1. 2. 3. · fiNal client: Orthofeet iMc Job#: Neu-13465 project: Orthofeet Vertical therapeutic...

Diabetic Shoes and Socks CatalogLT0712PB www.Orthofeet.com ©2012 Orthofeet Inc.

Medicare created the Therapeutic Shoe Bill to help patients with diabetes prevent foot problems.Medicare helps pay for up to 1 pair of qualifying shoes and 3 pair of inserts per year. Talk to your doctor to see if you qualify. It’s easy:

1. Tear out this form and take it to the doctor who treats your diabetes. Your doctor will fill it out.

2. After your doctor fills it out, take it to your local provider who sells Orthofeet® shoes. The provider will fit your new shoes, teach you how to wear them, and submit your forms for you.

3. Repeat at the same time next year.

Statement Of Medical Necessity For Therapeutic Shoes & Inserts

Patient’s Name: ________________________________ HIC#: ___________Address: _______________________________________________________City: _________________________________ State: _____ Zip: __________Phone: ___________________________________ DOB: ________________

I CERTIFY THAT ALL OF THE FOLLOWING STATEMENTS ARE TRUE:

Physician’s Signature: __________________________________Date: ________Physician’s Printed Name: _______________________________ NPI#: ______ Physician’s Address: ________________________________________________City: _____________________________________ State: _____ Zip: _________

1. THIS PATIENT HAS DIABETES MELLITUS ICD CODE: m 250.00 m 250.01 m 250.02 m 250.03 m Other

2. THIS PATIENT HAS ONE OR MORE OF THE FOLLOWING CONDITIONS (Check all that apply):

m History of partial or complete foot amputation m History of previous foot ulceration m History of pre-ulcerative callus m Peripheral neuropathy with history of callus formation m Foot deformity m Poor circulation

3. I AM TREATING THIS PATIENT UNDER A COMPREHENSIVE PLAN OF CARE FOR HIS/HER DIABETES.

4. THIS PATIENT NEEDS SPECIAL DEPTH SHOES AND INSERTS BECAUSE OF HIS/HER DIABETES.

#Units HCPCS CODE PRESCRIPTION

1 2 A5500 Extra-Depth Shoes

2 4 6 A5512 Heat-Molded Insert

2 4 6 A5513 Custom Insert

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With Orthofeet®,

You’re FreeTo Go

APPROVED

FOR MEDICARE

COVERAGE

OrthOfeet Vertical therapeutic ShOe BrOchureactual Size: 5 ”X 7”

fiNal client: Orthofeet iMc Job#: Neu-13465 project: Orthofeet Vertical therapeutic Shoe Brochure Date: July 25, 2012file Name: M-Orth_Vertical_therapeutic_Shoe_Brochure.indd contact info: Julie evans

2 www.Orthofeet.com 3

Go with the Orthofeet® Biomechanically Engineered

Advantage.Orthofeet® shoes provide you with ultimate comfort and

protection because they are designed by engineers to work with your body.

Protective, Seamless Lining The lining of Orthofeet® shoes does not have seams and is made from soft fabric and padded foam to eliminate irritation and soothe every step.

Ergonomic SoleThe trademarked Ergonomic-Stride™ design of Orthofeet® soles helps propel your foot forward as it softens your step.

Stretchable UppersThe lining of Orthofeet® shoes features elastic uppers that stretch to the shape of your feet, easing pressure and enhancing comfort.

Heat-Molded Diabetic Inserts Orthofeet® ThermoFit™ inserts are molded with heat for an exact fit, providing unsurpassed comfort and protection for people with diabetes.

Custom-Made OrthoticsOrthofeet® orthotics are made using an advanced computer system that carves the orthotic precisely to the impression of your foot.

Go with the shoe with the heart in its sole.

Your mobility, or freedom to move, is at the heart of

every Orthofeet® shoe design. It’s why Orthofeet® shoes

are designed differently from other shoes. Every detail—

from their seamless lining to their ergonomic soles that

help propel your foot forward—is innovated for your

comfort, protection and movement. So keep going... and

look great doing it! With Orthofeet®, you’re free to go.

Orthofeet® Sandals:Free to be casual and cool.

