InCare

DME DIABETIC FOOTCARE PROGRAM

InCareInCare

DMEDME DIABETIC FOOTCARE PROGRAMDIABETIC FOOTCARE PROGRAM

Implementation PresentationImplementation Presentation

Nancy Cummings, RN, Clinical Director Nancy Cummings, RN, Clinical Director Greg Wolfe, Pres., C.Greg Wolfe, Pres., C.PedPed..

Bob Schwartz, Bob Schwartz, CPedCPed., C.O.F.., C.O.F.Lori Schwartz, C.Lori Schwartz, C.PedPed., C.O.F.., C.O.F.

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http://www.incaredme.comhttp://www.incaredme.com••

Phone (866) 936Phone (866) 936--7463 7463

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Fax (818) 991Fax (818) 991--49514951

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sales@sales@incaredmeincaredme.com.com

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Nancy Cummings (443) 786Nancy Cummings (443) 786--21672167••

Customer Service & Applications StaffCustomer Service & Applications Staff

InCare

Therapeutic Shoe ProgramInCareInCare

Therapeutic Shoe ProgramTherapeutic Shoe Program

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Medicare Therapeutic Shoe BillMedicare Therapeutic Shoe Bill••

The Diabetic FootThe Diabetic Foot

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InterventionIntervention••

Diabetic Shoes and InsertsDiabetic Shoes and Inserts

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The Sizing ProcessThe Sizing Process••

The Fitting ProcessThe Fitting Process

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The Ordering ProcessThe Ordering Process••

DeliveryDelivery

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GauntletsGauntlets••

ConclusionConclusion

The Medicare Therapeutic Shoe BillThe Medicare Therapeutic Shoe BillThe Medicare Therapeutic Shoe Bill

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Created by Medicare in June 1993. This is a Created by Medicare in June 1993. This is a Medicare Part B program.Medicare Part B program.

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Preventative Measure.Preventative Measure.••

Renewable Renewable everyevery calendar year.calendar year.

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1 pair Therapeutic Shoes1 pair Therapeutic Shoes••

3 Pair: 3 Pair: ––

Custom Molded InsertsCustom Molded Inserts

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Heat Moldable InsertsHeat Moldable Inserts

The Diabetic FootThe Diabetic FootThe Diabetic Foot

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The Diabetic Patients feet are at RISK.The Diabetic Patients feet are at RISK.••

More than 25% of all Diabetic hospitalizations are foot related.More than 25% of all Diabetic hospitalizations are foot related.

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ADA states that there are 20.8 million people with Diabetes. ADA states that there are 20.8 million people with Diabetes. ••

Every 21 seconds someone in the USA is diagnosed with DM.Every 21 seconds someone in the USA is diagnosed with DM.

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Every 30 seconds, a lower limb is lost to diabetes somewhere in Every 30 seconds, a lower limb is lost to diabetes somewhere in the the worldworld.. ..

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More than 170 million people suffer from diabetes globally, and More than 170 million people suffer from diabetes globally, and the World Health Organization expects that number to double the World Health Organization expects that number to double by 2030.by 2030.

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More More ½½

of those cases are of Medicare age. of those cases are of Medicare age. ••

This is your most seen groupThis is your most seen group..

The Diabetic FootThe Diabetic FootThe Diabetic Foot

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72,000 amputations each year result from complications 72,000 amputations each year result from complications of diabetes.of diabetes.

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½½

of the patients who had a foot or leg amputated will of the patients who had a foot or leg amputated will endure yet another amputation within five years .endure yet another amputation within five years .

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The cost to Medicare for a (LEA) is approx. $54,000 The cost to Medicare for a (LEA) is approx. $54,000 per patient for the life of the patient. per patient for the life of the patient.

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The cost to the Patient IMMEASURABLE!The cost to the Patient IMMEASURABLE!••

““Prevention is keyPrevention is key””. Hence, the Medicare Therapeutic . Hence, the Medicare Therapeutic Shoe Bill.Shoe Bill.

Risk Factors for AmputationRisk Factors for AmputationRisk Factors for Amputation

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Peripheral NeuropathyPeripheral Neuropathy••

Sensory DepravationSensory Depravation

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Altered BiomechanicsAltered Biomechanics••

Peripheral Vascular DiseasePeripheral Vascular Disease

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Evidence of Increased Pressure, Evidence of Increased Pressure, Callus and CornsCallus and Corns

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History of UlcerationHistory of Ulceration••

Previous Amputation Previous Amputation

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Severe Nail PathologySevere Nail Pathology

What else happens with a patient’s foot?

