When to Consult a Podiatrist

Should you seek advice on insoles and shoes from a podiatrist or a pedorthist?

Podiatrist examining patient's foot
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When is it time to see a podiatrist about your foot problems? If you are typical, you probably first tried to get relief from your foot pain with over-the-counter insoles. Some people then visit a store that has a pedorthist to get a custom shoe fitting and insole recommendation. Three podiatrists comment on the limitations of these methods and when it is best to see a podiatrist instead.

Podiatrists vs. Pedorthists

Podiatrists are medically and surgically qualified to treat foot and ankle problems.

They can prescribe medication, treatment, and surgery. Their education includes four years of podiatric medical school and three years of hospital residency training. A podiatrist can use the designation DPM (doctor of podiatric medicine). Many also are board certified and may complete further fellowships to specialize in areas of practice.

A pedorthist is an allied health professional. They are not required to have a college education. Their training is in the specialized area of footwear fitting, orthotic design and fabrication, and shoe construction and modification. This training can be done at approved sites and may be done online as well as in person. They then complete 1,000 hours of practical experience to qualify to take the certification exam. Once they pass the exam, they are a certified pedorthist (C.Ped). Some states require a license to practice as a certified pedorthist.

The podiatrists giving their views are:

  • Dr. Brian Harley, Chief of Podiatry, Wellstar Windy Hill Hospital, Marietta, Georgia
  • Dr. Lisa Klemeyer of the Aesthetic Family & Podiatry in Sarasota, Florida
  • Dr. Andrew J. Schneider, Tanglewood Foot Specialists

Symptoms That Need a Podiatrist

The podiatrists noted that you can only get a true diagnosis of the cause of your foot problems by seeing a podiatrist or physician.

While insoles and changes to your shoes may help, this is best done after being assessment by a medical professional. Some symptoms that warrant seeing a podiatrist include:

A podiatrist will use X-ray, ultrasound, and other methods to diagnose the problem. The podiatrist is able to diagnose underlying causes of pain and discomfort that shoes and inserts alone cannot treat. For example, numbness and tingling may be due to diabetic peripheral neuropathy, which might even be the first sign of undiagnosed diabetes. A podiatrist can refer such problems to other physicians or he may specialize in treating diabetic foot problems.

For many orthopedic problems, a podiatrist can prescribe medication, administer injections, prescribe custom orthotic devices, and, when necessary, perform surgery.

Using a Pedorthist

Pedorthists are not licensed to diagnose acute issues, but they are skilled at recommending shoes and insoles. A pedorthist can be consulted when there is a persistent ache or pain when walking or running, according to Dr. Schneider.

"The pedorthist then will be in a good position to recommend a particular shoe, insert, or combination to improve the gait, foot efficiency, and reduce the level of pain."

The podiatrists said that they may refer a patient to a pedorthist after diagnosing a condition that can be treated with shoe modifications or braces. But they say it is best when a pedorthist works together with a podiatric physician.

Visiting a shoe fitting or insole store can be of value. Here are some of the situations noted by the podiatrists:

  • To get a recommendation for a shoe the will maximize the effectiveness of a custom orthotic prescribed by a podiatrist
  • To get a foot analysis and recommendation for an over-the-counter arch support or insole
  • To have a custom insole produced to support your foot properly, which may include casting and molding
  • To have a podiatric prescription filled for diabetic therapeutic shoes and accommodative inserts, custom shoes, and custom modifications to shoes
  • When looking for shoes for specific issues such as flat feet, painful arches, painful heels, bunions, hammertoes, diabetes, and arthritis

Dr. Harley notes that people should not be fooled by over-the-counter or online "custom" orthotics which are not truly custom, just to save some money. "With orthotics and braces, you get what you pay for. You get not only a quality product, but the training behind it which allows the pedorthist to diagnose the problem, determine which materials are needed, and fabricate the inserts properly."

Sources:

Harley, Brian. Email interview. May, 2010.

Klemeyer, Lisa. Email interview. May, 2010.

Schneider, Andrew J. Email interview. May, 2010.

Your Path to Becoming a Pedorthist. Pedorthic Footcare Association. https://www.abcop.org/individual-certification/Documents/ABC%20Pedorthic%20Brochure%202-10-16final.pdf.

What Is a Podiatrist? American Podiatric Medical Association. http://www.apma.org/Education/content.cfm?ItemNumber=992.

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