Podiatry: Does Medicare Cover Foot and Ankle Treatment?

Foot and ankle pain is no joke. If your feet or ankles have ever hurt, you understand how debilitating that pain can be. WebMD says that by the time you are 50, your feet have walked more than 75,000 miles. No wonder they hurt!

Your feet play a huge part in all of your weight-bearing activities, acting as shock absorbers as they move your body forward. Any problems that interfere with these functions can cause you to lose your mobility, or at the least slow you down.

If you suffer from foot or ankle pain, there are things you can do for relief. Foot and arch supports, topical anti-inflammatory solutions, in-office treatments, and surgeries are all potential options.

We contacted Dr. Dennis Vaughn, DPM, a board-certified podiatrist and owner of Vaughn Foot and Ankle Clinic, in Mt. Zion, IL, for information about podiatry and seniors.

Foot Pain Over 50

Here are a few interesting facts about foot pain and people over 50:

• It affects one in four seniors – foot pain most commonly affects the forefoot and toes and is disabling in about two-thirds of reported cases.
• It impairs mobility and balance – you tend to compensate for pain felt in your feet and ankles by limping or stepping in an unnatural way, which can slow you down and throw you off balance.
• It’s a risk factor for falls – being unsteady on your feet can cause you to lose your balance.
• Women are more likely than men to report foot pain – they tend to develop bunions and hammertoes more often than men, possibly from their choice of footwear.

Certain conditions can exasperate foot pain: 

• Obesity: added weight, especially over time, can cause swelling of the ligament that connects your heel to your toes, causing a sharp pain in your feet. Overweight people are also at greater risk of sprains, which limits mobility.
• Diabetes: high blood sugar levels can, over time, contribute to nerve problems.
• Arthritis: through years of use, your joints can become inflamed and eroded, causing high levels of pain. 
• Depression: you’re more aware of aches and pains that otherwise might go unnoticed, and pain you might be feeling seems to be heightened.

If you ever find yourself affected by foot or ankle pain, you’ll be happy to know that there is help available, and Medicare will probably cover the treatments. 

What is Podiatry?

Podiatry is the branch of medicine that diagnoses and treats disorders of the foot and ankle. If left untreated, these disorders can cause a lot of pain.

Dr. Vaughn says the good news is “there are many different things we can do to help manage or alleviate your pain.”

People are living longer than ever before, which adds extra years of wear and tear on your body, including your feet.

“We treat things from injuries to ongoing issues like heel pain, ball of the foot pain, fat pad atrophy, bunions, hammertoes, and tendon dysfunction from flatfootedness.” 

How Podiatrists Can Help

The human foot is a fascinating part of your body. It provides a foundation for your whole being, and is known as "the mirror of health.” 

Your foot can harbor signs of health conditions such as diabetes, arthritis, and circulatory diseases. A podiatrist is often the first to see these underlying health issues.

Dr. Vaughn explains the different ways he can help. “A lot of times, we’ll add support in their shoes, or sometimes we can try to accommodate them with extra padding.”

“There’s also anti-inflammatory medications, creams, and gels that we can offer to help,” he adds.

“In some cases,” Dr. Vaughn says, “we can treat conditions like arthritis and tendinitis in the office with a procedure called Iontophoresis,” a process where electrically charged ions penetrate the tissue of the foot through electrical currents. You might feel a tingling sensation, but Iontophoresis treatments aren’t painful. Most sessions are over quickly, lasting about 10-15 minutes, although it may take several treatments for your symptoms to go away.

Dr. Vaughn also uses cortisone shots as needed to help manage pain.

What About Surgery?

Surgery is an option, but it's usually the last resort when dealing with foot or ankle pain. Dr. Vaughn says he will do surgery if it’s bad tendon dysfunction or there’s a significant amount of arthritis.

Depending on how much damage there is and the location of the tendon dysfunction or arthritis, Dr. Vaughn will either fuse the joint or replace it.

He says, “if the pain is in the big toe, I typically replace it instead of fusing it.”

When the pain is in the mid-foot or ankle, he adds, “you can sometimes use a custom brace” for support and pain relief, “but if the pain is bad enough, I’ll have to go in and either replace or fuse the joint.”

Joint Fusion or Arthrodesis

In joint fusion, the two bones that make up the joint are fused or welded together to make one solid bone (Web MD).

This procedure relieves your pain and makes that joint more stable so it can bear more weight. The downfall to joint fusion is you’ll lose your range of motion in that area. However, losing some movement might be an acceptable trade-off for pain relief.

Recovery from a joint fusion can be lengthy, sometimes taking months, so that’s something to consider when deciding on the best treatment options.

Joint Replacement

Your doctor may choose to do a joint replacement rather than a joint fusion. With joint replacement, the bone on either side of the joint is partially removed and replaced with metal, plastic, or a combination of both (FootCare MD).

Joint replacement relieves the pain, and you retain your range of motion. The major downfall is that a mechanical joint won’t last forever. 

