Medicare Patients: Diabetic Foot Care & Custom Shoes Covered at Balance Foot & Ankle

In This Guide

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If you have diabetes and Medicare, you’re likely eligible for free therapeutic shoes every year — and most people don’t know it. The Medicare Therapeutic Shoe Bill is one of the most underused preventive benefits in all of healthcare. In our clinic, we estimate that fewer than 20% of eligible diabetic patients are taking advantage of this benefit, leaving thousands of dollars in covered preventive care on the table.

Proper diabetic footwear isn’t a luxury — it’s a medical necessity. Diabetic shoes with custom inserts reduce ulcer risk by up to 60% (American Diabetes Association, 2024), and a single diabetic foot ulcer costs an average of $33,000 to treat. The math is simple: a covered pair of shoes now prevents a devastating complication later.

The Medicare Therapeutic Shoe Bill Explained

The Therapeutic Shoe Bill (TSB) is a Medicare Part B benefit that covers therapeutic footwear for patients with diabetes. Enacted in 1993, it recognizes that proper footwear is essential medical equipment for preventing diabetic foot complications — the leading cause of non-traumatic lower limb amputation in the United States.

Under the TSB, Medicare covers one pair of depth shoes (or custom-molded shoes if medically necessary) plus three pairs of custom inserts per calendar year. The benefit resets every January 1st. Your 20% coinsurance is typically covered by supplemental insurance (Medigap) — meaning many patients pay nothing out of pocket.

At Balance Foot & Ankle, we’re certified therapeutic shoe providers. We handle the entire process: eligibility verification, the required foot exam, shoe fitting, custom insert fabrication, and Medicare billing. Most patients walk out with their shoes at no cost.

Who Qualifies for Medicare Diabetic Shoes

To qualify for Medicare therapeutic shoes, you need three things: a diabetes diagnosis (Type 1 or Type 2) documented by your primary care physician or endocrinologist, at least one qualifying foot condition, and a comprehensive diabetic foot exam within the past 12 months from a podiatrist or qualifying physician.

Qualifying foot conditions include peripheral neuropathy (numbness or tingling in the feet), history of pre-ulcerative calluses, history of foot ulceration, foot deformity (bunions, hammertoes, Charcot foot), poor circulation (peripheral arterial disease), or previous amputation (partial or complete). In our experience, the vast majority of diabetic patients over age 50 qualify — neuropathy alone is present in over 50% of diabetic patients who’ve had the disease for 10+ years.

You do NOT need to have had a foot wound to qualify. The program is preventive — it’s designed to prevent the first ulcer, not just treat existing problems. If you have diabetes and any loss of sensation in your feet, you almost certainly qualify.

What Medicare Covers for Diabetic Footwear

Each calendar year, Medicare Part B covers:

• 1 pair of depth shoes (extra-depth shoes with removable insoles to accommodate custom inserts and foot deformities) — OR —
• 1 pair of custom-molded shoes (for severe deformities that cannot fit in standard depth shoes — requires additional documentation)
• 3 pairs of custom-molded inserts (multi-density insoles fabricated from a mold of your foot to redistribute pressure away from high-risk areas)

Medicare pays 80% of the approved amount. Your Medigap supplemental plan typically covers the remaining 20% coinsurance. If you have both Medicare and a supplemental plan, your out-of-pocket cost is usually $0. If you don’t have supplemental coverage, the 20% coinsurance is typically $30-$60 depending on the shoe style — still far less than retail therapeutic shoes ($150-$400).

The benefit resets every January 1st. If you received shoes in 2025, you’re eligible for a new pair starting January 1, 2026. Don’t let the calendar year end without using this benefit — it does not roll over.

How to Get Your Medicare Diabetic Shoes at Balance Foot & Ankle

We’ve streamlined the process into 4 simple steps:

Step 1: Schedule your comprehensive diabetic foot exam. Call (810) 206-1402 or book online. If you haven’t had a diabetic foot exam in the past 12 months, we’ll perform one during your visit. This exam is also covered by Medicare.