What else happens with a patientWhat else happens with a patient’’s s foot?foot?

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Loss of feeling in the footLoss of feeling in the foot••

Pain in legs while walkingPain in legs while walking

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The shape of the foot changesThe shape of the foot changes••

Loss or decrease blood flow to the extremitiesLoss or decrease blood flow to the extremities

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Decreased resistance to infectionDecreased resistance to infection••

Delayed wound healingDelayed wound healing

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Impaired Leukocyte Impaired Leukocyte ChemotaxisChemotaxis

(BG + 240mg/dl)(BG + 240mg/dl)••

AmputationAmputation

Callus and CornsCallus and CornsCallus and Corns

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Areas at Risk and Example of Hammer ToeAreas at Risk and Example of Hammer Toe

BunionsBunionsBunions

Bunion (Hallux Bunion (Hallux AbductoAbducto

Valgus)Valgus)

Taylor’s Bunion or Bunionette

The Diabetic FootThe Diabetic FootThe Diabetic Foot

The Foot AssessmentThe Foot AssessmentThe Foot Assessment

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Objectives:Objectives:––

Identify patients who are at risk for problemsIdentify patients who are at risk for problems

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Know when NOT to fit and refer to Primary Care Know when NOT to fit and refer to Primary Care PhysicainPhysicain

(PCP), or Podiatrist if appropriate. (PCP), or Podiatrist if appropriate.

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Never size or fit therapeutic shoes if the patient Never size or fit therapeutic shoes if the patient has open sores.has open sores.

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Educate and reinforce proper foot careEducate and reinforce proper foot care––

Categories of Risk (low or high)Categories of Risk (low or high)

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Document findingsDocument findings––

Note the shape of the foot and obvious foot Note the shape of the foot and obvious foot conditioncondition

InterventionInterventionIntervention••

What can be done?What can be done?

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Must work closely with Physician.Must work closely with Physician.••

Encourage the patient to maintain tight control Encourage the patient to maintain tight control of blood glucose levels (A1c)of blood glucose levels (A1c)

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See a Podiatrist on a regular basis (at least See a Podiatrist on a regular basis (at least annually). annually).

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Proper fitting therapeutic shoes and inserts. Proper fitting therapeutic shoes and inserts. ••

Personal education and lifestyle info. on DMPersonal education and lifestyle info. on DM

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Improved foot hygiene and care Improved foot hygiene and care

Information for the PatientInformation for the PatientInformation for the Patient

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Inspect the feet daily including between toesInspect the feet daily including between toes••

Use mirrors if necessary to inspect all aspects of feetUse mirrors if necessary to inspect all aspects of feet

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Inspect shoes daily prior to wearing. Run hand inside of shoes Inspect shoes daily prior to wearing. Run hand inside of shoes and feel for sharp areas or foreign objectsand feel for sharp areas or foreign objects

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Once the patient has been fitted with diabetic shoes and insolesOnce the patient has been fitted with diabetic shoes and insoles, , educate the patient to change the insoles every 4 monthseducate the patient to change the insoles every 4 months

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DonDon’’t walk barefoot or wear sandalst walk barefoot or wear sandals••

Do not soak feetDo not soak feet

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Have either a DPM or healthcare professional trim nailsHave either a DPM or healthcare professional trim nails••

Never us acid or chemicals to remove corns and callus.Never us acid or chemicals to remove corns and callus.

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Education is crucial to good outcomes(Education is crucial to good outcomes(KramesKrames

educational educational pieces; pieces; ““Diabetes and Diabetes and FootcareFootcare, Foot owner manual, Foot owner manual””, LEAP , LEAP info.)info.)

Therapeutic Shoes/InsertsTherapeutic Shoes/InsertsTherapeutic Shoes/Inserts

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Extra Depth shoes,Extra Depth shoes,••

Unique construction. Unique construction.

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Deeper and wider reinforced toe boxes.Deeper and wider reinforced toe boxes.••

Large variety of lengths/widths. Large variety of lengths/widths.

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Ridged Shank, rocker bottom. Ridged Shank, rocker bottom. ••

Seamless or minimal seam construction.Seamless or minimal seam construction.

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Inserts are total contact, multiple density, Inserts are total contact, multiple density, made directly from a model of the patientmade directly from a model of the patient’’s s foot or molded directly to the patientfoot or molded directly to the patient’’s foot.s foot.

