One of the beauties of modern medicine is that from head to toe, there’s a doctor out there who’s well-versed in how to care for every inch of the human body. And when it comes to the often overlooked but perennially hard-working feet, the podiatrist is the doctor tasked with keeping you healthy and fully functional.
Given how hard our feet work day in and day out, it should come as no surprise that foot pain and problems related to the lower extremities are quite common. The American Podiatric Medical Association reports that 77 percent of U.S. adults aged 18 and older have experienced foot pain at some point, with about a third of those individuals seeking care from a podiatrist.
As the APMA explains, “a podiatrist is a doctor of podiatric medicine (DPM), a physician and a surgeon who treats the foot, ankle and related structures of the leg.” An expert in the lower extremities, the podiatrist has extensive training in all that can go wrong, from ingrown toenails and bunions to sprained ankles and diabetes-related neuropathy.
Similar to how other physicians are trained, podiatrists complete four years of undergraduate education followed by four years of specialized training and education at a podiatric medical school. That’s followed by three or more years of hospital residency training. Some podiatrists complete additional fellowship training after residency, particularly if they’re planning to subspecialize in fields such as sports medicine, pediatrics, wound care, geriatrics, surgery, dermatology, diabetes care or a number of other areas.
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Although the focus is on injuries and diseases that affect primarily the lower extremities, “it’s really a broad profession,” says Dr. Charlton Woodly, a podiatrist in private practice and founder of Woodly Foot & Ankle Specialists in Weatherford and Richland Hills, Texas. Podiatry also intersects with many other aspects of medicine. For example, podiatrists who specialize in wound care or helping diabetics with peripheral neuropathy may interact regularly with the patients’ primary care physicians, nephrologists, and other specialists. “You would think, ‘What do a foot doctor and a nephrologist have in common?’ Well we have a lot in common because we treat the same people,” Woodly says. And treatment of one condition can impact the other.
Dr. Miguel Cunha, a podiatrist in private practice and founder of Gotham Footcare in New York City, says heel pain is the most common condition he treats. “It can be broken down into plantar fasciitis or Achilles tendonitis, but 70 percent of my patients come in with either of those two conditions,” he says. They both can result from biomechanical problems and frequent walking. Because he’s based in Manhattan, most of his patients do a lot of walking, and “every step they take will put a lot of strain on the plantar fascia or the Achilles.”
In addition to heel pain, sports-related ankle sprains are also very common, as are bunions, hammer toes and neuromas, Cunha says. (A neuroma is a painful thickening of the tissue on the ball of the foot.) A podiatrist may also be able to help you with tendon disorders or injuries, arthritis, broken bones in the foot and ankle and conditions that may require surgery on the foot, ankle and related structures.
All of these various conditions have a range of treatment options from surgery and medication to rest or physical therapy. Woodly, who specializes in minimally invasive surgical procedures, says there’s a lot of innovation in the field, and some of the more cutting-edge treatments may be available to you depending on the situation. Some of these can be completed in the office and you’ll be able to walk out that same day, hopefully with less pain.
Before surgery becomes an option, Cunha says it’s important to start with conservative treatments if possible, such as stretching exercises, heating and icing, topical or oral pain relievers, orthotic shoe inserts, added padding or wider shoes. “Most people don’t want surgery and most people can treat their condition nonsurgically.” Still, sometimes surgery is necessary, and in such cases, “I always reserve the more advanced or the most invasive procedure as the last resort,” Cunha says.
When looking for the right podiatrist for your situation, Cunha says there are three primary areas that you should consider. “One is that they’re clinically and surgically competent. Two is a good bedside manner. And three is they’re goal-oriented.” Clinical and surgical competency relates to their training — look at where the doctor completed surgical residency and whether he or she has board certification. Is the doctor active in a medical association? Is the doctor staying up-to-date with advances in medical care?
Bedside manner refers to how well the doctor communicates with you and whether you feel comfortable with him or her. Does the doctor make eye contact with you? Do you feel like you can trust this person? Woodly says that word of mouth can be a good guide to finding a doctor with a good bedside manner, but he cautions that “just because there’s a doctor that’s right for you doesn’t mean it’s going to be the right one for me.” He recommends making an appointment to meet with the doctor to see how you “gel with that doctor.”
In being goal-oriented, Cunha means that the doctor should take into consideration what you’re trying to achieve. Are you a marathon runner who needs help getting back on the road? Are you a diabetic who’s getting frequent wounds or ingrown toenails? Because there’s a wide variety of patients and problems in podiatry, it’s important to know what you want to achieve and ask your podiatrist to help you get there. This is all part of the shared decision-making aspect of health care, in which you need to be involved in your own care. “It’s important to let the patient actively participate with all decisions related to their health care to assess each situation carefully and individually,” Cunha says.
To find the right doctor, Cunha recommends looking at whether the doctor has an online presence, because “that means they’re active and targeting the demographic that they’re treating.” In addition, he recommends searching on the condition you think you have and using phrases such as “best neuroma doctor in NY,” which may reveal different results than simply searching for “podiatrist in New York.” If you’re a runner, he recommends searching terms like “best running doctor” in your area and see who pops up. He says by searching terms like “best” you may get a higher quality of doctor. “Essentially, you want to find the specialist within the specialty. There’s a lot of foot surgeons,” but not every foot surgeon provides cutting-edge procedures. And if the doctor has a lot of positive reviews on his or her website, that could indicate high patient satisfaction and higher quality.
Prior to coming in for your first appointment, Cunha recommends doing some research on your condition, but cautions that you “come in with an open mind. You want (patients) to be informed and have good questions, but there are some patients who think they’ve got their diagnosis all figured out, and they’re not going to be open-minded to suggestions or recommendations.” Therefore, you should have some idea of what’s going on, but let the doctor do his or her work to determine the appropriate diagnosis and treatment plan.
When you meet with the doctor, Woodly says he or she should be speaking plain “English as opposed to medical speak,” and if there seems to be a miscommunication, or your problem doesn’t resolve, advocate for yourself. Speak up, and if the doctor still doesn’t seem to be understanding or taking your concerns seriously, find a new doctor. “If you’re not getting what you need from one podiatrist, find another. That’s not just for podiatry, that’s for any doctor across the board.”
“You want to have a vibe or feel like you connect with the doctor,” Cunha says. This can be a gut feeling that can be hard to quantify, but the bottom line question you should ask yourself is “Do you feel comfortable with them, especially as you may have to see them for multiple visits? Are they comforting? Do they reassure your confidence?”
Woodly adds that “there’s a lot of innovation out there and you don’t have to live with foot pain. There’s always something you can do,” to either completely resolve the pain or at least lessen it so that it’s not as disruptive to your daily activities. “Foot pain and leg pain are not normal. Don’t just live with it,” because if you just “ignore it, it’ll just get worse and often becomes even harder to get rid of,” he says.
Lastly, Woodly notes that the shoes we wear are a major contributor to the health of our feet. If you’re having foot pain of any sort, “look at the type of shoes you’re wearing.” He says this is the first thing he looks at when a new patient comes in. “When you buy shoes, if they don’t feel comfortable the day you put them on, those aren’t the right shoes for you. There’s no such thing as ‘breaking in a new pair of shoes.’ It doesn’t work that way. The shoe is going to break you in.” And Cunha adds you should always buy shoes at the end of the day, because our feet tend to swell over the course of the day. A shoe that fits comfortably at the end of the day is more likely to also fit comfortably in the morning.
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