The customer is not always right where Jerry Teer, CFts, fits feet to footwear.
Medcare Home Medical in Paducah, Ky., is not a retail shoe store. The firm dispenses oxygen and home medical equipment and therapeutic footwear for diabetes patients.
Patients are not the same as customers, Teer said.
“A lot of times, they want to pick the shoes like they do in a regular shoe store. My job is to educate them about the right shoe they need, which is not always the shoe they want.”
Teer said it did not take him long to realize that the more he learned about therapeutic shoes and inserts, the better he could educate his patients. So he started studying for the Certified Fitter-therapeutic shoe credential (CFts) offered by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) since 2006. He earned certification in February 2013.
The right to fit leads to good compliance.
Images: Craig B.
Patient protection
“The driving force behind the creation of the CFts credential was patient protection,” said Steve Fletcher, CPO, LPO, ABC’s director of clinical resources. “ABC’s leadership recognized that the marketplace had created an environment that allowed for the provision of diabetic shoes and inserts by persons with virtually no education or experience dealing with this high risk population.”
Fletcher said ABC had found evidence that some companies were shipping footwear and inserts to patients without properly fitting them or assessing the appropriateness of the shoes. “ABC believes this puts patients at great risk of potential harm,” he said.
Fletcher said ABC’s certified orthotist (CO) and certified pedorthist (CPed) credentials were available for providers of custom diabetic shoes and inserts. “However there was a need for a credential that focused on the provision of non-custom diabetic shoes and inserts, due to this growing patient population,” he told O&P Business News. “ABC continues to educate payers on the need of formal education, structured experience where competency is assessed and completion of certification exams as a minimal bar for individuals wishing to provide this important aspect of patient care.”
Likewise, Catherine A. Carter, ABC executive director, said the organization “recognized that there was little consistency in the education and training of therapeutic shoe fitters despite the potential of their patients to be high risk patients.” She added that in devising the CFts credential, ABC was guided by the idea that primary education programs for credential seekers should meet common standards, such as those required by the National Commission on Orthotic and Prosthetic Education.
She explained that ABC determined “that fitters seeking national recognition (ABC certification) should pass an exam based on a valid practice analysis and written by subject-matter experts. Our program also requires continuing education to maintain the credential.”
In addition, Carter said that ongoing continuing education helps maintain and improve the health care system and delivery of services.
“ABC credential holders are required to earn the majority of their continuing education credits with content specifically related to their ABC credential.”
Continuing education
Teer trained for the CFts through the Dr. Comfort Shoe Company, headquartered in Mequon, Wisc. He takes the requisite continuing education courses online. ABC has a list of approved courses on its website.
In turn, Teer said, he educates his patients every day at the fitting stool.
“Studies have shown that a high percentage of amputations could have been avoided if people wore the proper footwear to begin with. A lot of them do not know that.”
He added that many patients do not understand the dangers of diabetic neuropathy.
“If a sore comes up on their feet, they don’t feel it because of the numbness. They also don’t realize that they have to be very careful when they trim their toenails because they can cut themselves,” Teer said. Such seemingly minor injuries can lead to major problems.
“It is a chain reaction. They don’t know they have a sore and they keep walking on it. The sore gets worse and they get gangrene, and that’s where amputation comes in,” Teer said. “When you lose a digit, it alters the way you walk. That puts more pressure on the other digits, creates more rubbing and another sore. They lose another digit and another one, and then a foot and possibly a leg. That is why it is so important they have the right shoes and inserts.”
Jerry Teer assesses each foot thoroughly.
Many of Teer’s patients are in the wrong shoes when they first see him. “Most of them are wearing loose shoes of some sort that are not therapeutic at all. They want shoes that are easy to get on and off, like flip flops. But they do not understand there is friction with those type of shoes.”
Therapeutic type footwear used to be short on style, “but that has changed,” Teer said. “Dr. Comfort, the line we carry, recently came out with a high-heel dress shoe. The women are pretty excited about that.”
Before he fits footwear or inserts, Teer spends close to an hour assessing each foot. “I start with the paperwork from the doctor with his exact orders, and where he has marked what is wrong — neuropathy, that sort of thing.
“I check the wear pattern on their old shoes. I look between their toes for any kind of wounds. I look for red areas where their shoes have been rubbing. Sometimes, in the red area there will be this white spot, which tells me something is going on — it might be a blister or a corn. I also check for deformities in the toes that might create a rubbing in the shoe. If I see a problem, I tell them to see their doctor right away.”
He also said a lack of hair on the instep and toes can indicate poor circulation, another diabetes-related problem. “Because of the poor circulation, once they get a sore, it is hard for it to clear up because the antibiotics don’t circulate through the body as well,” he said.
After Teer’s assessment, which includes a foot sensitivity test, he measures his patients’ feet with a bright blue, yellow and silver Dr. Comfort Brannock device and also molds their feet in foam boxes. “I order the shoes from Dr. Comfort. They use a computer to make the inserts from the molds I send them.”
While some patients balk at wearing sensible shoes, Teer said compliance is high with the patients he sees. “One of the keys to compliance is to keep working with patients and getting them the shoe they need. It is a cliché, but every foot is different. For example, a lot of patients don’t have any swelling the morning, but in the evening, their feet swell up like balloons. You have to make sure you give them a shoe that is expandable.
“I reassure them that if they have any problems whatsoever to come back and see me, and we will reassess,” Teer said. “I tell them we will keep working on it until we get it right. People are tickled to death when they get a nice pair of shoes that feel good. Seeing the patient satisfaction is the part of my job I like best.”
