1. FOOTWEAR PRESCRIBERS’ ONLINE WORKSHOP
Rehabilitation Appliances Program
(RAP)
2011

2. THE WORKSHOP The aim of the workshop is to:
provide you with a better understanding of the Department’s requirements relating to prescribing and supplying medical grade footwear.

3. Rehabilitation Appliances Program (RAP)
The aim of RAP is to keep veterans in their own homes as long as possible and
Provides equipment or appliances for self help and rehabilitation

4. RAP
Program provides:
Aids to daily living eg mobility aids, home modifications
Treatment aids eg continence products, oxygen
Medical Grade Footwear (since July 2000)

5. Spending of public money
DVA, RAP can lawfully utilise public money in the provision of aids or appliances to eligible beneficiaries under the provisions of:
Section 90 of the Veterans’ Entitlements Act and
Treatment Principles Part 11
The link below offers in depth material – Federal Register of Legislative Instruments (Frli):

6. Who is Eligible
Gold Card Holders - full range of treatment (footwear supplied where clinically necessary)
White Card Holders - full range of treatment for accepted disabilities (footwear supplied where clinically necessary for accepted disability)
** White card holders need prior approval before podiatry and
footwear treatment

7. The Cards GOLD card holders assessed on basis of clinical need
The TPI Gold Card looks the same but references Totally & Permanently Incapacitated
Gold Card

8. No eligibility for RAP items Pharmaceuticals ONLY
WHITE card holders assessed on basis of clinical need related to an accepted disability (AD)
No eligibility for RAP items
Pharmaceuticals ONLY
FACT SHEETS
WHITE CARD
ORANGE CARD

9. MEDICAL GRADE FOOTWEAR (MGF)
MGF Review
An initial review undertaken in 2004/05
The review included the definition of what constitutes MGF Footwear clinically prescribed for the purpose of correcting, alleviating or replacing deficiencies or deformities in gait, feet or lower limbs.
As part of this review the MGF Register of suitable footwear was compiled

10. MEDICAL GRADE FOOTWEAR
Review of MGF Register (an accepted list of footwear which meet specific criteria, and referred to as medical grade) undertaken in 2010
Some shoes removed due to their not being considered clinically appropriate
Suppliers of MGF are selected from an open tender process, last completed 2010.

11. MEDICAL GRADE FOOTWEAR
Definition:
Footwear clinically prescribed for the purpose of correcting, alleviating or replacing deficiencies or deformities in gait, feet or lower limbs.
MGF is prescribed when readily available everyday footwear cannot be used or modified for this purpose.

12. Medical Grade Footwear
Ready-made Depth/Width
Ready-made has specific features that
accommodate foot abnormalities. Listed on
Register of DVA Approved Ready-Made
Depth/Width Medical Grade Footwear.
Determined by a technical advisory panel
according to specific technical criteria.
Custom Made
Manufactured to individual specifications.

13. Examples of Technical criteria
Examples of technical criteria for ready-made Depth/Width footwear include a defined:
Min Depth 6.0mm added evenly along the last. Inside back heights a min. of 67.0mm for size 7 women’s shoes and 72.0mm for size 9 men’s shoes, with a 2.0mm difference in back height between each size.
Min Width should be avail in 3 width fittings with a minimum width sizing of a standard EE forefoot.
Design should allow for easy donning and doffing. The shoe should be lace up, velcro or buckle closure and able to be modified in this respect.
Quality and thickness of materials used for soles, in uppers, linings and torsional stability.

14. Examples of Ready-made Depth/Width Brands
Drew Barefoot Freedom
Apex Ambulator
OAPL
Essential
Doc Cobbler
Drew
Gadean
PW Minor
Luttgens
Oceana
JJJ’s
Mt Emey
Walkon

15. Custom-made Footwear
Made from lasts or casts built to replicate the feet.
Specifically designed to accommodate gross deformity and/or biomechanical anomalies.

16. WEBSITE LINKS MGF National Register and Fee Schedules
RAP Schedule & Forms

17. Non-medical grade footwear
stock or off the shelf walking shoes
slip-on shoes/boots/court shoes
runners/joggers
“reef style” or “orthopaedic moulded” sandals

18. Podiatry Advisors Are available for you to discuss MGF issues,
treatment concerns etc
DVA Health Provider Line
(metro)
(regional)
Press Option 1 for RAP (aids and appliances & medical grade footwear)

19. Procedures for assessing lower limb management
Podiatrists must assess the client by the following order of interventions, as clinically appropriate.
Consider the use of:
more appropriate stock footwear;
corrective insoles;
modifications to stock footwear;
ready-made footwear; or
When no other clinically suitable option remains the prescription of :-
custom footwear

20. Key to Success 1
Thorough assessment of the client’s foot type and shape is the first step to prescribing adequate
treatment interventions
orthoses or footwear.