Step 2: Certification. Your treating physician (PCP or endocrinologist) signs a Statement of Certifying Physician confirming your diabetes diagnosis and need for therapeutic shoes. We provide the form and can fax it directly to your doctor’s office.

Step 3: Fitting and ordering. Our certified shoe fitter measures your feet, assesses your deformities and pressure points, and helps you select shoes from our therapeutic inventory. We take impressions for custom inserts. Most patients find a shoe they like from our selection of modern therapeutic styles — these aren’t the clunky “grandma shoes” of the past.

Step 4: Delivery and education. When your shoes and inserts arrive (typically 2-3 weeks), you return for fitting and adjustment. We verify proper fit, demonstrate how to inspect your feet daily, and educate you on break-in protocol (2 hours the first day, increasing by 2 hours daily).

The Required Comprehensive Diabetic Foot Exam

The comprehensive diabetic foot exam is both a Medicare requirement for therapeutic shoes and a critical screening tool. During this exam, your podiatrist performs monofilament testing (detects neuropathy by testing 10 points on each foot), vibratory sensation testing (tuning fork assessment of nerve function), vascular assessment (pedal pulses, capillary refill, skin temperature), skin and nail inspection (calluses, corns, fissures, fungal infections, wounds), musculoskeletal evaluation (deformities, joint limitation, Charcot changes), and footwear assessment (current shoes evaluated for fit and condition).

This exam takes about 15-20 minutes and catches problems before they become emergencies. The American Diabetes Association recommends comprehensive foot exams at least annually — more frequently for patients with neuropathy or prior ulceration. Medicare covers this exam as a preventive benefit with no deductible.

Types of Therapeutic Diabetic Shoes

Therapeutic diabetic shoes differ from regular shoes in ways that protect vulnerable diabetic feet. Extra-depth design provides 1/4 to 1/2 inch more depth than standard shoes, accommodating custom inserts, hammertoes, bunions, and swelling. Seamless interior lining eliminates friction points that cause blisters and ulcers on neuropathic feet. Firm heel counter stabilizes the hindfoot and reduces abnormal motion. Rocker sole design reduces pressure under the ball of the foot during push-off — the highest-risk area for diabetic ulcers.

Modern therapeutic shoes look remarkably normal. We carry athletic styles, casual styles, and dress options. Many patients are surprised that their Medicare shoes look no different from what they’d buy at a shoe store — but the protective features inside make all the difference.

For patients with severe deformities (Charcot collapse, significant amputation, extreme bunion or hammertoe deformity), custom-molded shoes are fabricated from a plaster cast or 3D scan of your foot. These require additional documentation but are covered by Medicare when medically justified.

Custom Molded Inserts vs Over-the-Counter Options

Medicare covers 3 pairs of custom-molded inserts per year because they’re clinically superior to OTC insoles for diabetic foot protection. Custom inserts are fabricated from an impression of your foot, using multi-density materials that offload high-pressure areas. They redistribute force away from bony prominences, calluses, and prior ulcer sites — the places most likely to break down.

That said, when you need additional support between annual fittings or want insoles for non-therapeutic shoes, PowerStep Pinnacle insoles are the OTC orthotic we recommend most in our clinic. Medical-grade arch support at a fraction of custom orthotic cost. For diabetic patients with severe flat feet, PowerStep Maxx provides maximum control.

The key difference: custom Medicare inserts are specifically designed to prevent diabetic ulcers by mapping your pressure points. OTC insoles like PowerStep provide excellent arch support and cushioning but aren’t tailored to your specific risk areas. For optimal protection, use your Medicare inserts in your therapeutic shoes and PowerStep in casual shoes.

