Sherri Fleming, CFts, is proud of her crisp white lab coat with a patch that says she is an ABC-certified therapeutic shoe fitter.

Yet Fleming, staff shoe fitter at Rice Pharmacy in Beaver Dam, Ky., population 3,300, admits she doesn’t always wear her white coat when she sees her diabetes patients.

“The coat intimidates some people,” she said. “It’s kind of like my daddy when I used to take him to the doctor. He’d be so sick the night before, but when we’d get to the doctor he’d be well.” On the other hand, “when I put on the white coat, it makes some people think I know what I’m doing,” she said. Fleming, loves what she does. “This is not about selling shoes,” she said. “This is about helping my patients keep from losing a limb.”

She said diabetes cuts short the lives of many Kentuckians. “It’s not just elderly people any more. I am seeing more and more young people who are obese and have diabetes and are not taking care of themselves.”

Before she became a certified shoe fitter, Fleming spent 14 years working for car dealerships in nearby Greenville, where she still lives. She confessed she knew little about the danger of diabetes.

Diabetes’ role in other diseases

Before she became a certified shoe fitter, Fleming knew little about the dangers of diabetes.

Images: Berry Craig, O&P Business News.

“I’d hear about somebody who died of heart disease, or kidney disease or infection,” she said. “But a lot of people have heart disease and kidney disease because of diabetes. People can also have an infection and lose a foot because of diabetes, and it goes on and on. I didn’t realize it was such a terrible disease.”

Fleming said more than a few of her patients are unaware that diabetes can claim limbs and lives. “They take something for a stomach ache, and they feel better. They think if they just take insulin, they will be all right. They don’t know the effect of diabetes on their bodies, especially their feet.”

Diabetes can result in peripheral neuropathy.

“They lose feeling in their feet. One of my patients, another little old lady, came in to see me, and when I examined the bottom of her foot, I found a rock embedded in it. She didn’t realize it was there because the bottom of her foot was numb.”

Thus, Fleming preaches foot care to her patients with almost missionary zeal. “It can mean the difference between saving a toe or a foot and losing a toe or a foot. Of course, all of us are guilty of not paying attention to our feet. We wash them when we take a shower or a bath and forget them. You can’t do that if you have diabetes.”

She urges her patients to carefully inspect their feet daily.

“I also give them tips like never rubbing lotion between the toes because moisture builds up between the toes, and lotion can cause the skin to break down. That can lead to ulcers, and they can lead to the loss of toes.”

Patient education

Fleming educates her patients about how shoes and inserts work together to help them. “Inserts are especially important. You want to protect the toes and the heels most of all. They’re the parts of the foot most likely to be injured.”

Fleming educates her patients about the benefits of inserts to protect the toes and heels.

Inserts are supposed to cradle the foot and keep it stable in the shoe. She prepares heat molded inserts in her small in-store lab. “But I also take impressions with the foam box and send it away to the lab at Dr. Comfort Shoes.”

Fleming is partial to the Dr. Comfort line. “They really last, and that’s important in our area. A lot of my patients are on Medicaid. For some of them, the shoes they get from me are the only shoes they have.”

Patients who are not on Medicare or Medicaid and cannot pay for their shoes are not turned away at Rice’s Pharmacy. The owner, Levi Rice, has flashed Fleming the green light to give shoes to needy patients. “It’s built into my budget,” she said. “He also provides shoes anonymously to needy people in our area. It’s a good feeling to work for a boss like that.”

Fleming said patients feel good when their shoe fitter takes time to get to know them. “It’s about spending time with them and getting to know them and their needs and learning about their kids and grandkids. It’s about making a difference in their lives. We don’t just talk about shoes and inserts. We visit.”

She sees patients in a small room off the pharmacy’s main sales floor. “I carry several different lines of shoes so they can at least have a choice. But it all depends on the condition of their feet and what their doctor has prescribed.

“For example, if they have bad circulation, you want to make sure that the shoe they are getting doesn’t bind the foot. If somebody has a pre-callus, you want to make sure that part of the foot is never being rubbed by the shoe.”

She confessed that her shoe lines are less than stylish. “But they’re a lot more fashionable than they used to be,” she said. When patients balk at wearing sensible shoes, “I ask them, ‘Do you want to risk losing a toe or a foot, or do you want to wear these shoes?’ That usually convinces them.”

Local outreach

For diabetes patients away from the pharmacy, she puts on programs for local organizations and nursing home residents. “I reach out to a lot of people who have diabetes, such as people who work in factories. A lot of them can get shoes through their insurance at work.”

She warns against people who sell diabetic footwear out of motel rooms.

“They’re completely outside of the caring part of working with patients with diabetes. They’re just trying to sell shoes. The patient goes in and the people ask ‘What size?’ They write it down and then mail them their shoes, which often don’t fit. But by then, the people are the next state. But I’m here all the time.”

She also points to what fly-by-night operators do not have — ABC certification.

Fleming would like to hang another framed certificate on her wall. “I wouldn’t mind becoming a board certified pedorthist. The more I do my job, the more I like it.

“Fitting is more of an art than a science,” she said. “You can measure somebody’s foot correctly but that doesn’t make you a fitter. A fitter is somebody who goes beyond just getting the right size. Fitters know the right shoes for their patients. Fitters also take the time to listen to their patients. You don’t know how a little old man’s foot feels inside the shoe, you can’t tell by feeling from the outside. So you let him tell you.

“I love what I do. I look forward to coming to work every day.”