9.6. Orthopedic Footwear
NOTE: Over the Counter (OTC) Standard Orthopedic Oxford (dress, casual, athletic) need to be used when a foot can be reasonably accommodated in this type of shoe.
a. Inlay shoes may be furnished to eligible beneficiaries after it has been determined that shoe modifications will not accommodate the foot deformity and that an insole or additional space is necessary.
(1) Inlay shoes may be ordered from commercial sources when cost-effective to prevent a hardship to the beneficiary.
(2) Modifications or repairs of the insole and/or inlay shoes need to be done by the local VA Orthotic Laboratory. Facilities not having Orthotic Laboratories may request modifications from their nearest Shoe Last clinic. All requests for modifications must be initiated by a VA Form 10- 2529-3 (ADP), Request and Receipt for Prosthetic Appliances or Services, clearly identifying the modification desired. The same ordering procedures may be applied electronically (Prosthetic Veterans Health Information Systems and Technology Architecture (VISTA) Program).
(3) Replacements of all shoes must be authorized when repairs are no longer practical. Eligibility must be confirmed prior to initiating any replacement order by the referring station.
(4) The issuance of spare shoes must be in accordance with the general policy for spare custom-made orthopedic footwear contained in subparagraph 6 (i)(2).
(5) VA facilities may be authorized to maintain a limited supply of the most common sizes of shoes to facilitate immediate patient care.
NOTE: Inventory control must be in accordance with VA policy and procedures contained in subparagraph 6 (d)(3) of this Handbook.
b. Healing and/or cast shoes may be authorized when medical determination has been made that the foot cannot be slipped into a standard shoe.
(1) Healing and/or cast shoes must be obtained from local commercial sources.
(2) Modifications to healing and/or cast shoes must be done by VA Orthotic Laboratory or qualified commercial sources.
(3) The issuance of replacement, authorization of spares, or repair of healing and/or cast shoes is not usually required since this type of shoe is normally needed for a short period of time.
c. Alternative footwear may be authorized when a medical determination is made that no other type of shoe or modification adequately accommodates the foot deformity or condition.
(1) Molded shoes may be purchased from established VA contracts.
(2) Molded shoes must be replaced sufficiently in advance so as not to interrupt their use; the amount of repair that can be done to this type of shoe is minimal.
(3) Spare molded shoes must be furnished in accordance with the general policy for spare orthotic footwear.
d. Plastizote healing shoes may be furnished to eligible beneficiaries when medically indicated.
(1) Plastizote healing shoes may be obtained from commercial sources.
(2) Modifications to plastizote healing shoes need to be done by VA Orthotic Laboratories or qualified commercial sources.
(3) VA facilities may be authorized to maintain a limited stock of the most common sizes of plastizote shoes to facilitate patient care. All requests for inventory must be initiated by memorandum from the Prosthetic Representative. Inventory control must be in accordance with VA policies and procedures.
(4) Replacement plastizote shoes may be authorized when necessary for the treatment of eligible beneficiaries. Spares will not normally be provided since these shoes are used for a short duration.
e. Custom-made orthopedic shoes may be initially furnished to eligible beneficiaries upon receipt of a properly executed prescription. The orthopedic shoes must be custom fabricated at the VA Shoe Last Clinic or by a local contractor. Reasonable doubt regarding the patient's need for orthopedic shoes normally is resolved in favor of the beneficiary. In conflicting situations, the facts will be referred to the Prosthetic Clinic Team of the field facility for resolution.
(1) Initial issues of custom-made orthopedic shoes are authorized when a physician or podiatrist determines that the severity of the foot condition is such that a lesser means, for example, inlay shoes, shoe modifications, etc., cannot adequately compensate for the deformity or there is a leg discrepancy length at least of 1 and 1/2 inches in length or greater.
(2) Initial custom-made orthopedic shoes, lasts, and patterns normally are obtained when the severity of the foot disability requires the physical presence of the beneficiary for casts, measurements, and possible trial fittings.
NOTE: There is not to be a foot examination at a VA Shoe Last Clinic when the measurements and prescribed corrections can be transmitted by mail.
f. VA Form 10-2908, Measurement for Orthopedic Shoes, must be used in conjunction with VA Form 10-2529-3 (ADP) to order initial orthopedic shoes. The same ordering procedures may be applied electronically (Prosthetic VISTA Program).
NOTE: See clinical evaluation notes section in Footwear Program Guide for checkout procedure for custom orthopedic shoes.
g. All orthopedic shoes are to be appropriately coded indicating the: month, year of fabrication, and the source, which is obtained from a block of numbers in numerical sequence assigned to each VA Shoe Last Clinic or local contractor.
h. Initial custom-made orthopedic shoes, lasts, and patterns must be obtained from the nearest VA Shoe Last Clinic when:
(1) The severity of the foot disability requires the physical presence of the beneficiary for casts, measurements, and trial fittings.
(2) The measurement and desired corrections cannot be transmitted by mail and there are no qualified local contractors.
NOTE: VA Form 10-2529-3 (ADP) must be used to order custom-made orthopedic shoes from the nearest VA Shoe Last Clinic. The same ordering procedures may be applied electronically through the Prosthetic VistA Program.
i. Initial custom-made orthopedic shoes, lasts, and patterns must be obtained from the local contractor.
(1) Initial custom-made orthopedic shoes, lasts, and patterns must be obtained from local contractors when mail transmittal of measurements and corrections is not feasible and the veteran cannot be transported to the nearest VA Shoe Last Clinic or, it is economically in the best interest of VA. NOTE: VA Form 10-2421 (ADP), Prosthetic Authorization for Items or Services, is to be used as the normal procurement document.
(2) The facility must provide spare or repeat orders of custom-made orthopedic shoes when a VA Shoe Last Clinic has delivered a second pair of custom-made orthopedic shoes which are medically acceptable.
(a) VA Shoe Last Clinics, or local commercial contractors, normally provide replacement custom-made orthopedic shoes.
(b) VA Shoe Last Clinics, or local commercial contractors, need to retain the lasts and patterns after the second successful fitting of a patient.
j. Continued service may be furnished by a VA Shoe Last Clinic when it has been medically determined that the severity of the foot condition requires personal fitting and an examination prior to the fabrication of each additional pair of shoes.
k. Local contractors may be used for the procurement of additional pairs of custom-made orthopedic shoes whenever replacements are warranted and the veteran has previously been furnished shoes through that source.
l. Repairs to custom-made orthopedic shoes must be provided when required.
m. Repairs for beneficiaries must be submitted by the medical center responsible for the beneficiary's treatment. VA Form 10-2529-3 (ADP) must be prepared. The same ordering procedures may be applied electronically by using the Prosthetic VistA Program.
n. VA Shoe Last Clinics routinely provide repairs for permanent Shoe Last Clinic cases. Pre- addressed labels and mailing containers may be furnished to eligible beneficiaries to facilitate repair services. When shoes are referred from a field facility, VA Form 10-2529-3 (ADP) must be used to request repairs. VA Shoe Last Clinics may provide minor repairs to custom orthopedic shoes.
o. Local sources need to repair custom orthopedic shoes purchased from that source. Repairs to shoes provided by VA Shoe Last Clinics may be provided by local sources if mail transmittal is not feasible and the veteran cannot be transported to the nearest VA Shoe Last Clinic or it is economically in the best interest of VA.