Name of the Procedure:

Modification (including fitting) of Off-the-Shelf Depth-Inlay Shoe or Custom-Molded Shoe with Metatarsal Bar, per Shoe.
Commonly referred to as: Shoe Modification for Diabetics, Custom-Molded Diabetic Shoe, Diabetic Shoe Fitting.

Summary

This procedure involves modifying a diabetic patient's shoe to include a depth inlay and metatarsal bar. The customization aims to improve comfort and reduce pressure on sensitive areas, crucial for those with diabetes to prevent foot ulcers and other complications.

Purpose

The procedure is designed to help diabetic patients who experience foot issues due to neuropathy or poor circulation. It aims to redistribute weight, alleviate pressure points, and provide a better fit to reduce the risk of ulcers and sores.

Indications

• Diabetic neuropathy with or without foot ulcers.
• Chronic foot pain due to diabetes.
• Deformities in foot structure.
• History of foot ulcers or risk of developing them.

Criteria:

• Diagnosed diabetes.
• Foot abnormalities necessitating customized footwear.

Preparation

• No specific fasting or medication adjustments required.
• Patient may need a thorough foot examination.
• Measurements and possibly a casting or scanning of the patient's feet for custom fittings.

Procedure Description

1. Assessment: Patient's foot is evaluated for areas needing pressure relief.
2. Measurement: Exact measurements of the foot are taken, or a 3D scan/casting is performed.
3. Modification: An off-the-shelf depth-inlay shoe or a custom-molded shoe is modified to include a metatarsal bar.
4. Fitting: The modified shoe is fitted to ensure proper alignment and comfort.
5. Adjustment: Any necessary adjustments are made to ensure the shoe fits perfectly.

Tools and Equipment:

• Depth-inlay shoes or custom-molded shoes.
• Metatarsal bars.
• Measurement tools or 3D scanning technology.

Anesthesia or Sedation:

• Not necessary for this non-invasive procedure.

Duration

The entire process, including assessment, measurement, and fitting, may take 1-2 hours.

Setting

Typically performed in an outpatient clinic, podiatrist's office, or specialized orthotics facility.

Personnel

• Podiatrist or specialized foot care professional.
• Medical assistant or orthotist.

Risks and Complications

Common:

• Minor discomfort initially as the patient adjusts to the new footwear.

Rare:

• Improper fit leading to additional foot issues.
• Allergic reaction to materials used.

Management:

• Follow-up appointments for adjustments.
• Immediate consultation if discomfort or complications arise.

Benefits

• Reduced risk of foot ulcers and sores.
• Improved comfort and walking ability.
• Better foot health and reduced pain.

Realization Timeline:

• Benefits can be noticed almost immediately after fitting, with continued improvement as the patient adjusts to the shoe.

Recovery

• No significant recovery time needed.
• Follow-up visits may be necessary to ensure proper fit and make adjustments.
• Patients should monitor their feet for any issues and maintain regular foot care practices.

Alternatives

• Standard off-the-shelf diabetic shoes without specific modifications.
• Custom orthotic inserts.

Pros and Cons:

• Alternative options might be less personalized, potentially offering less effective pressure relief.

Patient Experience

During the Procedure:

• Patients will feel minimal discomfort during measurements and fittings. No pain should be associated.

After the Procedure:

• Initially, there might be mild discomfort as they adapt to the modified shoe, but this should resolve quickly.

Pain Management and Comfort:

• Any discomfort should be minimal and manageable with over-the-counter pain relief, if necessary. Regular follow-up ensures ongoing comfort and effectiveness.