Name of the Procedure:

Modification of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe (HCPCS Code: A5503)

Summary

In simple terms, this procedure customizes a specific kind of shoe for diabetics to help manage problems related to foot pressure and movement. This involves reshaping the shoe's bottom to either a roller or rigid rocker design.

Purpose

This procedure is mainly for diabetic patients to alleviate pressure on specific parts of the foot, reduce pain, and prevent ulcers or other complications.

Indications

• Diabetic patients with peripheral neuropathy (nerve damage)
• Chronic foot ulcerations due to diabetes
• Foot deformities like Charcot foot
• Patients experiencing significant foot pain or pressure points

Preparation

• No fasting or special pre-procedure requirements.
• A thorough foot examination and possible imaging studies (e.g., X-ray) to understand the patient’s foot structure.
• Evaluation of the patient's medical history and current condition.

Procedure Description

1. The patient is seated and a detailed foot measurement and examination are conducted.
2. Selection of an appropriate off-the-shelf depth-inlay shoe or custom-molded shoe.
3. The chosen shoe is then modified by adding or reshaping the bottom to either a roller or rigid rocker configuration.
4. Fitting is done with the patient, ensuring the shoe's modifications relieve pressure points and improve comfort.

Tools/Equipment:

• Depth-inlay shoes or custom-molded shoes
• Specialized shoe modification tools

Anesthesia/Sedation: Not applicable as this is a non-invasive procedure.

Duration

Approximately 1-2 hours, including fitting and adjustments.

Setting

Generally performed in an outpatient clinic, orthopedic office, or specialized medical footwear facility.

Personnel

• Orthotist or Podiatrist
• Medical assistant or technician

Risks and Complications

Common Risks:

• Initial discomfort as the patient adjusts to the modified shoe

Rare Risks:

• Incorrect fit leading to worsening of foot issues
• Potential minor skin irritations or blisters

Possible Complications:

• Managed through readjustment of shoe fit or design.

Benefits

• Reduced pressure on specific foot areas
• Lowered risk of foot ulcers and related complications
• Increased walking comfort
• Benefits typically noticed immediately or shortly after fitting.

Recovery

• The patient can walk immediately after the fitting.
• Follow-up appointments to assess effectiveness and make any necessary adjustments.
• Continued monitoring for foot health, particularly for diabetics.

Alternatives

• Standard diabetes footwear without modifications
• Full custom-made shoes specifically designed from scratch
• Orthotic insoles or inserts

Pros and Cons of Alternatives:

• Standard footwear might not provide adequate pressure relief.
• Full custom-made shoes can be more costly and time-consuming but offer a personalized fit.
• Orthotic inserts can be less expensive but may not address all foot deformities effectively.

Patient Experience

During the procedure:

• Comfortable seating and a non-invasive fitting process.
• Minor adjustments may involve slight discomfort but generally painless.

After the procedure:

• Initial period of getting used to the modified shoe.
• Any discomfort usually decreases as the foot gets accustomed to the new fit.

Pain Management and Comfort:

• Minimal discomfort expected. Standard over-the-counter pain relief can be used if needed.
• Follow-up fittings and adjustments ensure maximum comfort.