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Dear all
Is anyone aware of any guidelines on prescribing footwear to patients with diabetes? In our Trust we generally prescribe footwear to patients with diabetes who (using the Texas guidelines) are at risk and have deformity or are of high risk (i.e. previous ulceration).
This raises an obvious problem i.e. how do you classify deformity and how does this relate to a shoe? One answer is to prescribe when the patient is unable to wear commercial shoes. If there were clear guideliness on this subject I am sure it would be of benefit to us.

Doe anyone have any thoughts on this subject?
Cheers
Gafin

In our trust we employ a footwear fitter in our dept - a lay person we trained in house.

We hold a stock of shoes from those that are available but not "medical". Padders, DB shoes, Klaveness some Cosyfeet etc. these are all deep, various width fittings, half sizes and removeable sockliners.

The footwear fitter measures and tries on the shoes to establish if a "fit" can be found. If it can, the patients must BUY the shoes as they are all shoes they could purchase directly on their own nad not considered medical treatment, we offer guidance on sizing and style. They can order directly from the companies or much more frequently we order for them.

When no shoes can be found then we refer on for "medical" footwear - OTC or custom from the Orthotist and this is then deemed medical treatment and PROVIDED free of charge.

Related threads:
Ill-fitting footwear and foot problems
Inadequate footwear tripled risk for amputation
Footwear and orthotic effects on soft tissue strain in neuropathic foot
Foot wear and ulcer over dorsum of toes
Poor fitting shoes in those with diabetes

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Thanks Lawrence
I can assume from what you have said that if the patient is unable to fit into commercial shoes they are prescribed footwear. We are also carrying out a similar process here in S. Wales. However a podiatrist is assessing the footwear and recommending commerical shoes. How have you found the system you are using? Are patients willing to purchase the shoes from the in-house service? Are you making any profit form this for the department? Cheers
Gafin

ps also thanks to admin for related links

the system is invaluable. we have gone from a "fingers crossed" at the outset to now being unable to manage without!!

Yes, if unable to fit commercial shoes - and we will do orthoses, stretching etc to facilitate, then they are prescribed footwear by the Orthotist - FOC.

We sell at the RRP and buy in at trade thus making a "profit" which pays the footwear fitter salary, selling at RRP cannot be enforced by suppliers but... we also sell to all trust staff at cost and this is important to raise the profile. Patients are allowed to have the shoes for a couple of weeks and return for a full refund if found unacceptable for some reason. The stock we hold - approx 100 prs on 2 sites, is a try on stock, we have negotiated with our suppliers to buy single pairs as needed rather than buying large numbers of whole size runs at the start of each season. we pay a higher trade price but it works for us. Not all suppliers will do this particularly those that advertise the most in the professional press!! ironic. having a try-on stock is crucial to detirmine proper fit and to gain patient acceptance.

we would like to expand to at least one more site.

"....prescribe footwear to patients with diabetes who (using the Texas guidelines) are at risk and have deformity or are of high... "

Any chance you could guide me to where l can read the "Texas guidlines" please.

__________________
David Sutton
C.Ped.CM
My location
www.bilbyshoes.com

Hi Lawrence
i carry a stock of footwear from Reeds Medical for try on/fit, they are seconds but as you say it works really well to carry a fitting stock

regards
Paul