Name of the Procedure:

Custom Molded Diabetic Foot Insert (HCPCS Code: A5513)

Summary

A custom-molded diabetic foot insert is a specially designed insole created from a model of a diabetic patient's foot. It offers total contact with the foot, including the arch, through multiple density materials to provide optimal support and pressure distribution.

Purpose

These inserts are designed to address foot-related complications in diabetic patients, such as ulcers, calluses, and pressure sores. The goal is to provide comfort, improve foot functionality, and prevent complications that can result from uneven pressure on the foot.

Indications

• Diabetic neuropathy
• Foot ulcers or history of foot ulcers
• Calluses or high-risk pressure points on the foot
• Deformities or other structural foot issues related to diabetes

Preparation

Patients may be advised to:

• Clean and dry their feet thoroughly before the appointment
• Bring any existing orthotics or footwear for comparison No specific fasting or diagnostic tests are generally required.

Procedure Description

1. Foot Examination: A healthcare professional will examine the patient's foot to identify high-risk areas.
2. Model Taking: A model of the patient's foot is created either through casting or 3D scanning.
3. Insert Fabrication: The custom insert is made from a multiple density material, ensuring it’s at least 3/16 inch thick with a Shore A 35 durometer or higher. This includes an arch filler to maintain total contact.
4. Fitting: The insert is placed in the patient's shoe, and adjustments are made to ensure a precise fit.

Duration

The entire process, from foot examination to final fitting, can take several days to a few weeks. The in-office model making and fitting typically take about 1-2 hours.

Setting

This procedure is typically carried out in an outpatient setting, such as a podiatry clinic or specialized orthotic center.

Personnel

• Podiatrist or Orthotist
• Medical Assistant or Technician

Risks and Complications

• Initial discomfort as the patient adjusts to the new insert
• Possible skin irritation or pressure sores if the insert does not fit properly
• Rarely, allergic reactions to materials used

Benefits

• Improved foot comfort and posture
• Reduced risk of pressure sores and foot ulcers
• Enhanced mobility and foot function

Recovery

• Patients should gradually break in the new inserts by wearing them for short periods initially.
• Follow-up appointments may be necessary to make adjustments.
• Full adaptation typically occurs within 2-4 weeks.

Alternatives

• Over-the-counter insoles
• Standard diabetic footwear
• Custom-made shoes Each alternative has its pros and cons related to customization, cost, and effectiveness.

Patient Experience

Patients might feel initial discomfort as they adjust to the new insert. Pain management typically involves over-the-counter pain relievers if needed. Most patients report significant improvement in comfort and foot condition within a few weeks.