While technology is continually evolving, a toe-joint replacement lasts about 5-10 years, and an ankle-joint replacement can last 10-20 years. So, longevity is something you should discuss with your doctor when considering this as a treatment.

Typically, recovery from a joint replacement is relatively easy. After a brief, non-weight bearing period and some physical therapy, you can expect to start walking within a few weeks.

What Happens During a Podiatrist Visit?

If you’ve never been to a podiatrist before, you might not know what to expect. We asked Dr. Vaughn what a typical appointment looks like, and he walked us through the procedure.

He said new patients at Vaughn Foot and Ankle Clinic would:

1. Fill out paperwork, including your medical history and general patient information.
2. Go to an exam room where a nurse will ask you about medications, allergies, the history of your problem, and possibly take X-rays.‍
3. Dr. Vaughn will perform a physical exam to diagnose your problem and set up a treatment plan with you.

All-in-all, it’s an easy process, much like a typical doctor’s appointment.

Don’t Live In Pain

Knowing when to go to the doctor can be tricky. We all experience pain from time-to-time, so how do you know when you should have foot or ankle pain looked at by a podiatrist?

Sometimes, you have pain because of irritation from a walk or an activity, but “that should subside within a week or so,” says Dr. Vaughn.

“If you have discomfort or pain for a couple of weeks that doesn’t ease up, or if the pain stays persistent or worsens, then it's time to come in,” he adds.

Medicare and Podiatry

According to Medicare.gov, Medicare Part B covers foot care received by a podiatrist if it’s considered medically necessary.

What services are considered medically necessary services?

Medically necessary services are health care services or treatments that are needed to diagnose or treat:

• Illness
• Injury
• Conditions
• Diseases 
• or the symptoms of these

CMS.gov lists some instances where Medicare won’t cover services received from a podiatrist. These include:

• Treatment of Flat Foot : fallen arches, which require services or devices to care for or correct this condition, even with a prescription
• Routine Foot Care: cutting or removing corns or calluses, trimming toenails, or hygienic or preventative maintenance care
• Supportive Devices for Feet: most orthopedic shoes and supportive devices are included, except for shoes that are fitted into medically necessary braces

There are some exceptions to this list, so check with your podiatrist to see if these services might be covered if you need them.

What Will You Pay?

Medicare covers 80% of these costs, and you will be responsible for the remaining 20% plus your deductible. If you receive these services in an outpatient setting, you’ll also have to pay the copayment.

Dr. Vaughn says, “It always helps to have a Medicare Supplement, because Medicare leaves a patient with some costs.” 

If you have a Medicare Supplement, you’ll have low, or possibly even no out-of-pocket-cost. The amount you’ll owe will depend on the plan you have.

Three of our favorite Medicare Supplement Plans are:

• Plan F - $0 out-of-pocket expenses

‍Note: Plan F is no longer available for purchase unless you were eligible for Medicare Part B before January 1, 2020.

• Plan G - you’ll pay the $198 Part B deductible for 2020
• Plan N - you’ll pay the $198 Part B deductible for 2020 and possibly a copay of up to $20 for some office visits

Related reading:

• Michael Sams Helps Couple Save $960 on Medigap Plan G
• 7 Questions to Ask About Medigap Insurance
• Why Exactly is Plan F Being Phased Out?

Further Advice From Dr. Vaughn

It’s hard to beat good basic foot care.

Dr. Vaughn says, “When you shower, dry between your toes and don’t put a lot of lotion between them, so you don’t keep everything wet and saturated.”

He also says to “pay attention to your footwear, especially if you're having foot trouble.” 

Shoes can play a big role in the health of your feet. Dr. Vaughn said it’s funny to see people come into his office, especially women wearing “cute little shoes." He explains, "They have foot problems. A lot of them will say, ‘I don’t want to wear Grandma shoes.’ But in reality, there are good shoes out there that have good support.”

He suggests brands such as SAS, Extra Depth Shoes, Clarks, Born, and Rockport for good, supportive, and fashionable sandals, dress, and casual shoes.

As far as tennis shoes, Dr. Vaughn recommends Asics, Brooks, New Balance, and Saucony.

“If you’re going to wear a sandal, wear one that has some arch support to it,” he says. He suggests Orthaheel or Vasyli for sandals and shoes that offer fashion as well as support.

Conclusion

Foot and ankle pain are no laughing matter. Preventative care is always best, but sometimes, wear-and-tear takes its toll on even the most well cared for things. 

If your feet hurt and you have problems that persist longer a couple of weeks, it’s probably time to contact Dr. Vaughn. You can rest assured he has the knowledge and skills to take care of you, and he treats all conditions in the foot and ankle using both conservative and surgical measures.

After carrying you for thousands upon thousands of miles throughout your life, you owe it to your feet to give them the best care possible; without them, you can’t go anywhere on your own.

Dr. Dennis Vaughn, DPM, is a podiatry specialist in Mount Zion, IL, and has been practicing for 19 years. He specializes in podiatry and podiatric foot & ankle surgery.