We spend fortunes chasing the next molecule, the next biologic, the next robot. Meanwhile, one of the most powerful tools we have to keep people walking has been sitting in the closet since 1993.
Our former research manager Ryan Crews, with first author Carol Szmuilowicz Kurth out of Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin, just put numbers on something many of us have felt for years. They surveyed 580 clinicians across podiatry, primary care, physical therapy, orthotics and prosthetics, and diabetes education. Ninety percent knew about the Therapeutic Shoe Benefit. Ninety-eight percent recommend supportive shoes for their patients with diabetes.
And still, fewer than one in five eligible patients ever gets the shoes.
Sit with that. We have known about this story as an awareness problem for a long time. The surprise here is that knowing is not the bottleneck. The bottleneck is friction. Documentation complexity. The runaround of getting three different provider types to talk to one another. Reimbursement that does not come close to covering the labor it takes to do the right thing.
A pair of shoes will never get a press release the way a new biologic does. It is not glamorous. But offloading is about as close to a sure thing as we have in this disease, and the shoe bill is the on-ramp. The intervention with the broadest reach is the one we use the least, simply because we made the easy thing hard.
The cure is not missing. The delivery is broken. Let’s fix the delivery.
Thank you, Ryan and Carol, for shining a light where we needed it.
Kurth CS, Crews RT. Healthcare Provider Knowledge and Utilization of the Medicare Therapeutic Shoe Benefit. J Am Podiatr Med Assoc. 2026;116(3):32. doi:10.3390/japma116030032. PMID: 42200995
#diabeticfoot #amputationprevention #MedicareShoeBill #therapeuticshoes #offloading #remission #footcare
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