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Mature Feet


Though Falls Prevention Awareness Day isn’t until Sept. 22 this year, preventing falls is important every day, especially with the upcoming month of May being Older Americans Month. Falls are the leading cause of fatal and nonfatal injuries among adults age 65 and older in the United States. They account for more than 3 million emergency department visits, 900,000 hospitalizations and about 30,000 deaths each year. One in three adults over age 65 takes a serious tumble each year (Prevention). Even more troubling, death rates from falls increased by more than 30% (from 47 to 62 per 100,000 people) between 2007 and 2016. They are also the leading cause of traumatic brain injury, and more than 95% of hip fractures are caused by falling (Everyday Medical). These injuries can make it hard for a person to get around, do everyday activities or live on their own.

The Impact of Falling

Many people who fall, even if they are not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker, which then increases their chances of falling.

The economic impact of fall injuries and deaths is substantial, accounting for nearly $50 billion in direct medical costs each year. Fall injuries are among the 20 most expensive medical conditions, and government-funded programs, such as Medicare and Medicaid, finance about 75% of these costs. As the American population continues to age, with 10,000 people in the United States turning 65 every day, we could expect to see 49 million falls, 12 million fall injuries and almost 60,000 fall-related deaths per year by 2030 (AARP).

An Ounce of Prevention Is Worth a Thousand Pounds Of Cure

Falls are not an inevitable part of aging. There are many resources and routines available to help keep older adults safe and independent longer. Preventing and reducing falls lowers healthcare spending, improves health and fosters independence. Simply put, the best way to reduce falls is to continually maintain and even strengthen one’s balance.

Balance is a crucial survival skill, but it's also perishable. The muscles we use to stand tall weaken ever so gradually after we hit 30. How well we maintain our balance in midlife can protect us as we grow older. The best ways to maintain and build up your balance are;

  • Check Eyesight Annually – As we age our vision deteriorates. It is important to make sure you have corrective glasses if they are needed. Otherwise without proper vision, it may throw off one’s sense of balance.
  • Stand on One Leg – It is important to help strengthen the core and lower-body muscles that keep you steady on your feet. You can begin with this exercise for 5–10 seconds per leg and build from there. Once you can hold this pose for 30 seconds on each side, you can enhance the exercise by (i) holding weights, (ii) closing your eyes or (iii) standing on less stable surfaces like a couch cushion.
  • Take an Exercise Class -  Tai Chi practitioners are in the 90th percentile of the American Fitness Standards and a study found that people participating in Tai Chi were less likely to fall than those who took part in basic stretching programs or made other lifestyle changes. Yoga also works as studies have shown women 65 and older who took twice-weekly yoga classes for 9 weeks, increased ankle flexibility and were more confident when walking (Prevention).
  • Sleep Tight – Sleep deprivation can slow reaction time and in turn have a direct correlation to the ability to prevent, or “catch yourself” from falling. The ideal amount of sleep is usually around 7+ hours per night.
  • Make Your Home Safer – A safer home means to generally enhance the functionality of the living environment. This includes; (i) install hand rails where support may be needed, (ii) make sure there is nothing loose or slippery on the floor (i.e. area rugs), that can cause tripping and (iii) have furniture arranged to maximize walking space for optimal mobility.

Always Wear Proper Foot Gear

Wearing appropriate footwear can help improve balance, especially in older people who may struggle with mobility and balance issues. This is a 24 hour / 7 day rule, whether out running errands or at home cooking dinner. The right footwear can support and strengthen your foot and arch, in turn enhancing overall balance and mobility.

When selecting a shoe to improve balance, always press on both sides of the heel area to ensure the heel is stiff and won't collapse. Also, bend the shoe to check for toe flexibility. The shoe shouldn't bend too much in the toe box area, but it shouldn't be too stiff and inflexible either. Finally, try the twist test to ensure it doesn’t twist in the middle.

Natural aging and health changes can cause foot size to change, so it’s important to have your feet professionally measured every time you purchase shoes. Measure both feet—late in the day—and shop for the larger foot. Another good tip is to bring the type of socks you plan to wear and walk around with them in the shoes before purchasing.

Shoes should feel comfortable and supportive right away. If they don't, breaking them in won't improve things. Often shoes can be complimented with the used of orthotic inserts to provide additional support and mobility to the foot, as well as additional comfort the shoe may lack. Common indications that foot orthotics are necessary for balance include: muscle weakness, fallen arches, ataxia, gait abnormality, joint instability, difficulty walking, peripheral neuropathy, limb pain, arthropathy and hemiplegia. Using a good supportive orthotic insert for these conditions will contribute to helping reduce the risk of falls. Podiatry Today.