The Assessment ProcessThe Assessment ProcessThe Assessment Process•• Verify patientVerify patient’’s eligibilitys eligibility•• Get signed Statement of Certifying Physician/RXGet signed Statement of Certifying Physician/RX•• Remove patientRemove patient’’s socks or stockingss socks or stockings•• Perform foot assessment and document findingsPerform foot assessment and document findings•• Take digital images of that top and bottom of the feet. Take digital images of that top and bottom of the feet.

(Make sure to frame a piece of paper in shot with the (Make sure to frame a piece of paper in shot with the patients name written so that itpatients name written so that it’’s clearly visible.s clearly visible.

•• Trace the foot with pen at a 90Trace the foot with pen at a 90ºº angle to floor.angle to floor.•• Put the patientPut the patient’’s socks back on Before next steps socks back on Before next step•• Measure patientMeasure patient’’s feet using the Ritz Sticks feet using the Ritz Stick•• Inspect shoes the patient is currently wearing. Note wear Inspect shoes the patient is currently wearing. Note wear

patternpattern

Assessment FormAssessment Form

Taking Foam ImpressionsTaking Foam Impressions

•• Have patient stand next to foam box while holding Have patient stand next to foam box while holding onto a chair or other assistive device(s). onto a chair or other assistive device(s).

•• Set the Foam Impression box next to person so that Set the Foam Impression box next to person so that you can maneuver each foot into the foam.you can maneuver each foot into the foam.

•• Place palm of your hand over the instep and press Place palm of your hand over the instep and press foot into the foamfoot into the foam while the person steps into the while the person steps into the foam.foam.

•• Without hurting the patient, make sure impression Without hurting the patient, make sure impression cavitycavity is at least 2 inches deep.is at least 2 inches deep.

•• The deeper the better.The deeper the better.

The Ordering ProcessThe Ordering Process

•• Complete the order form Complete the order form (remember to include an (remember to include an alternate shoe selection) alternate shoe selection)

•• Send tracing Outline with Order (do not fax outline, it Send tracing Outline with Order (do not fax outline, it shrinks the image)shrinks the image)

•• Send Foam Impression boxSend Foam Impression box to to InCareInCare for processing.for processing.•• Deliver and fit the shoes to patient, get necessary Deliver and fit the shoes to patient, get necessary

documents signed by patientdocuments signed by patient•• Return the signed delivery document to Return the signed delivery document to

InCareInCare DME for claim processing.DME for claim processing.

Order FormOrder Form

ConsiderationsConsiderationsConsiderations

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Time required to do sizing and fitting. If the patient Time required to do sizing and fitting. If the patient has edema, size and fit about the same time of day.has edema, size and fit about the same time of day.

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Obtaining the Physician signed CMN/RX Obtaining the Physician signed CMN/RX ••

Turn around time for HMI or CMI and shoe delivery Turn around time for HMI or CMI and shoe delivery to the beneficiary.to the beneficiary.

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Have the patient sign all Medicare required documentsHave the patient sign all Medicare required documents••

Give the patient wearing instructions, warranty Give the patient wearing instructions, warranty information, HIPAA, Supplier Standards, satisfaction information, HIPAA, Supplier Standards, satisfaction survey and complaint procedures.survey and complaint procedures.

Follow UpFollow UpFollow Up••

Speak to beneficiary within the first five days Speak to beneficiary within the first five days after delivery to see if there are any adverse after delivery to see if there are any adverse changes in their feet.changes in their feet.

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Ask about red spots or other discomfort.Ask about red spots or other discomfort.••

Confirm the break in process, wear shoes one Confirm the break in process, wear shoes one hour a day, increasing wear time one hour a day hour a day, increasing wear time one hour a day for five days.for five days.

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Reassert the benefits of the footwear & inserts Reassert the benefits of the footwear & inserts for the beneficiary and the importance of for the beneficiary and the importance of changing inserts as scheduled.changing inserts as scheduled.

Completion of FormsCompletion of FormsCompletion of Forms

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Must have Dr. Must have Dr. (MD/DO), (MD/DO), signature, date and UPINsignature, date and UPIN

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MD must attest to Diabetes MD must attest to Diabetes MellitusMellitus

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MD must indicate secondary MD must indicate secondary conditions and add appropriate conditions and add appropriate ICDICD--9 codes9 codes

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Patient can deliver to Dr. for Patient can deliver to Dr. for completion, ORcompletion, OR

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Agent can FAX to Agent can FAX to InCareInCare••

Keep Copies for Your Records.Keep Copies for Your Records.