NEW

! WO

MEN

’S & MEN

’S SANDAlS • W

omen’s Sizes: 5, 51/2

- 12 • Widths: M

edium, W

ide, Extra-Wide

Men’s Sizes: 7, 7 1/2

- 11 1/2 ,12, 13, 14 • W

idths: Medium

, Wide, Extra-W

ide


NEW!

For Women and Men• Heel strap allows you to

adjust the grip around the heel• Stretchable design gives you

a customized fit at the forefoot• Unique tie-less fastening system

allows you to adjust the strap length on both sides of the shoe

• Lacing system enables you to adjust the fit throughout the entire forefoot

• Soft padded lining provides ultimate comfort and protection

Women’s 875

Women’s 873

Men’s 573

You are geniuses of shoe design. Your shoes

have changed my life. For years I searched for shoes that would fit

my wide toe area and narrow heel. As soon as I tried on Orthofeet® it was love at first fit. At age 60 plus I can out-walk everyone I know, even those a third my age. Vivian I.”

Medicare helps pay for certain diabetic shoes and insertsMedicare, Medicaid, or insurance may help pay for your Orthofeet® shoes. For more information and easy directions, see the back page of this booklet.

Tie-less Fastening System

“

APPROVED

FOR MEDICARE

COVERAGE

Orthofeet® Mary Janes: Free to buckle up and enjoy the ride.

855 856

854

859

WO

MEN

’S SHO

ES • Sizes: 5, 51/2

- 12 • Widths: M

edium, W

ide, Extra-Wide


Elastic• Stylish design has an elastic upper

for ultimate comfort• Unique tie-less fastening system

and heel strap for a custom fit

Traditional• Classic styling always looks and feels great • Model 865 also available in Narrow

877 878

864

Elastic UpperStretchable fit

Heel StrapCustom fit for comfort

879

865

Also see page 9

for Women’s Stretchable Mary Janes.

Mesh • Unique tie-less fastening system

allows you to adjust the strap from both sides of the shoe

• Modern, breathable mesh design• Available in 6 fashionable colors• Models 854, 855, and 856 feature

a sport sole for added function

853

Sport Sole

851

876862861

= Available Narrow N

N

WO

MEN

’S SHO

ES • Sizes: 5, 51/2

- 12 • Widths: M

edium, W

ide, Extra-Wide


Orthofeet® Women’s Casual: Free to step out in style.

710721

Protective lining

Supple leather

Cushioning Heel

Suede leather with Stretch

715

Full Grain leather

704 708

Tie Shoes• Combine modern styling with

Orthofeet® comfort• Model 701 also available in

Extra-Extra-Wide

Tie-less Fastening System• Innovative design combines

laces with a strap, so shoes can be tied, or simply strapped on

Stretchable with Strap• Elastic uppers provide a

comfortable, loose fit• Eliminates pressure on diabetic feet

with lesions, poor circulation or edema• Also fits comfortably on feet with

bunions or hammer toes • Model 850 is made of suede

leather and stretchable spandex • Models 824 and 825 are made

of synthetic materials and are also available in Extra-Extra-Wide

Stretchable Mary Janes• Mary Jane styling with all the

therapeutic benefits of Orthofeet® stretchable shoes

• Models 826, 827 and 828 also available in Extra-Extra-Wide

825

850

827

828

826

Washable

701

= Available Extra-Extra-WideXXW

XXW

XXW

XXW

XXW

XXW824

Strap Enclosures• Classic styling and easy

closure for all-day comfort• Model 810 also available

in Extra-Extra-Wide

WO

MEN

’S SHO

ES • Sizes: 5, 51/2

- 12 • Widths: M

edium, W

ide, Extra-Wide


810

830

871 874

Orthofeet® Women’s Dress: Free to have style and substance.Easy Slip-on®

• Great-looking shoes have a wide opening for easy on and off

• Unique two-way fastening system allows you to adjust the strap length on both sides of the shoe for a perfect fit

• Models 812 and 814 feature a stylish 1½” heel • Models 817 and 818 come with an

additional longer strap• Model 817 also available in Narrow

Orthofeet® Fisherman Sandals: Free to breathe.Fisherman Sandals• Extraordinary design combines

Orthofeet® comfort and protection with the comfort and breathability of a sandal

• Elastic design enhances the fit

814

818

817

Orthofeet® Women’s Boots: Free to kick it up a notch.Strap Boots• Extremely lightweight boots feel like

you’re wearing sneakers• Offer excellent support• Innovative design features an

easy closure strap, so boots can be simply strapped on

• Extra foam padding prevents irritation, and offers a unique comfortable fit

812

881

820

872

XXW

= Available Extra-Extra-WideXXW = Available Narrow

N

N

Orthofeet® Women’s Athletic Shoes: Free to go the distance.

