{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:21:55Z","timestamp":1785424915424,"version":"3.56.0"},"reference-count":16,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"American Podiatric Medical Student Association"},{"id":[{"id":"https:\/\/ror.org\/04tdavc85","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness across multiple healthcare disciplines and documented barriers to utilization. An online study surveyed healthcare providers practicing in the United States to determine familiarity with TSB and barriers to prescribing therapeutic shoes. The project was IRB-reviewed and received exempt status. The survey was sent to a wide variety of healthcare practitioners including: podiatrists, primary care providers, physical therapists, orthotist\/prosthetists, specialty providers, and diabetes educators. This was done through targeted emails from professional organizations, word-of-mouth messaging through private practice groups, and marketing on LinkedIn. The survey was administered via Qualtrics with embedded branching logic used to gather data from the TSB\u2019s three classifications of healthcare specialists: certifying physicians, prescribing practitioners, and suppliers. A total of 580 valid completions of the survey were analyzed. Irrespective of the TSB, podiatric physicians and medical professionals providing direct patient care recommend supportive shoes for patients with diabetes 98.2% (336\/342) of the time. When asked about knowledge of the TSB, 522 or 90% of respondents indicated awareness of this Medicare benefit. Knowledge by specialty was hard to differentiate due to low responses by some specialties; however, prescribing podiatrists and prosthetic providers both responded with a familiarity rate above 92%. Common obstacles to providers prescribing shoes were: complexity of documentation (67.8%), challenges communicating with other providers (55.0%), and financial reasons\/labor-to-reimbursement ratio (38.4%). TSB has the potential to reduce amputations and wound care costs. However, therapeutic shoes are underutilized with less than 20% of potential beneficiaries accessing this benefit. This research strengthens the argument that streamlining the process may increase access to therapeutic shoes.<\/jats:p>","DOI":"10.3390\/japma116030032","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:12:41Z","timestamp":1779268361000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare Provider Knowledge and Utilization of the Medicare Therapeutic Shoe Benefit"],"prefix":"10.3390","volume":"116","author":[{"given":"Carol Szmuilowicz","family":"Kurth","sequence":"first","affiliation":[{"name":"UCSF Stanyan Hospital Podiatry Residency Program, San Francisco, CA 94117, USA"},{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-1960","authenticated-orcid":false,"given":"Ryan Thomas","family":"Crews","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2337\/dci24-0022","article-title":"Trends and inequalities in diabetes-related complications among U.S. adults, 2000\u20132020","volume":"48","author":"Saelee","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.2337\/dc21-0072","article-title":"Trends in nontraumatic lower-extremity amputation among privately insured adults with diabetes in the U.S., 2004\u20132018","volume":"44","author":"Zhou","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/dmrr.2738","article-title":"A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable","volume":"32","author":"Bus","year":"2016","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s11892-005-0049-5","article-title":"The pivotal role of offloading in the management of neuropathic foot ulceration","volume":"5","author":"Wu","year":"2005","journal-title":"Curr. Diabetes Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e3651","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/107110070502600108","article-title":"The Therapeutic Shoe Bill: Medicare coverage for prescription footwear for diabetic patients","volume":"26","author":"Janisse","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2015.10.003","article-title":"The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine","volume":"63","author":"Hingorani","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). Retinopathy, neuropathy, and foot care: Standards of care in diabetes\u20142024. Diabetes Care, 47, S231\u2013S243.","DOI":"10.2337\/dc24-S012"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e3652","DOI":"10.1002\/dmrr.3652","article-title":"Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis","volume":"40","author":"Raspovic","year":"2024","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2337\/diaclin.33.2.51","article-title":"Does your patient need diabetic therapeutic footwear? Where benefit, evidence, and bureaucracy collide","volume":"33","author":"Brunner","year":"2015","journal-title":"Clin. Diabetes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1177\/107110079902001105","article-title":"American Orthopaedic Foot and Ankle Society shoe survey of diabetic patients","volume":"20","author":"Pinzur","year":"1999","journal-title":"Foot Ankle Int."},{"key":"ref_14","first-page":"73","article-title":"Therapeutic shoes for diabetics are proven to be helpful: So why aren\u2019t they prescribed more? Here\u2019s how to tackle the barriers to patient usage","volume":"41","author":"White","year":"2022","journal-title":"Podiatry Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/JXX.0000000000000306","article-title":"Nurse practitioners and barriers to diabetic foot treatment","volume":"32","author":"Anderson","year":"2020","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/17085381231154805","article-title":"Risk factors for diabetic foot ulcers: A systematic review and meta-analysis","volume":"32","author":"Tang","year":"2023","journal-title":"Vascular"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/32\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:30:10Z","timestamp":1779273010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/32"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["japma116030032"],"URL":"https:\/\/doi.org\/10.3390\/japma116030032","relation":{},"ISSN":["1930-8264"],"issn-type":[{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}