Statement of Certifying Physician with Prescription

Statement of Certifying Physician Statement of Certifying Physician with Prescriptionwith Prescription

Helpful Sizing HintsHelpful Sizing HintsHelpful Sizing Hints

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EveryoneEveryone’’s feet will vary in size and length from left foot to right s feet will vary in size and length from left foot to right foot. foot. Always order shoes for the longest and widest Always order shoes for the longest and widest measurements of the two feet.measurements of the two feet.

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If the patient wears an AFO (ankle foot orthoses) measure the If the patient wears an AFO (ankle foot orthoses) measure the patient wearing the AFO as the AFO will make the length patient wearing the AFO as the AFO will make the length measurement longer and in some cases the width measurement measurement longer and in some cases the width measurement wider. You will receive 1 pair of shoes but only insoles for thwider. You will receive 1 pair of shoes but only insoles for the e foot that does not have an AFO.foot that does not have an AFO.

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In the case of AFO, you should order the extra depth shoes.In the case of AFO, you should order the extra depth shoes.••

If the patient has had a leg amputated, measure not only the If the patient has had a leg amputated, measure not only the natural foot but also the prosthetic foot. You will receive 1 pnatural foot but also the prosthetic foot. You will receive 1 pair air of shoes but only insoles for the natural foot.of shoes but only insoles for the natural foot.

How to Make a Foam ImpressionHow to Make a Foam ImpressionHow to Make a Foam Impression

•• Remove shoes and Remove shoes and sockssocks

•• We recommend wearing We recommend wearing surgical gloves.surgical gloves.

How to Make a Foam Impression -

StandingHow to Make a Foam Impression How to Make a Foam Impression --

StandingStanding

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Place foam impression box on the floor next to Place foam impression box on the floor next to standing patient, while they are holding onto an standing patient, while they are holding onto an assistance device.assistance device.

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Maneuver foot to center of foam area with hand on Maneuver foot to center of foam area with hand on top of the foottop of the foot

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Have patient weight bear onto foot while you press Have patient weight bear onto foot while you press down, pushing foot at least down, pushing foot at least 2 inches2 inches

into the foam. into the foam.

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The deeper the better.The deeper the better.

At same time, apply pressure At same time, apply pressure to lateral aspect of foot with the palm of the other to lateral aspect of foot with the palm of the other hand.hand.

How to Make a Foam Impression (continued)

How to Make a Foam Impression How to Make a Foam Impression (continued)(continued)

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Finish impression by pressing Finish impression by pressing down each toe with your down each toe with your finger.finger.

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Lift foot straight up out of Lift foot straight up out of the foam while holding the the foam while holding the ankle.ankle.

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Repeat this procedure with Repeat this procedure with other foot.other foot.

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If the impression is not deep If the impression is not deep enough, discard and repeatenough, discard and repeat

Ritz Stick MeasurementsRitz Stick MeasurementsRitz Stick Measurements

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Spray Ritz Stick with Antiseptic Spray prior to Spray Ritz Stick with Antiseptic Spray prior to each useeach use

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For length of a foot: Place the foot on the For length of a foot: Place the foot on the device with heel against stop. Move slide to device with heel against stop. Move slide to longest toe. Make sure your reading is for longest toe. Make sure your reading is for WomanWoman’’s or Mans or Man’’s length. Take note of s length. Take note of length measurement. Repeat with other foot.length measurement. Repeat with other foot.

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For width of a foot: With the slide on the For width of a foot: With the slide on the outside of the foot, place ball of foot across outside of the foot, place ball of foot across the device Hold slide in place and release. the device Hold slide in place and release. Take note of width. Repeat with the other Take note of width. Repeat with the other footfoot

Guidelines for Shoe SelectionGuidelines for Shoe SelectionGuidelines for Shoe Selection

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You the technician should always select the proper shoe style You the technician should always select the proper shoe style for the patient. for the patient.

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You should never give the patient the catalog and ask them to You should never give the patient the catalog and ask them to select the shoes they would like.select the shoes they would like.

If your patient has minimal If your patient has minimal

foot deformities, you can select from a wider selection of foot deformities, you can select from a wider selection of shoe.shoe.

