If you have received a prescription for orthopaedic shoes from your doctor, you might be wondering what it is, and if insurance will cover this kind of expense.
Unfortunately for many years coverage for orthopaedic shoes was looked on as a yearly allowance for free shoes, which was not its intended purpose. The benefit was supposed to be for those who had justifiable foot issues. Granted, people who spend a lot of time on their feet tend to develop pain, but does this justify orthopaedic shoes?
Types of Shoes
There are four categories of shoes. Off the shelf, off the shelf orthopaedic, off the shelf orthopaedic modified, and custom shoes.
Off the Shelf Shoe
An off the shelf shoe tend to value style over substance. They could be softer, more flexible, less supportive, and/or not the correct shape of your feet. High heels and canvas sneakers are a good example of an off the shelf shoe. Some force your feet into unnatural and harmful shapes or allow them to do what they want. This can be detrimental for current and future foot concerns. This category of shoe is not designed for problems you may be having with your feet. Some of these shoes may even exacerbate foot, ankle, knee, hip or back issues because of their lack of support or how they fit on your feet.
Great strides, pun intended, have been made over the last few years to take the foot shape and support into account. There are off the shelf shoes that are better for your feet, but you have to know what to look for.
Off the Shelf Orthopaedic Shoes
Off the shelf orthopaedic shoes are usually shoes that can all kinds of feet and have a firmer construction. A true orthopaedic shoe should include the following features:
- Fully adjustable closure such as Velcro or laces
- Tortional stability (resists twisting motion of the shoe)
- Firm heel counter to support the heel
- Extra space in the shoe to prevent extra pressure (ex. Extra depth, doesn’t point at the front)
- A sole that is at least as wide as the top of the shoe (wide base of support)
- Multiple widths and shapes to accommodate different foot shapes
- Can be easily modifiable
How the various features mentioned help to address various foot issues is for another article.
Off the Shelf Orthopaedic Modified Shoes
Off the shelf modified shoes have the same qualities as an orthopaedic shoe, however they have been modified to address specific abnormalities. These modifications can include adding a lift to one shoe, adding material to increase stability (buttresses, sole widening) or changing the shoe accommodate a deformity (balloon patches, excavation), to name a few. Simple changes such as inserting an orthotic, or adding arch support inside the shoe are not included in this category. They provide great support inside a shoe, but it would not be considered a modified shoe. To be classified as a modified orthopaedic shoe, it must first be an orthopaedic shoe, then be rendered unsalable to any another individual by a permanent modification(s). If modifications are done to a non-orthopaedic shoe, it would not be classified under this category. In this case, the modification to an off the shelf shoe would be classified as a shoe modification. This modification may be covered by your insurance plan, but the shoe would not be.
Custom Made Shoes
Custom shoes are made specifically for the individual and made from casts taken of the foot and ankle. From this cast, a model (last) of the foot shape, size and deformities is made. This model is used to construct the shape of the shoe and they are designed specifically for the individual. The process may take about six to eight weeks before receiving the final shoe. Because of all the work needed for one custom shoe, they cost significantly more than the previous options.
Custom shoes are usually used for individuals who cannot fit in any of the categories above (off the shelf, orthopaedic, or modified orthopaedic shoes). Individuals who typically benefit from a custom shoe are those with congenital deformities, post traumatic deformities resulting in rigid skeletal deformities, partial amputations or deformities from disease such as Charcot Marie disease and polio.
Custom shoes have come a long way with many different styles available, but if you are in need of a custom shoe, then style will be taking second place to mobility and pain reduction. I worked in the custom shoe business for many years and I found that the true custom shoe patients are the ones who come to me later and tell me, “I love them, I can walk without pain for the first time since…”
Insurance and Taxes
When a doctor prescribes an orthopaedic shoe, modified orthopaedic shoe or custom-made shoe, you do not need to pay the GST/HST because they are considered a medical device. You may also be able to use them on your income taxes for that year. Otherwise, if your insurance plan covers these kinds of shoes, a prescription would also be necessary. The prescription is necessary in both cases to confirm that the shoe is being used for a specific medical purpose. These shoes must also be dispensed by a qualified health care provider, to ensure the appropriate shoe is selected for the medical condition.
With all the different terms, it can be confusing to know what is and isn’t covered by insurance. Check with your insurance company and talk to your health care provider if you want to make sure you have the right information.
If you are having foot problems and need advice, talk to your local Canadian Certified Pedorthist. They will help educate you on the proper choice of shoes and support when necessary. You can find a Pedorthist at https://www.pedorthic.ca/.
Written by Jaimie McVean, C. Ped (C)