Name of the Procedure:

• Common Names: Diabetic Shoe Modification, Shoe Wedge Addition
• Medical Term: Modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe (HCPCS Code: A5504)

Summary

This procedure involves modifying an existing diabetic shoe by adding wedges to improve foot support and alleviate pressure points. It's designed to accommodate foot deformities, prevent ulcers, and enhance the overall comfort of diabetic patients.

Purpose

• Medical Conditions/Problems Addressed: Diabetic foot complications, foot deformities, pressure ulcers.
• Goals/Expected Outcomes: Improved foot support, reduced risk of developing foot ulcers, increased comfort, and better overall foot health for diabetic patients.

Indications

• Symptoms/Conditions: Foot deformities, existing foot ulcers, uneven pressure distribution when walking.
• Patient Criteria: Diagnosed with diabetes, experiencing discomfort or complications related to improper foot support.

Preparation

• Pre-Procedure Instructions: No specific fasting or medication adjustments are typically required.
• Diagnostic Tests: Assessment of foot condition by a healthcare provider, possibly including footprints analysis or pressure mapping.

Procedure Description

1. Foot Assessment: Detailed examination of the patient’s foot to determine the required modifications.
2. Shoe Selection: Choice between modifying an off-the-shelf depth-inlay shoe or a custom-molded shoe.
3. Wedge Placement: Precision fitting of wedge(s) to redistribute pressure and support foot deformities.
4. Fitting Check: Ensuring the modified shoe fits well and provides the intended support and comfort.
5. Final Adjustments: Any necessary adjustments are made to achieve an optimal fit.

• Tools/Equipment: Depth-inlay or custom-molded diabetic shoes, wedges, fitting tools.
• Anesthesia/Sedation: Not typically required.

Duration

• Approximately 30-60 minutes, depending on the extent of modification needed.

Setting

• Usually performed in a specialized outpatient clinic or a podiatrist's office.

Personnel

• Healthcare providers involved include podiatrists, orthotists, and specialized medical staff trained in diabetic foot care.

Risks and Complications

• Common Risks: Minor irritation, temporary discomfort during adjustment phase.
• Rare Risks: Long-term discomfort if improperly fitted, allergic reactions to materials used.
• Management: Follow-up appointments to monitor fit and function, adjustments as needed.

Benefits

• Expected Benefits: Reduced foot pain, prevention of ulcers, enhanced foot stability, and improved quality of life.
• Realization Timeline: Benefits typically noticed soon after fitting, with progressive improvement as the patient adjusts to the modified shoe.

Recovery

• Post-Procedure Care: Regular monitoring for fit and comfort, gradual break-in period for the modified shoe.
• Recovery Time: Immediate use, but comfort and full efficacy may take a few days to weeks.
• Restrictions and Follow-Up: No significant restrictions, but follow-up appointments may be necessary to ensure optimal fit and ongoing comfort.

Alternatives

• Other Options: Custom orthotics, physical therapy, non-modified diabetic shoes.
• Pros and Cons:
  • Custom Orthotics: Tailored to patient’s foot but may require more frequent adjustments.
  • Physical Therapy: Addresses underlying biomechanical issues but may not provide immediate relief.
  • Non-Modified Shoes: Less invasive, but might not address specific pressure points or foot deformities adequately.

Patient Experience

• During Procedure: Little to no discomfort expected; akin to a regular shoe fitting.
• Post-Procedure: Some initial discomfort as the foot adjusts to the new support. Pain management typically not necessary, comfort measures include gradual break-in and proper sock use.