COF COF Diabetic & Therapeutic Footwear 2 — Questions and Answers
Question 1: Which insole material is most appropriate for a diabetic patient with plantar calluses?
- Rigid polypropylene
- Viscoelastic/PPT foam (Correct answer)
- Steel shank
- Hard leather
Correct answer: Viscoelastic/PPT foam
Viscoelastic materials like PPT absorb shock and reduce shear forces, protecting insensate diabetic feet from callus formation and skin breakdown.
Question 2: What condition must a physician certify to qualify a patient for Medicare therapeutic shoes?
- Osteoarthritis
- Diabetes mellitus with at least one qualifying lower limb condition (Correct answer)
- Bunions only
- Plantar fasciitis
Correct answer: Diabetes mellitus with at least one qualifying lower limb condition
Medicare requires physician certification that the patient has diabetes mellitus with at least one qualifying foot condition such as neuropathy, ulceration, or Charcot foot.
Question 3: A rocker-bottom shoe modification is used primarily to:
- Increase shock absorption at heel strike
- Reduce pressure on the metatarsal heads and forefoot during propulsion (Correct answer)
- Correct supination
- Increase lateral stability
Correct answer: Reduce pressure on the metatarsal heads and forefoot during propulsion
Rocker-bottom soles roll the foot through gait, reducing peak pressure at the metatarsal heads and decreasing the need for toe extension at push-off.
Question 4: Which situation is a contraindication for placing a standard metatarsal pad?
- Metatarsalgia
- Morton's neuroma
- Active plantar ulcer directly beneath a metatarsal head (Correct answer)
- Hammer toe
Correct answer: Active plantar ulcer directly beneath a metatarsal head
Placing a metatarsal pad over an active ulcer increases pressure at that site and worsens the wound; total contact offloading is required instead.
Question 5: What does 'DMEPOS' stand for in relation to therapeutic footwear reimbursement?
- Diabetic Medical Equipment and Podiatric Orthotic Supplies
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (Correct answer)
- Diabetic Managed Equipment, Prosthetics, Orthotics, and Shoes
- Durable Medical Exam and Peripheral Orthopedic Supplies
Correct answer: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DMEPOS is the Medicare billing category that includes therapeutic footwear, prosthetics, orthotics, and other durable supplies.
Question 6: What is the primary purpose of a metatarsal bar on therapeutic footwear?
- Provide lateral ankle stability
- Offload pressure from the metatarsal heads by transferring load proximally (Correct answer)
- Correct hallux valgus alignment
- Increase overall shoe flexibility
Correct answer: Offload pressure from the metatarsal heads by transferring load proximally
A metatarsal bar placed proximal to the metatarsal heads transfers weight to the metatarsal shafts, reducing peak pressure over the heads.
COF COF Diabetic & Therapeutic Footwear 2
Which insole material is most appropriate for a diabetic patient with plantar calluses?