFO with Rocker Sole

A diabetic sock is recommended for use with the boot but a cotton knee high is also acceptable.  The orthotist will carefully examine the bivalved AFO with rocker sole 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.

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 Footcare 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 footcare.  The physician managing the treatment of diabetes has to sign the 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 interpret benefits.

Coverage includes:

• Custom molded shoes and 4 inserts or modifications
• Extra-depth shoes and 6 inserts or modifications
• Wide shank shoes
• Multidensity arch supports or insoles
• Shoe modifications

Wright & Filippis provides custom fit and custom made items:

• Custom molded shoes
• Compression garments
• Custom AFOs
• Solid ankle walking boots
• Range of motion walking boots
• Nightsplints
• Ankle stirrups
• Ankle gauntlets

Double Upright AFO

Diabetic/Neuropathic Healing Boot