Kentucky Pharmacist Joins Ranks of Certified Therapeutic Shoe Fitters

David Prater, CFts, wears many hats to ensure his customers wear shoes that fit.

David Prater, CFts, had been dispensing diabetic footwear and inserts in Fulton, Ky., for 8 years when he decided he needed more credibility with his patients and their physicians.

He became one of a growing number of Kentuckians to become ABC-certified fitters of therapeutic shoes. But Prater is apparently a rarity among holders of the CFts credential anywhere.

He is a pharmacist. “A pharmacist who is also a certified fitter seemed like the way to go for me,” Prater said. “Pharmacy is considered to be one of the most ethical professions in America. Most people trust their pharmacists.”

Prater is a staff pharmacist at Evans Drug Co. and at Parkway Regional Hospital, both in Fulton, an historic old railroad town that shares the state line with South Fulton, Tenn. He is owner of Evans Total Care LLC, a durable medical equipment company next door to the drug store.

David Prater predicts Medicare will require people who dispense diabetic shoes to be certified. David Prater predicts Medicare will require people who dispense diabetic shoes to be certified.
David Prater predicts Medicare will require people who dispense diabetic shoes to be certified.
Image: Craig B, O&P Business News.

He founded the DME business in 2002 with his former partner and Evans Drug Co. owner, David Woolf. “It was an easy spin off from the drug store, which has been open since around 1905,” Prater said. “David Woolf suggested we keep the Evans name which gave us instant credibility.”

Prater added that when he started out with Evans Total Care, he “had no background in shoes and really only a minimal background in medical equipment. But I knew about diabetes and the importance of footwear in preventing amputation.”

Searching for certification

Prater had earned expert fitter certificates from some of the companies whose shoes and inserts he provided his patients. “But I wanted more.”

So he surfed the internet.

“I found ABCOP. It is the gold standard of the industry — the Cadillac or Mercedes Benz. The certified fitter-therapeutic shoes credential seemed right for me.”

He got certified in 2010. “I also thought it was a good idea because sooner or later, Medicare will probably require people who dispense diabetic shoes to be certified.”

He said Evans Drug Co. and Evans Total Care offer one-stop shopping for patients with diabetes. “People can go next door for their meds, and they can come to us for their diabetic supplies.”

Like many, if not most, certified fitters and pedorthists, Prater says shoe fitting is both art and science. “You measure their feet, but you also know your lines. You know what shoes are going to work best with different types of feet.”

Besides shoes, Prater dispenses heat-moldable, over-the-counter orthotics.

“As a pharmacist, I know what my scope of practice is and follow it. I do the same thing as a certified fitter. If somebody comes in needing custom orthotics, I refer them to a full-blown orthotics and prosthetics facility. You always want to do what’s best for the patient.”

He said all of his patients are doctor referrals. “But sometimes, if a person comes in for diabetic supplies, we ask them if they have ever had a pair of diabetic shoes. We have a great rapport with our local physicians who can then refer them to us for shoes.”

Prater stresses he does not run a shoe store. “We have a large selection of sample shoes. People come in, we fit them, and we order the shoes. We can have the shoes in a couple of days.”

Occasionally, he does sell diabetic footwear to people who just want a comfortable pair of shoes. “But the retail side of the business is very small. This is a cash-poor area.”

But Prater said diabetic footwear is not just for people with diabetes. “I wear the shoes myself. It also gives me good rapport with my patients. They are glad to see that I am wearing the shoes they might be wanting.”

Prater said he is not a “fashionista.” Yet he said many of his diabetes patients want shoes that are stylish and not just supportive. “When I started in the business, some of these shoes were really ugly. But that’s changed. You get more compliance when the shoes are a quality product that looks great.”

Practice Tip

Shoe fitting experts who use the venerable Brannock device know that arch length is the most important measurement to make. David Prater, CFts, has his own way of measuring for arch length. “I move the slide all the way to the top first, then look straight down over the foot and slowly slide it down into position. It gives me a better feel for where the ball of the foot is.”

 

Education solution

He said compliance can be a problem. Education, he added, is the solution. “It depends on the patient. Sometimes I joke with them. Other times, you have to be blunt. Diabetes is a disease that can cause you to lose toes or your foot.

“I tell patients that it doesn’t matter how old you are, you still have life left and you’re going to have a harder time getting around on a prosthesis. Once they start amputating toes and feet, things start to go downhill.”

Neuropathy usually precedes amputation. As a result, many people with diabetes want tightly-fitting shoes so they can feel them. “That of course, decreases the circulation and makes things worse. So I explain to them why diabetic shoes are best – how a wider toe box, for example, helps increase circulation.”

Prater confessed that not all patients heed him. “You get it as a pharmacist, too. When I try to explain to people about their prescriptions, they sometimes say ‘My doctor knows best, just count the pills, put them in the bottle and give them to me.’ They won’t talk to their doctor that way, but they will to the pharmacist because they just want their prescription filled so they can be on their way. But I’m big on counseling whether I am filling prescriptions or fitting shoes.”

Use psychology

Shoe fitting sometimes requires psychology, too, he said, especially when trying to coax a patient into a larger size shoe.

“Mrs. Smith comes in and says she wears a size 5. You measure her as an 8½. ‘Oh, no,’ she says, ‘I’m a 5.’ I won’t order a 5. But I will order a 7½ and an 8½. Then I try both pairs on her. She says the 7½ is a little tight, but the 8½ feels great. Then I tell her it doesn’t look like she’s got a water ski on.”

Prater the pharmacist-certified-fitter-psychologist is proud of what he does. Fulton, population of about 2,800, never had a DME company.

“People here never had the option of getting diabetic shoes in town. I really enjoy this. I feel like we are doing everything we can to accommodate our patients.”