Name of the Procedure:

Fitting and Custom Preparation of Off-The-Shelf Depth-Inlay Shoes for Diabetics (HCPCS Code: A5500)

Summary

This procedure involves the fitting, custom preparation, and supply of off-the-shelf depth-inlay shoes specifically designed to accommodate multi-density inserts for individuals with diabetes. The shoes are crafted to provide extra support, reduce pressure, and prevent foot injuries.

Purpose

The primary purpose of this procedure is to protect diabetic patients from foot ulcers, blisters, and other injuries by providing specially designed footwear. These shoes are intended to accommodate multi-density inserts that distribute pressure evenly across the foot, reducing the risk of skin breakdown.

Indications

• Diabetic neuropathy leading to loss of sensation in the feet
• Previous history of foot ulcers or wounds
• Foot deformities (e.g., Charcot foot, hammer toes, or bunions)
• Peripheral vascular disease affecting the lower extremities Patients suitable for this procedure often have conditions that make their feet more vulnerable to injuries and require specialized footwear to prevent complications.

Preparation

• Patients may need to undergo a thorough foot exam by a podiatrist or other healthcare provider.
• Any existing foot infections or ulcers must be treated before fitting the shoes.
• Measurement and molding of the patient’s feet are required to ensure proper fit and customization.

Procedure Description

1. Initial Consultation:

   • Assessment of the patient's medical history and specific foot conditions.
   • Measurement of both feet to determine appropriate shoe size and depth.

2. Custom Preparation:

   • Selection of off-the-shelf depth-inlay shoe based on measurements.
   • Customization of the shoe to accommodate multi-density inserts that provide specific areas of cushioning and support.

3. Fitting:

   • Patient tries on the shoes with the inserts.
   • Adjustments are made to ensure a comfortable fit without excessive pressure on any part of the foot.

4. Follow-Up:

   • Follow-up appointments to monitor the fit and effectiveness of the shoes.
   • Adjustments made as needed based on patient feedback and observed wear patterns.

Duration

The initial fitting and custom preparation typically take about 1-2 hours. Follow-up appointments are generally shorter, around 30 minutes to an hour.

Setting

This procedure is usually performed in a specialized outpatient clinic or a podiatrist’s office equipped with the necessary tools for customization.

Personnel

• Podiatrist or diabetic specialist
• Orthotist or trained footwear specialist
• Medical assistants for support

Risks and Complications

• Improper fit leading to foot pain or pressure sores
• Allergic reactions to materials used in the shoes or inserts
• Delays in receiving custom footwear if additional adjustments are required

Benefits

• Reduction in the risk of foot ulcers and injuries
• Improved foot comfort and mobility
• Enhanced overall quality of life for diabetic patients

Recovery

• Immediate use of the shoes following the fitting
• Regular follow-up visits to assess fit and function
• Adherence to prescribed foot care and monitoring routines

Alternatives

• Standard diabetic shoes without custom modifications
• Custom-made shoes from a mold of the patient’s foot
• Use of orthotic insoles in regular shoes

Pros of the Described Procedure:

• Customization allows for precise accommodation of foot abnormalities.
• Typically less expensive than fully custom-made shoes.

Cons of Alternatives:

• Standard shoes may not offer the same level of protection and comfort.
• Fully custom-made shoes can be more costly and time-consuming to produce.

Patient Experience

Patients can expect a comfortable and supportive fit that reduces the chance of foot injuries. Mild discomfort may be experienced during initial adjustments, but this should quickly be resolved with follow-up fittings. Pain management and comfort measures are generally minimal, given the non-invasive nature of the procedure.