21. Assessment Guidelines
step 1 full examination of foot
bony abnormalities/exostoses
toe positions
oedema
the ‘at risk’ foot
unusual skin conditions
step 2 gait
structural weakness
abnormal function
condition of footwear in use

22. Assessment Guidelines cont.
step 3 adjunct therapies
- padding and strapping
digital devices eg. OKW; silipos products (gel padding/
inserts)
- internal shoe: Simple Insoles Moulded Inlays Functional Orthoses
- external shoe: Shoe modifications AFO’s; Callipers /
T-straps
- systemic: Medications; Surgical stockings

23. What Do I Want To Achieve when considering Footwear ?
Key to Success 2
What Do I Want To Achieve when considering Footwear ?
To facilitate correction, support or gait assistance ?
To facilitate stability ?; and / or
Accommodating abnormal foot structures ?

24. Is the existing footwear suitable for the clinical condition ?
Key to Success 3
Is the existing footwear suitable for the clinical condition ?
Existing footwear can be improved with
shoe modifications without need for MGF
Where necessary clients should be advised
to purchase more appropriate footwear
Readily available footwear is an acceptable choice if it has adequate depth, width, and stability.

25. MGF can be prescribed when:
Appropriate treatment and appliance therapy
have been tried and failed
Where appropriate, shoe modifications to the
veteran’s own footwear have been tried and
failed
There is significant clinical need and the
deformity or condition cannot be managed
without the use of ready-made or custom MGF

26. Key to Success What footwear and/or appliances are available to accommodate this clinical condition ?
As the MGF prescriber it is your responsibility to keep abreast
of the types of footwear available on the DVA MGF Register and
any changes occurring within the industry.
When prescribing MGF you should have an indication of what
type of shoe will be most suitable for your client and what
additional appliance/s would be beneficial.
Local suppliers are keen to work with Podiatrists to share information
about the range and styles available to match to patient foot type and
need.
DVA Pod Advisers may also be contacted for help with suggestions of
suitable choices/styles to suit the clinical need.

27. BASIC FOOTWEAR COMPONENTS
Back Quarter - quarters are the back sections of the upper which support and help control the hind-foot
Heel Counters - extended medially and/or laterally
Insoles - cut from last shape and determines the shape of the shoe, waist support and flexibility
Linings - material used to contact the foot for the purpose of absorbing perspiration, reducing heel slip, durability
Lug Length - the top opening of the shoe which runs down the dorsum of the midfoot (the laces area). The length is usually a standard proportion of the shoe. May be extended down the toebox. E.g used commonly for high insteps or forefoot amputations

28. BASIC FOOTWEAR COMPONENTS cont..
Outsole - base of shoe which contacts the ground – durable
Shank - reinforces the mid section of the shoe – critical !
Toe Puffs - can be walled or extend onto the dorsum over the digits
Tongue - may be padded or stitched down
Vamp - The material section of the shoe which covers the top part of the
foot

29. Deciding Ready-made or Custom
There are many factors which affect this decision.
For example clinical conditions need to be stable before prescribing
custom footwear and MGF, e.g. presence of oedema. It is essential to
have an up to date medical history including medications.
The following shoe features should also be considered:
Counter
Lug Length
Modifications

30. CUSTOM OR READY-MADE Custom is generally required when:
Toe box needs to be 30 mm or higher
Forefoot width is in excess of 3 fittings wider than hind-foot
Equinus foot shape
Rocker bottom foot
Severe adducted or abducted forefoot
Excessive Oedema
Severe Rheumatoid deformities
Other deformities which cannot be accommodated in
depth/width footwear e.g Marked asymetry between feet

31. SUMMARY
Key to success 1:
Thorough assessment of the client’s foot type and shape is the first step to prescribing adequate footwear.
Key to success 2:
What Do I Want To Achieve With Footwear?
Key to success 3:
Is the existing footwear suitable for the clinical condition?
Key to success 4:
What footwear and/or appliances are available to accommodate this clinical condition?