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The shape of the shoes must match the shape of the patientThe shape of the shoes must match the shape of the patient’’s s feet. feet. * Boxy square feet * Boxy square feet ––

straight last like straight last like OrthofeetOrthofeet

* Narrow curved foot * Narrow curved foot ––

curved last like sneakers and some of curved last like sneakers and some of the Drew shoesthe Drew shoes

Guidelines for Shoe Selection (cont)Guidelines for Shoe Selection Guidelines for Shoe Selection (cont)(cont)

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If the patient has edema, you should put the patient in a Lycra If the patient has edema, you should put the patient in a Lycra shoe like the shoe like the OrthofeetOrthofeet

825, 830. Some Lycra shoes have 825, 830. Some Lycra shoes have

more removable insoles and the Lycra material will better more removable insoles and the Lycra material will better accommodate the edema.accommodate the edema.

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If you do put a patient with edema in a leather shoe it must be If you do put a patient with edema in a leather shoe it must be a lace shoe (so you can open shoe sufficiently to put the foot a lace shoe (so you can open shoe sufficiently to put the foot in. A good leather shoe to get for this patient is the in. A good leather shoe to get for this patient is the PropetPropet

91089108••

Patients with edema should never be put into a Mary Jane Patients with edema should never be put into a Mary Jane style shoestyle shoe

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If the patient has a heel slippage problem, you should put the If the patient has a heel slippage problem, you should put the patient in a lace shoe with a fifth eyeholepatient in a lace shoe with a fifth eyehole

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If the patient wears an AFO, put the patient in the deepest If the patient wears an AFO, put the patient in the deepest shoe possible, such as shoe possible, such as PropetPropet..

Toe Amputations and Toe Filler Accommodations

Toe Amputations and Toe Filler Toe Amputations and Toe Filler AccommodationsAccommodations

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For patients with an amputated toe, or toes, please contact the For patients with an amputated toe, or toes, please contact the Applications Department at Applications Department at InCareInCare

DME, to help determine if DME, to help determine if

your patient is eligible for additional modifications. They wilyour patient is eligible for additional modifications. They will let l let you know if toe filler accommodations are necessary. you know if toe filler accommodations are necessary.

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If they determine accommodations are appropriate, you will need If they determine accommodations are appropriate, you will need to get a Pressure Stat, foam impression and foot measurements, to get a Pressure Stat, foam impression and foot measurements, as mentioned previously.as mentioned previously.

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A specific prescription from an MD or DO for specific A specific prescription from an MD or DO for specific modifications is required.modifications is required.

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It is imperative you trace the foot on the pressure stat.It is imperative you trace the foot on the pressure stat.

How the Custom Molded Inserts are Fabricated

How the Custom Molded Inserts How the Custom Molded Inserts are Fabricatedare Fabricated

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Foam Impression Box Foam Impression Box ••

Positive plaster mold of the patientPositive plaster mold of the patient’’s foot is createds foot is created

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The material is Heated to 450/FThe material is Heated to 450/F••

The material is molded over the cast.The material is molded over the cast.

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Inserts are trimmed to fit the specific shoes ordered Inserts are trimmed to fit the specific shoes ordered ••

A final finishing process smoothes all trim edges.A final finishing process smoothes all trim edges.

What to do With the Foam Impression Box…

What to do With the Foam What to do With the Foam Impression BoxImpression Box……

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Put the Foot Tracing in the Put the Foot Tracing in the boxbox

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Tape the impression box closed.Tape the impression box closed.

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Make sure the patientMake sure the patient’’s info on s info on the box is the box is fully completedfully completed

prior to mailing. prior to mailing. Be sure to Be sure to indicate an alternate shoe indicate an alternate shoe style/colorstyle/color

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Under Under ““CommentsComments““: note : note specific problems i.e.. Bunions, specific problems i.e.. Bunions, hammered toe, edema, sores, hammered toe, edema, sores, pain etc pain etc

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Make a copy of the top of the Make a copy of the top of the Impression. Box.Impression. Box.

..

How to Mail Foam ImpressionHow to Mail Foam ImpressionHow to Mail Foam Impression

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Place the box and the Place the box and the Pressure Stat in the Pressure Stat in the postage paid, selfpostage paid, self--

addressed mailing addressed mailing envelope.envelope.

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Please fax or call Please fax or call InCareInCare

DME when your DME when your

supplies need replenishing.supplies need replenishing.

Shoe DeliveryShoe DeliveryShoe Delivery••

Shoes and Inserts will be shipped with patients name and a Shoes and Inserts will be shipped with patients name and a tracking number on each item.tracking number on each item.

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Call patient to let them know shoes/inserts are available and Call patient to let them know shoes/inserts are available and arrange time to do final fitting. arrange time to do final fitting. Request the patient wear or Request the patient wear or bring socks to the fitting.bring socks to the fitting.

