The use of diabetic shoes has been steadily increasing since the Medicare Therapeutic Shoe Bill was passed. For some diabetics, these are of vital importance to reduce shoe related foot problems. Medicare began this benefit in order to limit the incidence of foot wounds and general injuries caused by the use of improperly fitting shoes. Shoes have been the source of many friction and pressure-related wounds, leading to infection, hospitalization, and possibly amputation. They also have allowed for irritation of foot deformities already present, including bunions and hammertoes. As many diabetics have peripheral neuropathy (nerve disease), shoe irritation pain cannot be readily felt and wounds form easily after a relatively short period of time. Combined with foot deformity like bunions and hammertoes, as well as chronic edema (swelling), the potential for the shoe to rub against the skin is dangerously increased. A diabetic shoe is defined as an extra depth shoe (especially in the toe area) to reduce pressure on the top of the toes, as well as sized appropriately for width to reduce pressure on the inside and the outside of the foot. This immediately protects feet with curled toes or bunions, and benefits normal feet as well. The shoe material generally should have a construction to limit seams within the shoe, and should be durable to last one year's worth of daily use. Of vital importance is the inclusion of an insert made mostly of a material called plastizote. This material reduces pressure and shear forces. It can be heat molded to the foot, or in some cases must be custom molded to a foot if severe foot deformity is present. These severe deformities may be from amputation voids or a disease that deforms the foot called Charcot deformity. Medicare has defined the minimum thickness, or durometer, of this material, and the use of anything less is inappropriate. When the extra depth shoe and plastizote insert are combined, the likelihood of shoe-related pathology is significantly reduced.