32. Referral MGF Flowchart
Veterans can be referred by the LMO to either Medical Specialists or Podiatrists for MGF assessment.
The process is the same.
Veteran
LMO
Podiatrist
Specialist
Supplier
DVA – RAP section
for approvals Modifications & repairs over $100 require approval

33. New Patients Referral from LMO Confirm MGF History –
Ask the Veteran - Do they have/ have they had footwear previously issued through the Department ?
Ask DVA if unclear

34. MGF Prescription Forms D0688
D0688 Forms are now available on the DVA website in pdf format for downloading go to:
Forms can also be ordered as follows:
Online – or
Telephone: ; or
Fax: ; or
Post: DVA Distribution, PO Box 251, Woden, ACT 2606

35. The MGF Prescription Form – D0688
There are 2 forms required to be filled out in the process of prescribing MGF for eligible veterans.
D Medical Grade Footwear Prescription (for the prescriber)
D MGF Footwear Supply
(completed by the supplier)
Please note that the two pads of forms are companion items, ie when one is ordered, the other is automatically provided with it.

36. Footwear Prescription
Clinical justification
Subjective symptoms
Objective assessment include deformities
Other therapies considered
Current footwear/modifications tried
Appropriate stock shoes attempted

37. Filling in the Prescription Form D0688
NOTE: the Guidelines for Prescribers on the cover
page of the prescription pad !
Succinctly:
Delays can be avoided by filling in the D0688 form completely, including all relevant:
clinical information and footwear details
information regarding modifications/repairs
list clearly any special instructions
NB. When insufficient details are provided a request for additional information, will be made to the Prescriber.

38. Prior Approval Process
Approvals / Rejections
If all criteria are met: Approved
If minimal criteria are met/provided: Rejected
MGF will not be provided for the sole
purpose of accommodating orthoses.

39. Footwear Supply
DVA has contracts with suppliers of MGF. Some provide only ready-made depth/width, others only custom-made, others provide both types of MGF.
Suppliers include:
Orthotists
Commercial Shoe Stores
MGF Specialists

40. The Podiatrist prescribing the MGF is the case manager...
Acquittals
The Podiatrist prescribing the MGF is the case manager...
Acquittal - is the formal “sign off” that the footwear is as prescribed by the case manager and suitable for the purpose for which it has been requested.
Acquittal maintains the warranty.
Acquittals are to be recorded on the D0688 or in patient’s clinical notes and comments made as necessary.

41. Process of Acquittal
Clinicians are strongly encouraged to provide the information below at time of acquittal.
Comments can include but are not limited to:
Acquittal dates and information
Acquittals should be done within 1-2 months of footwear being supplied
Problems at acquittal are the responsibility of the prescriber to liaise with supplier to adequately resolve in a timely manner
Prescriber must review - all footwear issued
Modifications to footwear must be reviewed
Excessive wear and quality issues should be referred to DVA offices rather than condemn and replace
Unsatisfactory supplies MUST be addressed

42. How Many? - Shoes 2 prs Day/Dress shoes at any one time
1 pr Recreational shoes - where MGF need to be modified to comply with a sporting club regulation. Must provide club letter confirming financial membership & playing status
1 pr Work shoes if required by an employer, in addition to day shoes - may need confirmation from employer e.g. SAFETY SHOES
1 extra pr day shoes for rural and remote residents (defined as >100km from a suitable Prescriber)

43. Replacing Footwear
“CONDEMN” FOOTWEAR when no longer repairable or clinically suitable
When condemning footwear and requesting replacement shoes, write details on script e.g. date approved, make, style, size, or colour.
Early condemning of footwear please write on prescription the reasons. Should only be a change in clinical circumstances not where a patient changes their mind
Punch holes in the tongue or mark an X in permanent marker (this identifies that MGF have been condemned and repairs will not be paid by DVA)
If high risk client - discard unsafe footwear

44. Repairs and Modifications
DVA pays for repairs to current DVA footwear - script given to client
Routine repairs may be done by the original supplier without need for prescription
Contracted suppliers are required to manage any warranty needs e.g repairs (generally 12mths)
An exception; unless extreme access issues exist in visiting or sending shoes to the contracted supplier. Prescriber to keep adequate notes.
After warranty has passed - Local repairers are able to repair - send invoice into the Department with copy of script.

45. How Many? Modifications to non DVA footwear
Clinically required - e.g heel collars, sole raises, stretching etc. to non DVA footwear
Limit of 3 self purchased pairs of footwear can be modified in any one year
Needs a prescription form completed
Contracted suppliers are required to manage any warranty needs e.g modifications (generally 12mths)
After warranty has passed - Local repairers are able to modify - send invoice into the Department with copy of script.