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Fully open shoes and remove packing materials and Fully open shoes and remove packing materials and inlays/insolesinlays/insoles

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Place the custom molded insole on the floor and have the patientPlace the custom molded insole on the floor and have the patient stand on the insole. You will be able to determine if the shoesstand on the insole. You will be able to determine if the shoes

are the correct length and width. The toes must not hang over are the correct length and width. The toes must not hang over the edge of the insoles and the sides of the feet must not hang the edge of the insoles and the sides of the feet must not hang over the sides of the insoles. To ensure length is correct, youover the sides of the insoles. To ensure length is correct, you

must have no less than must have no less than ½½

inch inch ––

¾¾

inch from the tip of the inch from the tip of the longest toe to the end of the insole.longest toe to the end of the insole.

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Place custom insert in each shoe Place custom insert in each shoe ••

Place on patients feet using shoe horn if needed.Place on patients feet using shoe horn if needed.

Checking the Fit with the Shoes and Insoles on the Patient

Checking the Fit with the Checking the Fit with the Shoes and Insoles on the PatientShoes and Insoles on the Patient

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Check the width at the ball of the foot. The leather on the topCheck the width at the ball of the foot. The leather on the top of the shoe should not be drum tight, nor should it be loose of the shoe should not be drum tight, nor should it be loose

enough to pinchenough to pinch--up a roll between thumb and finger. In general up a roll between thumb and finger. In general you should be able to run your thumb across the leather and you should be able to run your thumb across the leather and create a slight roll or wave of leather ahead of your thumb. create a slight roll or wave of leather ahead of your thumb.

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Run your finger around the collar of the shoe at the ankle to Run your finger around the collar of the shoe at the ankle to make sure it is not too tight or digs into the ankle.make sure it is not too tight or digs into the ankle.

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Have the patient take a few steps on a hard surface like tile.Have the patient take a few steps on a hard surface like tile.••

Ask the patient how the shoes feel. Remember to listen carefullAsk the patient how the shoes feel. Remember to listen carefully y to their description as it may contain important clues to aid yoto their description as it may contain important clues to aid you u in understanding and rectifying any problems.in understanding and rectifying any problems.

Breaking in the ShoesBreaking in the ShoesBreaking in the Shoes

••

Advise patient to wear the shoes indoors on carpet if possible Advise patient to wear the shoes indoors on carpet if possible for 1 hour the 1for 1 hour the 1stst. day, working up to 5 hours the 5. day, working up to 5 hours the 5thth. day. day

••

Advise the patient to change the custom insoles every Advise the patient to change the custom insoles every 4 months,4 months,

discarding the old insoles.discarding the old insoles.••

Current return/replacement policy: Current return/replacement policy: ––

5 days for fitting issues5 days for fitting issues––

30 days from shipping date for resizing.30 days from shipping date for resizing.––

1 year for materials and workmanship.1 year for materials and workmanship.••

If fit is immediately problematic, notify customer service at If fit is immediately problematic, notify customer service at InCareInCare

DME an arrange for replacement.DME an arrange for replacement.

••

Shoes returned for resizing must be in resalable condition. ShoeShoes returned for resizing must be in resalable condition. Shoes s that show signs of wear will not be replaced.that show signs of wear will not be replaced.

Break In InstructionsBreak In Instructions

Ankle & Foot Gauntlet

Size determinedBy shoe size

ConclusionConclusionConclusion

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Can Therapeutic Shoes and Inserts help?Can Therapeutic Shoes and Inserts help?••

Several large clinical centers have experienced a 44Several large clinical centers have experienced a 44--85% 85% reduction in Lower Extremity Amputations (LEA) reduction in Lower Extremity Amputations (LEA) with the implementation of improved footwith the implementation of improved foot--care care programs for diabetic patients. programs for diabetic patients.

••

Implementation of the Implementation of the InCareInCare

DME Therapeutic Shoe DME Therapeutic Shoe Program can and will made a difference in the foot Program can and will made a difference in the foot health of at risk Diabetic patients.health of at risk Diabetic patients.

••

Dramatic improvement in foot health and overall Dramatic improvement in foot health and overall benefit to the patient who avoids an amputation as benefit to the patient who avoids an amputation as result of this program is immeasurable.result of this program is immeasurable.

Thank You. Please feel free to ask us

questions!!!!

Thank You.Thank You. Please feel free to ask us Please feel free to ask us

questions!!!!questions!!!!