Typically, the type of patient that requires a toe filler is high risk. You must take extreme care in providing and monitoring the device to ensure that it’s properly accommodating their amputation, and not causing any further foot complications. Once dispensed, it is essential that you phone the patient two to three times the first week to check on the condition of their foot/feet. It is also recommended to have a face-to-face follow-up appointment 10 to 14 days from the date the diabetic shoes and toe filler are dispensed.
The patient must monitor any rubbing or red marks very closely. If there are any signs of irritation, they must be told to stop wearing the inserts/toe filler immediately and return to the office for review and possible adjustment.
There are several possible types of diabetic amputations. Listed below are the most common:
- Partial or entire toe
- Multiple toes
- Single or multiple toe metatarsal (e.g. the entire fifth toe and fifth metatarsal)
- Associated metatarsal (either the entire metatarsal or partial)
- Transmetatarsal amputation or Lisfranc disarticulation amputation
Simple toe amputations in many cases do not require a toe filler unless ordered by the physician. Consult the prescribing physician when this is requested. If you have any questions concerning the need for any additional modifications, contact the physician’s office to discuss. These orders must be sent to you listing the condition and the reason for the modification(s). The prescription must specify the toe, toes, or part of the foot missing, and give instruction as to how the accommodation should be made.
Fitting a diabetic amputee usually consists of providing a toe filler, equalizing the patient’s weight bearing with custom inserts, and protecting the remaining portion of the foot with diabetic/therapeutic shoes.
Points to Keep in Mind
- Hallux Amputation – Removal of the Big Toe
- Toe filler is beneficial to help minimize drifting of the remaining toes.
- Hallux toe filler helps normalize the patient’s walk/gait.
- Medicare will reimburse for this type of toe filler.
- Individual 2nd, 3rd, 4th, or 5th Toe Amputations
- Toe filler is not beneficial and can cause additional friction inside the shoe.
- Remaining toes provide enough support for proper walk/gait.
- Medicare will NOT reimburse for this type of toe filler.
- Metatarsal Phalangeal Amputation – Removal of all five toes at the metatarsal joint
- This type of amputation is more disabling than a simple toe amputation.
- Toe filler helps prevent creasing of the shoe at the point of the amputation.
- Toe filler helps prevent the breakdown and eventual collapse of the shoe.
The Anodyne lab offers hand-crafted partial foot toe fillers that allow for maximum foot support, total contact and enhanced stabilization. Moreover, our fillers can be used to isolate and individually treat any particular irregularity that a patient’s foot/feet may have. We have the capability of adding any sort of special accommodation to a patients’ toe filler, including the off-loading of certain areas, adding metatarsal pads, arch flanges, Morton’s extensions, heel raises, etc. All partial foot toe fillers crafted by the Anodyne lab are L5000 reviewed.