Increase in Diabetes Reflected in Pedorthic Practices Nationwide

Diabetes is so prevalent in south-central Kentucky that Randall Dunnam, CPed, added a diabetes branch to Tri-City Shoe Center, his pedorthics facility in Glasgow, Ky.

“A good 80% of my personal patients have diabetes,” Michael Baglione, CPed, who is on the staff at Nashville Orthotics and Prosthetic Services said.

But board-certified pedorthists in other parts of the country – from Maine to California – say they see many diabetic patients, too.

“My practice is probably 60% diabetic patients,” Michelangelo Scafidi, CPed, CFo, owner of Michelangelo’s Foot Comfort and Pedorthic Shoppe in Norridge, Illinois said.

Michael Lukowsky, CPed, OST, of Sole Control Inc., a pedorthics facility in St. Louis, also added, “About 35% of our business is prescribed diabetic shoes and orthotic devices.”


Such percentages seem likely to increase.

Diabetic shoe center
Image: Craig B, O&P Business News.

“New evidence shows that approximately 54 million people in the United States have prediabetes,” Center for Disease Control’s (CDC) Julie Louise Gerberding, MD, MPH, said in “Diabetes: Disabling Disease to Double by 2050,” an article on the CDC Web site. “Coupled with the nearly 21 million who already have diabetes, this places almost 25% of our population at risk for further complications and suffering. Together, we can and must do more to prevent and control this growing epidemic.”

Pedorthists say they are helping. Complications from the disease include the loss of toes, feet and legs. Pedorthists–and physicians–say properly-fitted therapeutic shoes and inserts may help prevent amputation.

Congress agreed, extending Medicare coverage to shoes and inserts for people with diabetes. Commonly called “Medicare’s Therapeutic Shoes for Diabetics Benefit (TSD),” the measure was a big boost for pedorthists, who are experts at fitting footwear and orthotics.

“Pedorthics is a practice that has been around a long time, but only defined in the 1970s and certainly given a broader purpose with the passing of the TSB,” Chris Stanley, CPed, of Lamey Wellehan Shoes in Auburn, Maine said.

Brian Lagana. executive director of the Washington-based Pedorthic Footwear Association (PFA), agreed.

“Diabetes is certainly the pathology that put pedorthics on the map way back when,” he said.. “[Clients with diabetes]…make up a large portion of many credentialed pedorthists’ practices, and that increased when the TSB was introduced a number of years ago. With diabetes truly becoming a national ‘epidemic’ due to American lifestyles, I can only see that increasing, coupled with other issues arising from an aging population.”


Type 2 diabetes – once called “adult onset diabetes” – is the most common form of the disease, according to the CDC. About 90% to 95% of all diabetes cases in the United States are type 2, the CDC adds.

Type 2 diabetes most often appears in people at least 40 years old and one in five U.S. adults older than 65 years have diabetes, the CDC says. Thus, age is a significant risk factor for type 2 diabetes. But so are obesity and a sedentary lifestyle, according to the CDC.

“Diabetes is a major problem in the entire country,” Marc Rosen, CPed, whose family owns Best-Made Shoes in Pittsburgh said. “In Pittsburgh, we have one of the oldest populations in the country and we see a large portion of type 2 diabetes due to diet, age, illness and lifestyle choices.”

While “Fat City” is a famous New Orleans nickname, the moniker could also apply to St. Louis, according to Lukowsky.

“Men’s Fitness ranked St. Louis the fifth fattest city of the 25 cities surveyed,” he said, adding that the majority of his diabetes clients are obese.

Percent of adults greater than or equal to 20 years old with diabetes
Type 2 diabetes most often appears in people at least 40 years old and one in five U.S. adults older than 65 years have diabetes.
Source: Centers for Disease Control and Prevention.

Bob Schwartz, CPed, owner of Eneslow, the Foot Comfort Center, in New York City agreed that diabetes is also a major problem in the Northeast and throughout the country.

Peg Lucas-Swisher, CPed, co-owner of Sole Comfort Shoes in Albuquerque agrees with this assessment citing ethnicity as another factor in diabetes.

“In the Southwest, we have large Native and Hispanic populations, both of which have a high propensity to diabetes,” she said

CDC statistics back up her deduction.

“African American, Hispanic, American Indian and Alaskan Native adults are twice as likely as white adults to have diabetes,” according to the CDC.

Diabetes is also common among Vietnamese immigrants in California, according to Marjorie Bonsall, CPed. She owns four Foot Solutions stores in San Jose, Calif. and Morgan Hill, Calif.

Dunnam said about 50% of his patients have diabetes when he started the Kentucky Diabetic Footwear Pedorthic Center as part of Tri-City Shoe Center in 2004.

“‘Tri-City Shoes’ didn’t communicate to people that they deal with diabetes patients,” Dunnam said. “The name ‘Diabetic Footwear Pedorthic Center’ does and it also lets doctors know what we do.”

Dunnam said diabetes is increasing in his part of the country.

“I believe it will keep on growing as obesity grows,” he added. “A lot of kids aren’t getting the proper exercise and they are not getting the proper nutrition. About the only exercise they get are with their thumbs and hands [as they play video games].”

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