WO

MEN

’S SHO

ES • Sizes: 5, 51/2

- 12 • Widths: M

edium, W

ide, Extra-Wide


916

Strap Enclosures

Lace

Orthofeet® Slippers*: Free to explore your soft side.Slippers*• Same trademarked

Ergonomic Stride™ soles and body-forming design as Orthofeet® shoes

• Extremely comfortable insoles can be removed and replaced with diabetic customized insoles

• Model S731 is available in Medium and Wide

*Not approved for Medicare coverage.

Tie-less Fastening System• Innovative design combines laces with a strap,

so shoes can be tied, or simply strapped on• Models 910 and 916 also available

in Extra-Extra-Wide • Model 916 also available in Narrow

Strap-and-Lace• Biomechanically engineered to provide

ultimate comfort and protection • Models 921 and 920 also

available in Extra-Extra-Wide

940 941

S731

950 951

910

920

921

Adjustable Fit

One step fastening

One step unfastening

Adjustable Elastic lace

= Available Extra-Extra-WideXXW= Available Narrow

XXW

XXW

XXW

XXW

XXW

XXW

XXW

XXW

N

N

Orthofeet® Men’s Athletic Shoes: Free to stay in the game.

MEN

’S SHO

ES • Sizes: 7, 7 1/2 -11 1/2

,12, 13, 14 • Widths: M

edium, W

ide, Extra-Wide


Athletic Strap

• Models 650 and 651 also available in Narrow

Athletic Lace

• Lightweight, cushioned sole with trademarked Ergonomic Stride™ design helps propel feet forward

• Models 640 and 641 also available in Narrow

Tie-less Fastening System• Innovative design combines laces with

a strap, so shoes can be tied or simply strapped on

• Model 610 also available in Size 15 and Extra-Extra-Wide

Strap-and-Lace• Biomechanically engineered to provide

ultimate comfort and protection

610

621

620

Adjustable Lace

650651

641640

= Available Extra-Extra-WideXXW = Available Narrow

XXW

N

N

N

N

N

Orthofeet® Men’s Dress: Free to step out in comfort.

MEN

’S SHO

ES • Sizes: 7, 7 1/2 -11 1/2

,12, 13, 14 • Widths: M

edium, W

ide, Extra-Wide


Strap Enclosures • Easy on-and-off strap for non-binding comfort and protection• Lightweight, cushioned sole with trademarked

Ergonomic Stride™ design helps propel feet forward• Model 510 also available in Size 15 and Narrow

and Extra-Extra-Wide

Easy Slip-on® • Innovative design combines

slip-on styling with an adjustable strap for comfort

Dress Lace• Classic styling can be dressed up or down• Seam-free lining with extra foam padding provides

ultimate comfort and protection

Easy Slip-on®

517

510

585

540

520

587

465

467

XXW

= Available Extra-Extra-WideXXW= Available Narrow N

N

Orthofeet® Men’s Casual: Free to go places in life.

Tie-less Fastening SystemInnovative design combines laces with a strap, so shoes can be tied, or simply strapped on

644

422

421415

462

461

MEN

’S SHO

ES • Sizes: 7, 7 1/2 -11 1/2

,12, 13, 14 • Widths: M

edium, W

ide, Extra-Wide


Casual Lace• Fast lace shoes with therapeutic Orthofeet® detailing

maximize comfort from heel to toe• Model 410 also available in Size 15 and Narrow


Orthofeet® Men’s Boots: Free to be rugged and handsome.Boots• Extremely lightweight boots feel

like you’re wearing sneakers• Offer excellent support• Model 481 is a lace boot.

