Inclusion Criteria:  Men or women 18 years old or older, Diagnosis of Diabetes Mellitus, Ambulatory, Uses prescribed diabetes footwear. Those willing and able to attend follow up visits such as long distance (i.e. greater than 30 miles to recruitment sites). Those able to read or follow directions.  Exclusion Criteria:  Active Charcot Arthropathy or major foot deformity, Cardiopulmonary disease (e.g. recent MI, Stroke), Gangrene, active infection. Montreal Cognitive Assessment (MOCA<20). Wide spread malignancy or systemically immunocompromising disease.