Orthotics/Prosthetics

Mike Stone of Paducah, Ky., wanted to show doctors and their patients with diabetes his durable medical equipment firm was serious about fitting diabetic footwear.

Stone, who owns 136-year-old Stone-Lang Co., earned his American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) certification as a therapeutic shoe fitter. So did a trio of his store staffers: Lauri Ezell, Belinda McManus and Elizabeth Vickery.

	Lauri Ezell tells her patients with neuropathy that they need to wear shoes all the time.
	Images: Craig B. O&P Business News

“Getting certified really helps you understand the needs of patients with diabetes,” Ezell said. “Besides, you now have to be certified to dispense diabetic footwear if you are going to bill Medicare.”

According to the ABC website, a “Certified Fitter-therapeutic shoes is a health care professional who is specifically educated and trained to provide non-custom therapeutic shoes and non-custom multi-density inserts.” The practice of a certified fitter (CFts) “…includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, follow-up and practice management.”

In addition, the CFts “is obligated to support and conform to professional responsibilities that promote and assure the overall welfare of the patient and the integrity of the profession,” according to the website.

“Overall welfare” includes sending patients on to an ABC-certified pedorthist if need be, according to Ezell, who manages the store. “We sell shoes and customized, heat-moldable over the counter inserts,” she told O&P Business News. “Sometimes, patients need more.”

Ezell agreed that she needed more shoe fitting expertise after she went to work at Stone-Lang, which was a pharmacy for many years before evolving into a DME business with a branch in nearby Murray, Ky. Both stores are ABC-accredited CFts facilities, she said.

“I’ve been here 6 years,” Ezell recalled. “I had been a pre-school teacher for almost 10 years when Mr. Stone contacted me. I was on the fence about staying with it or moving on to something else.”

She added, “I didn’t realize I would be a certified fitter of therapeutic shoes when I started here. But I am glad that I am. It has been so interesting to me.”

Ezell does not plan to pursue CPed certification right now. “But they are so needed,” she said.

Important role

Yet she said a CFts and a CPed require similar attributes when it comes to their practices. “You have to have a lot of patience and sympathy for patients. Patients are often confused. They sometimes have difficulty understanding what they need to do.

“The most important thing I do is make sure that they are not going to have any foot amputations or toe amputations,” she said. “A lot of times something starts out small on their foot. They don’t notice it because they can’t feel it or haven’t been to the doctor in a while. But that something small can be extremely dangerous and lead to amputation.”

Ezell talks up foot care at the fitting stool. “One of the things I tell them is that they have to wear shoes all the time if they have neuropathy. They need to put on house shoes if they get up in the night to go to the bathroom. They can step on something or stub their toe and not feel it. That can cause a serious problem.”

Ward off amputations

She explains to patients that diabetic shoes are specially designed to help them ward off amputations.

“I have actually seen people who were not wearing diabetic shoes and ended up with toe amputations. They told me it happened so fast — it was a little sore, then all of a sudden it became something else. So many people are unaware of the dangers of the disease.”

Ezell said people came to Stone-Lang for supportive footwear long before the firm began dispensing diabetic shoes. “They sold many pairs of the old Dr. Scholl’s shoes when Stone-Lang was a drug store.”

	Ezell says that most patients go along with footwear she recommends.

A store display includes photos of the old store and some old Dr. Scholl’s memorabilia.

The right shoes

Local podiatrists sent their patients to Stone-Lang. Referrals still come from podiatrists as well as from endocrinologists and other physicians.

“People know they can get shoes from us, but they often don’t know why diabetic shoes are so important,” Ezell said. “I educate them on how to take care of their feet to begin with.”

She also takes time to explain why diabetic footwear is special. “I tell them how diabetic shoes are made — with a wider toe box and they are deeper than normal shoes — which means they are not going to rub and make a callus that can be dangerous.”

Ezell conceded that diabetic shoes are not as stylish as fashion footwear. “I love shoes, and I wouldn’t want to wear something that is ugly. So I research and try to find shoes that are fashionable and yet appropriate for the patient. Is that always possible? No.”

But many times it is, she added. Ezell pointed to her feet. “I wear the diabetic tennis shoes to work every day. So does Mr. Stone.

“I am my own advertising. I not only wear them to work; I also wear them around the neighborhood to walk or jog.”

In the end, Ezell said, most patients go along with what she recommends, no matter how unfashionable the shoe might seem to be. “I tell them it might not be the greatest looking shoe, but it is going to make you feel better.”

Many patients with diabetes hurt their feet by wearing shoes that are too small. “They come in all the time,” Ezell said. “You have a lady who has a size 10 foot, but she says she wears an eight. It can be a touchy situation. I don’t want to rock the boat too much.

“To get them going in the right direction, I start talking about the shoes they’ve been wearing and the size they’ve been getting. I write it all down.”

Then Ezell casually asks, “Have you had your feet measured lately?” Almost all patients answer no, she said.

With that, Ezell produces a Brannock device or a Ritz stick and sizes them up. “Most people have been guesstimating their shoe size for years, and that’s why many people have hammertoes and bunions and all that other foot trouble. But would I give the lady who says she wears an 8 but is really a 10 a size 8? No. That would go completely against what we are trying to do here.”

Ezell said most patients appreciate the service and professionalism they get at Stone-Lang, one of the oldest businesses in historic Paducah, the first city Gen. Ulysses S. Grant captured in the Civil War.

“We have patients going on their fifth or six pair of shoes. They come back and say, ‘Last year, I got the brown, and now I want the black.’”