Daily Diabetic Foot Care Routine

Proper shoes are one part of diabetic foot protection — daily self-care is the other. In our clinic, we teach every diabetic patient the 5-minute daily foot check that prevents 85% of diabetic amputations:

• Inspect feet daily — tops, bottoms, between toes. Use a mirror or ask someone to help if you can’t see the bottom of your feet. Look for redness, swelling, cuts, blisters, calluses, color changes, and temperature differences.
• Wash feet daily in warm (not hot) water. Test temperature with your elbow or a thermometer if you have neuropathy. Pat dry thoroughly, especially between toes.
• Moisturize — apply urea-based cream to tops and bottoms but NOT between toes (moisture between toes promotes fungal infection).
• Never walk barefoot — even indoors. Neuropathic feet can’t feel glass, splinters, or hot surfaces.
• Check shoes before wearing — shake out and feel inside for pebbles, bunched socks, or seam irregularities.

Neuropathy and Why Proper Footwear Matters

Diabetic peripheral neuropathy — the gradual loss of sensation in your feet — is the primary reason therapeutic shoes save limbs. When you can’t feel pressure, friction, or pain, injuries develop silently. A pebble in your shoe, a seam rubbing your toe, or a shoe that’s too tight can create a wound you never feel — and diabetic wounds heal slowly because of impaired circulation and immune response.

In our clinic, we diagnose neuropathy in approximately 60% of diabetic patients who’ve had diabetes for 10+ years. Many patients don’t realize they’ve lost sensation until we perform the monofilament test. The 10-gram monofilament test is quick (under 5 minutes) and is the gold standard for detecting protective sensation loss. If you can’t feel the monofilament at 4 or more of 10 sites on each foot, you have clinically significant neuropathy and are at elevated risk for ulceration.

Treatment for diabetic neuropathy includes blood sugar optimization (the single most important factor), MLS laser therapy (reduces pain and improves nerve function), B-vitamin supplementation, alpha-lipoic acid, and regular nerve gliding exercises. But the first and most impactful intervention is protective footwear — every day, all day.

Recommended Diabetic Foot Care Products

These products complement your Medicare therapeutic shoes. Every item is recommended by our doctors and tested on real patients.

• PowerStep Pinnacle Insoles — The OTC orthotic we recommend most in our clinic. Use in casual shoes when you’re not wearing your Medicare therapeutic shoes. Medical-grade arch support at a fraction of custom orthotic cost.
• PowerStep Maxx — Maximum arch control for diabetic patients with severe flat feet. The structured heel cradle reduces pronation that leads to callus formation and ulcer risk.
• Doctor Hoy’s Natural Pain Relief Gel — Natural topical pain relief we use in our clinic. Arnica + camphor formula — safe for diabetic patients, apply to sore feet and calves 3-4x daily. Never apply to open wounds.
• DASS Medical Compression Socks — Graduated medical compression for diabetic patients with mild edema. 15-20mmHg for daily wear, 20-30mmHg for more significant swelling. Seamless toe construction prevents friction on neuropathic feet.
• CURREX WorkPro Insoles — For diabetic patients who stand all day at work. Dynamic flex zones reduce fatigue and redistribute pressure across the foot.

The Most Common Medicare Diabetic Shoe Mistake

The most common mistake we see is diabetic patients not knowing this benefit exists — and going years without therapeutic footwear. In our clinic, we ask every diabetic patient about their shoes, and the conversation typically goes the same way: “I didn’t know Medicare covered shoes.” “My doctor never mentioned it.” “I thought it was only for people with foot wounds.”

The program is preventive. You don’t need to have a wound to qualify — you need diabetes plus any qualifying foot condition (neuropathy, calluses, deformity). The goal is to prevent the first wound, not wait for one to develop. A 2024 study in Diabetes Care found that therapeutic shoes with custom inserts reduced first ulcer incidence by 60% over 3 years compared to regular shoes.

The fix: if you have diabetes and Medicare, call us today. A 5-minute phone call can determine if you qualify, and we handle everything from there. The benefit resets every January — don’t let another year pass without using it.

Frequently Asked Questions About Medicare Diabetic Shoes

How often can I get new Medicare diabetic shoes?

