Name of the Procedure:

• Common Name: Diabetic Foot Insert
• Technical Term: Multiple Density Insert for Diabetics (HCPCS K0903)

Summary

A diabetic foot insert is a custom-made orthotic designed to provide total contact with the patient's foot, including the arch. It is created using advanced CAM (Computer-Aided Manufacturing) technology from a digital scan of the patient's foot. The insert includes multiple density layers with a base layer of at least 3/16 inch thick material to offer optimal support and comfort.

Purpose

This custom insert addresses complications associated with diabetes, such as foot ulcers, neuropathy, and poor circulation. It aims to distribute pressure evenly across the foot, reducing the risk of sores, ulcers, and injuries. The goal is to improve foot function, provide pain relief, and enhance overall foot health.

Indications

• Presence of diabetic foot ulcers or sores
• Neuropathic pain and loss of sensation in the feet
• Deformities in foot structure
• Patients with high risk of developing foot complications due to diabetes

Preparation

• No specific pre-procedure preparations such as fasting or medication adjustments are usually required.
• A detailed foot assessment and digital scan will be conducted to create an accurate model for the insert.

Procedure Description

1. Foot Assessment: A healthcare professional will evaluate the patient’s feet, noting any deformities, pressure points, or areas of concern.
2. Digitized Scanning: The patient’s feet are scanned using a digitized scanner to create a precise 3D model.
3. CAD Model Creation: The 3D scan is used to create a rectified CAD model of the patient’s foot.
4. CAM Carving: Using CAM technology, the insert is carved directly from the CAD model, ensuring a perfect fit.
5. Insert Fabrication: The insert is made with multiple density layers and a base layer of at least 3/16 inch material.
6. Fitting: The finished insert is fitted to the patient’s foot and adjustments are made for comfort and efficacy.

Duration

The entire process, from assessment to final fitting, may span a few days to a couple of weeks. Each step, such as scanning and carving, is usually brief (15-30 minutes).

Setting

• The initial assessment and digital scanning are typically conducted in an outpatient clinic or specialized orthotics center.
• The carving and production of the insert take place in a specialized facility equipped with CAM technology.

Personnel

• Podiatrist or orthotist (foot specialist)
• Medical technician specialized in CAD/CAM technology
• Support staff for assisting in scans and fittings

Risks and Complications

• Common Risks: Minor discomfort or irritation during the breaking-in period.
• Rare Risks: Allergic reactions to materials used, improper fit leading to increased pressure points.

Benefits

• Reduced risk of foot ulcers and sores
• Alleviation of pain and discomfort
• Improved foot function and mobility
• Customized fit for maximum comfort and support
• Benefits may be realized within days to weeks post fitting

Recovery

• Post-procedure Care: Gradual breaking-in period where the insert is worn for increasing durations each day.
• Recovery Time: Generally minimal, with patients typically adapting to the insert within a few weeks.
• Follow-up: Regular check-ups to ensure proper fit and function, with adjustments made as needed.

Alternatives

• Standard Over-the-Counter Insoles: Less expensive but not customized, hence less effective.
• Custom-Made Insoles Without Digital Scanning: Custom, but may lack the precision of CAM technology.
• Surgical Options for Foot Deformities: More invasive with higher risk, usually considered if orthotics fail.

Patient Experience

• During Procedure: Minimal discomfort during the scanning process.
• After Procedure: Initial period of adjustment where mild discomfort may be experienced. Proper pain management and comfort measures will be discussed.Extended periods of improved comfort and relief as the insert helps manage foot-related complications effectively.