Model 581 is a double strap boot. Model 582 is an elastic strap-and-lace boot.

582

481

410

420 440

Tie-less Fastening System • The ultimate solution for

people who have trouble tying laces

• Unique fastening system allows you to adjust the strap length on both sides of the shoe for a perfect fit

581


XXW

N

N

Wide Opening,Adjustable Fit

Orthofeet® Men’s Stretchable Shoes: Free to expand your horizons.

MEN

’S SHO

ES • Sizes: 7, 7 1/2 -11 1/2

,12, 13, 14 • Widths: M

edium, W

ide, Extra-Wide


Orthofeet®

Men’s Slippers*: Free to relax in style.

Men’s Slippers*• Same trademarked Ergonomic Stride™

soles and body-forming design as Orthofeet® shoes• Extremely comfortable insoles can be removed and

replaced with diabetic customized insoles • Model S331 is available in Medium and Wide

• Elastic uppers provide a comfortable, loose fit• Eliminate pressure on diabetic feet with lesions,

poor circulation or edema• Also fit comfortably on feet with bunions or hammer toes • Model 525 also available in Size 15 and Narrow


Orthofeet® Men’s Fisherman Sandals: Free to open up a little.Men’s Fisherman Sandals• Extraordinary design combines

Orthofeet® comfort and protection with the comfort and breathability of a sandal

• Elastic design enhances the fit 572

S331

*Not approved for Medicare coverage.

571

525

Washable

550


XXWN

N

Orthofeet® Biosoft™ Bamboo Diabetic Socks:Start with a strong foundation.


SmoothToe Seam

VentilatedMesh

White Sole

loose, Wide Fit

Non-constricting DesignA very loose fit combined with super-stretch fabric helps maximize blood flow.

Smooth Toe Seam Innovative design makes the inside of the sock virtually seam-free, giving you maximum protection against blisters and irritation.

Natural Anti-bacterial and Anti-odor FabricIdeal for sensitive skin, bamboo fibers do not allow the spread of bacteria on the skin and work to eliminate odor.

Anti-blister Protection Bamboo fibers are brushed in a unique process, making the inside of the sock extremely soft for minimal friction and extraordinary comfort and protection.

Padded Sole SocksLoose knit design with super stretch soft terry padding with bamboo fibers• Smooth Toe Seam• White Sole• Ventilated MeshAvailable in S, M, L, XL

Dress/Casual SocksThin, light socks, ultra soft interior• Smooth Toe SeamAvailable in S, M, L, XL

Extra Roomy Fully Padded SocksWide, ultra loose welt • Soft terry padding with

bamboo fibers• All terry interiorAvailable in S, M, L, XL

Foot WarmersMicro fibers, thick and warm

Available in M, L

Size chart: S Women’s 4-7 M Men’s 6-8.5 Women’s 7.5-10 L Men’s 9-11.5 Women’s 10.5-13 XL Men’s 12-15

Available colors for all socks (except Foot Warmers)

PRESCRIPTION FOR THERAPEUTIC SHOES AND INSERTS

Patient’s Name: _________________________________ HIC#: ___________Address: _______________________________________________________City: __________________________________State: _____Zip: __________Phone: ___________________________________DOB: ________________

Physician’s Signature: _____________________________ Date: __________Physician’s Printed Name: _________________________ NPI# __________Physician’s Address: ______________________________________________City: __________________________________State: ______ Zip: ________Instructions: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PER STATEMENT OF THE CERTIFYING PHYSICIAN, THE PATIENT HAS ONE OR MORE OF THE FOLLOWING CONDITIONS:

m History of partial or complete m Peripheral neuropathy with foot amputation history of callus formationm History of previous foot ulceration m Foot deformitym History of pre-ulcerative callus m Poor circulation

INSERTS PRESCRIBED: SHOES PRESCRIBED:m Heat-Molded Insert m Extra-Depth Shoesm Custom Insert

www.Orthofeet.com

(continued on reverse side)

1. 2. 3. · fiNal client: Orthofeet iMc Job#: Neu-13465 project: Orthofeet Vertical therapeutic...

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Transcript of 1. 2. 3. · fiNal client: Orthofeet iMc Job#: Neu-13465 project: Orthofeet Vertical therapeutic...