Medicare covers one pair of therapeutic shoes and 3 pairs of custom inserts per calendar year. The benefit resets every January 1st. If you received shoes in 2025, you’re eligible for new ones starting January 2026. We recommend scheduling your annual fitting in Q1 so you get maximum use from each pair.

Do I need a referral from my doctor for Medicare diabetic shoes?

You need a Statement of Certifying Physician signed by your treating physician (PCP or endocrinologist) confirming your diabetes diagnosis and need for therapeutic footwear. This is not a referral — it’s a certification. We provide the form and can fax it directly to your doctor’s office for signature.

What if I also need custom orthotics?

The Medicare Therapeutic Shoe Bill covers custom inserts specifically designed for your therapeutic shoes. If you also need prescription custom orthotics for other shoes, those are covered separately under Medicare Part B as durable medical equipment. You can have both — therapeutic inserts for your diabetic shoes and custom orthotics for other footwear.

Can I choose the style of my Medicare diabetic shoes?

Yes. Modern therapeutic shoes come in athletic, casual, and dress styles. At Balance Foot & Ankle, we carry several options so you can find shoes that match your lifestyle. The protective features (extra depth, seamless lining, firm heel counter) are built in — the outside looks like a regular shoe.

What if my Medigap plan doesn’t cover the 20% coinsurance?

If you have Medicare only (no supplemental plan), you’re responsible for the 20% coinsurance — typically $30-$60 depending on the shoe style. This is still significantly less than the $150-$400 retail cost of therapeutic shoes. HSA and FSA funds can also be used for the coinsurance amount.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your diabetic foot concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Sources

1. Centers for Medicare & Medicaid Services. Therapeutic Shoe Bill: Coverage Criteria and Documentation Requirements. CMS.gov, 2025.
2. American Diabetes Association. “Standards of Care in Diabetes — Preventive Foot Care.” Diabetes Care, 47(Suppl 1), 2024.
3. Bus SA, et al. “Effectiveness of Therapeutic Footwear in Reducing Reulceration.” Diabetes/Metabolism Research and Reviews, 40(3), 2024.
4. Armstrong DG, et al. “Diabetic Foot Ulcers: Prevention, Diagnosis and Treatment.” JAMA, 330(1), 2023.
5. Medicare Learning Network. Therapeutic Shoes for Persons with Diabetes Fact Sheet. MLN Matters, 2025.

In-Office Diabetic Foot Care at Balance Foot & Ankle

Beyond therapeutic shoes, our podiatrists provide comprehensive diabetic foot care including annual screenings, neuropathy treatment with MLS laser therapy, wound care, routine nail and callus management, custom orthotics, and Charcot foot monitoring. Early intervention prevents 85% of diabetic amputations.

Same-day appointments available. (810) 206-1402 · Book online →

Related resources: Diabetic Foot Care Hub · Daily Foot Care Checklist · Neuropathy Treatment Hub · Diabetic Shoes Guide · Neuropathy Supplements · Shop Recommended Products

Watch: Diabetic Foot Care and Medicare Coverage

Watch Dr. Tom explain diabetic foot protection, proper footwear, and how to get the most from your Medicare benefits:

https://www.youtube.com/embed/A11FFjCXAX4

Book your diabetic foot exam → · (810) 206-1402

The Bottom Line

If you have diabetes and Medicare, you are likely eligible for therapeutic shoes and custom inserts at little to no cost. In our practice, we handle the entire process — from the qualifying exam to the fitting to the Medicare paperwork. The Therapeutic Shoe Bill exists because proper diabetic footwear prevents ulcers, infections, and amputations. Too many patients do not know about this benefit or assume it is complicated. It is not. One appointment at Balance Foot & Ankle is all it takes to get started.

Dr. Tom’s Recommended Products: See our clinically tested product recommendations for this condition. View Dr. Tom’s recommended products →

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
• Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
• Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.

What is Diabetic foot?

Diabetic foot is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of diabetic foot include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of diabetic foot respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

American Diabetes Association: Diabetic Foot Care

Recovery timeline and prevention

Recovery from diabetic foot varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.