46. How Many? - Orthoses/ Insoles Etc
1pr Customised - to move from shoe to shoe
Where a clinical need exists (e.g. issues with manual dexterity) another pair of orthoses may be requested
Where different shoe style makes transfer of orthosis difficult the orthosis could be mildly modified to adapt to the different shoe or shoes
Veteran could purchase appropriate footwear to accommodate the orthosis
To replace an orthosis:
Replace by surrendering old one to podiatrist or supplier
Provider supplying orthosis/es then clearly states this on prescription form

47. Prescription of Stock Footwear
Requested through Rehabilitation Appliances Program (RAP)
Prescription form on website –
DVA Forms Form D this is not the same form as when requesting MGF
Stock - AJ07 or Temporary - AJ06
Issued as essential part of a leg appliance e.g. amputee
Modification/s to self purchased footwear may be required to accommodate a calliper
Temporary footwear (AJ06) also available - cast boots/shoes e.g. “DARCO”
Guideline for the prescription of Pullman slippers; extreme oedema, current ulceration and subsequent leg and foot bandaging

48. Warranties
Newly manufactured MGF - 12 months (workmanship, materials, fitting)
Repairs/modifications - 3 months
As a quality assurance measure – The Department may request the Prescriber returns those shoes that have failed to last an acceptable amount of time.

49. Home Visits for Suppliers
Needs prior approval from the Department to be able to claim travel
Requested on the Prescription Form by the Prescriber outlining the clinical reasons why the veteran cannot be transported to supplier
Considered only where it is clear the client is medically confined to home
A general rule of thumb –
1 (one) home visit for MGF and
2 (two) visits for custom MGF when requested by the podiatrist

50. Transport to Podiatry treatment
Beneficiaries can claim reimbursement for travel costs for medical treatment to the closest practical provider - taxis or mileage
(incl. to contracted footwear supplier or orthotist appt.)
Service provider to sign travel form (available from the DVA’s Transport section)
Booked Car with Driver (BCWD) scheme was made available to all beneficiaries over the age of 80 in 2006.
See online DVA FACTS HSV125

51. MEDICAL GRADE FOOTWEAR (MGF) COMPLICATIONS & DIFFICULTIES
What to do when:
Footwear provided is not suitable the Veteran should:
NOT sign the voucher if presented by the Supplier;
Contact the Prescriber to discuss with Supplier and organise modifications.
Footwear provided is not suitable the Prescriber should:
NOT acquit the footwear;
Advise supplier ASAP;
Discuss and organise modifications.
The veteran changes their mind:
Veteran has financial responsibility for costs.
There are problems with the supplier;
Contact DVA RAP if unable to resolve.

52. MEDICAL GRADE FOOTWEAR (MGF) WHAT IF?
Suppliers
nearest contracted supplier is too far away
liaise with supplier to work out possible solution - eg foot tracings; girth measurements and let DVA know of issues
nearest supplier cannot supply most suitable MGF register shoes
other suppliers can be contacted
Maintain adequate records to support this approach

53. MEDICAL GRADE FOOTWEAR (MGF) WHAT IF?
Prescribers
do not complete the D0688 correctly
form will be returned with request for more details
are unsure as to the most appropriate shoe
be specific in description of MGF characteristics
discuss with a DVA Podiatry Adviser
assess the beneficiary as not meeting clinical criteria
explain to veteran and do not complete D0688 or
send completed D0688 directly to DVA and attach a note indicating assessment that stock footwear is suitable
keep precise clinical notes in case a review is requested

54. MEDICAL GRADE FOOTWEAR (MGF) MGF SUPPLIER LOCATIONS
Contracted MGF suppliers are located throughout each State
Please see the link below to locate the closest contracted supplier
List of suppliers
NOTE: Names and locations as listed are correct at time of
publication.

55. MEDICAL GRADE FOOTWEAR (MGF) CONTACT NUMBERS
DVA Health Provider Line
(metro)
(regional)
Press
Option 1 for RAP (aids and appliances & medical grade footwear)
Option 3 for Medical & Allied Health (podiatry treatment)

56. MEDICAL GRADE FOOTWEAR (MGF)
Thank you
This completes the on line workshop
Should you have further questions about MGF or the content of this presentation
please contact
DVA Health Provider Line
(metro)
(regional)
Option 1 for RAP (aids and appliances & medical grade footwear)