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This blog is adapted with permission from the author at

Just as we know we can treat anything in the foot and ankle from ingrown toenails to plantar fasciitis to complex fractures, we know aging adults are prone to chronic foot problems, especially if they have an underlying disease such as diabetes. In a study of diabetic seniors (U.S. National Library of Medicine), it indicates that educating patients about foot self-care encourages routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently. We also know that Medicare doesn’t cover all podiatry services so acting independently to maintain overall foot health is crucial to avoid the need for podiatric Medicare.

Rules of Medicare

Medicare has specific rules for coverage, based on the patient’s diagnosis and proposed treatment. Make sure your physician understands these rules and helps to formulate a treatment plan around these guidelines. This will clarify why certain decisions are made. It also enlightens the patient as to how help can be provided not only for themselves but also for their loved ones now and in the future.

Medicare doesn’t cover routine foot care except in situations in which another health condition requires it and class findings (such as diabetic neuropathy) are met. It may be of benefit to incorporate this information into your initial patient exam. By understanding these class findings, you have a clear understanding as to why it may not be a covered service. If this is in fact the case, you can then follow up for an Advance Beneficiary Notice (ABN) for the non-covered service ( An ABN, also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

No Shoes For You

Medicare also doesn’t cover supportive devices, such as orthopedic shoes, unless they are included in the price of a leg brace or when the patient has diabetes. Even when the patient has diabetes, there is a specific algorithm that determines eligibility for this service and it may not include every patient with that diagnosis. Many patients with diabetes erroneously assume they are entitled to “free shoes” when in reality treatment is much more complicated than that. If “free” is not in the cards for you, an excellent alternative to diabetic shoes can be achieved through OTC insoles & inserts that are a fraction of the price while providing useful support needed for your foot.

Medicare will only cover podiatry services that are considered necessary to diagnose or treat a medical condition ( Conditions such as hammertoes, heel spurs and bunion deformities yield Medicare coverage for treatment in the form of an evaluation and management visit. However, patients need to understand their evaluation and what to expect when it comes to coverage. Patients need to be made aware that Medicare Advantage plans specifically may require referrals or authorizations for certain services, such as X-rays.

Patients with diabetes may qualify more clearly for services when it comes to foot care because they have a greater risk of developing foot conditions (AARP). However, it is very important for them to understand the role of the podiatrist in their overall health and wellness. They should be seeing the doctor (primary physician or endocrinologist) treating their diabetes within six months of their podiatry visit. It is shocking that this is not routine for some patients with diabetes.

Helping Patients Understand How Medicare Pays For Podiatry Services

As podiatry services are mostly performed in an outpatient setting, Medicare Part B applies. Medicare Part B will pay 80 percent of covered medical costs. The patient is responsible for both an annual deductible and 20 percent of the bill. Many patients are not aware of the yearly deductible and are shocked when receiving their invoice. Optimally, physicians will take the time to educate patients, whether through postings in their office or even a brief conversation with all patients and staff.

If patients require surgery to treat a foot condition and are admitted to the hospital as inpatients, Medicare Part A will come in effect as well. A larger deductible applies here as does the 20 percent co-insurance. This deductible also covers the first 20 days in a skilled nursing facility (SNF) if it is recommended that the patient finish recovery there. Medicare will only cover the SNF stay if the patient was admitted to the hospital for at least three days (Podiatry Today).

When a patient applies for Medicare, he or she may ask what plans are recommended. Although this varies wildly by region, the patient may want to consider supplemental coverage to help pay for things traditional Medicare does not. Medicare plans such as Medigap and Medicare Advantage can help lower some of these costs. Medigap plans can help cover a patient’s Part A deductible and Part B deductible, copays, and coinsurance. Medicare Advantage plans can help lower a patient’s out-of-pocket costs by setting a copayment amount that may be lower than a patient’s normal Part B coinsurance. Medicare Advantage plans also may offer extra podiatry services, such as routine foot care exams. In certain situations, Medicare will also pay for orthotics -custom made as well as pre-fab OTC insoles (

In summary, obtaining knowledge about Medicare and related insurance may help you maneuver through podiatry services as it relates to coverage. The confusing and complex aspects of insurance coverage may pose a barrier to obtaining the proper services needed and you want to limit that confusion by discussing with your physician if when available.