Podiatrists play an important role in healthcare, treating conditions related to the feet, ankles and lower legs. However, some allied health professionals can offer services that complement or even exceed those of podiatrists in certain areas. This article explores some of the alternative providers that may be preferable over podiatrists for specific foot, ankle and lower leg issues.
Physical Therapists
For some conditions, physical therapists (PTs) can provide more comprehensive treatment than podiatrists alone. PTs take a whole-body approach and focus on restoring strength, mobility, balance and function. They can design customized exercise programs to stretch tight muscles, strengthen weak areas, improve coordination and retrain proper movement patterns. This can often resolve underlying biomechanical causes of foot and ankle pain that podiatrists may not address. PTs may utilize techniques like joint mobilization and soft tissue massage along with therapeutic exercises and modalities like heat, ice and electrical stimulation. For issues like plantar fasciitis, Achilles tendinitis and ankle sprains, physical therapy is frequently the best first-line treatment approach. PTs can also fabricate custom orthotics to support flat feet, overpronation or other biomechanical abnormalities.
Massage Therapists
Massage therapy can provide symptomatic relief and improve circulation for many foot and ankle problems. Manual techniques like trigger point therapy, myofascial release, cross-fiber friction, assisted stretching and joint mobilization can help break up adhesions, reduce swelling, alleviate neuropathic pain and increase range of motion. Massage may be particularly helpful for conditions like plantar fasciitis, ankle sprains, shin splints, neuropathy, rheumatoid arthritis and fibromyalgia that affect the lower extremities. Some massage therapists receive advanced certification in reflexology techniques that apply pressure to reflex points on the feet corresponding to areas throughout the body. Reflexology cannot treat underlying medical conditions, but it can promote general relaxation and wellbeing.
Acupuncturists
Acupuncture involves inserting extremely thin needles into specific points on the body to stimulate the nervous system and release endorphins and other neurochemicals. Scientific research indicates acupuncture can effectively reduce pain and inflammation for numerous musculoskeletal conditions related to the feet, ankles and legs. Acupuncture may enhance outcomes when combined with standard podiatric treatments for heel pain, ankle sprains, shin splints, arthritis, neuropathy and other issues. Some studies show acupuncture provides superior and longer-lasting pain relief compared to corticosteroid injections. Acupuncturists trained in Chinese medicine can also prescribe customized herbal formulas that may accelerate healing after foot and ankle surgery or injury.
Orthotists
Orthotists design and fit specialized foot orthotics and braces based on a biomechanical evaluation. An orthotist may fabricate more effective custom orthotics than a podiatrist provides. Orthotists can also construct ankle-foot orthoses to stabilize weakened or paralyzed muscles in conditions like stroke, multiple sclerosis and neuropathy. Prefabricated orthotics from drug stores often fail to adequately correct some foot and ankle problems. For complex conditions like severe overpronation requiring multilayered orthotics or neuropathy requiring ankle-foot orthoses, visiting an orthotist may produce better outcomes than podiatrist-prescribed supports. However, a podiatrist referral is required for custom orthotics covered by many insurance plans.
Athletic Trainers
For foot and ankle injuries related to sports and exercise, athletic trainers can complement podiatry care. Athletic trainers assess joint range of motion, muscle strength, gait mechanics and functional movement patterns to identify biomechanical causes of overuse syndromes like plantar fasciitis, Achilles tendinitis and shin splints. They develop targeted stretching and strengthening programs to prevent and treat such injuries. Athletic trainers utilize techniques like cryotherapy, heat, TENS, ultrasound, kinesiology taping and manual therapy to accelerate return to activity. For sprains and fractures, they design progressive rehab protocols focused on flexibility, proprioception, balance and sport-specific skills. Athletic trainers typically provide more individualized, ongoing rehabilitation than a podiatrist prescribes post-injury.
Prosthetists
For patients requiring partial or total amputation of the foot or leg, a prosthetist designs and fits the prosthetic limb. Prosthetists have expertise in biomechanics and gait analysis to make prostheses that optimize function and mobility. They select appropriate components like sockets, liners, joints and feet based on factors like activity level and residual limb shape. Prosthetists frequently collaborate with podiatrists to ensure proper fit and alignment that prevents pressure ulcers and mobility complications. However, the prosthetist has specialized skills in prosthetic rehabilitation and maximizing function that exceed most podiatrists’ knowledge. Patients requiring custom ankle-foot orthotics with prosthetic limbs need both a podiatrist and prosthetist’s expertise.
Pedorthists
Pedorthists specialize in foot orthotics and footwear modifications to address foot, ankle and lower extremity conditions. They perform comprehensive foot and gait evaluations to identify biomechanical abnormalities. Based on this assessment, pedorthists may provide custom-molded orthotics, prefabricated orthotics, footwear modifications and protective devices for preventing or treating symptoms. A pedorthist often has more training in footwear prescription and orthotics fabrication than a podiatrist receives. For some patients, visiting a pedorthist first before pursuing podiatry treatment can provide faster relief through proper orthotics and shoes. However, a prescription and oversight from a podiatrist are recommended for any underlying medical conditions.
Occupational Therapists
Occupational therapists (OTs) receive extensive instruction in foot and ankle anatomy, biomechanics and kinesiology during their education. OTs assess feet, ankles and lower legs for limited mobility or function that interferes with daily activities. They can provide foot and ankle flexibility and strengthening exercises, massage techniques, modalities like paraffin wax and whirlpool baths, custom splinting and assistive devices. For conditions like arthritis, diabetes complications, wounds, amputations or neurological issues, OTs design therapeutic activities for increasing strength and range of motion while preventing further injury. OT foot and ankle rehab focuses on safely performing functional tasks like standing, walking and driving. OTs often work closely with podiatrists to complement foot and ankle surgery recovery protocols.
When to Choose Alternative Providers Over Podiatrists
Here are some common situations when these other practitioners may provide better outcomes than podiatrists alone:
- Chronic foot or ankle pain due to muscle weakness or imbalance would benefit from physical therapy to correct biomechanical causes.
- Foot pain, numbness or tingling related to diabetes, arthritis or nerve damage could improve with massage and acupuncture to increase circulation and reduce inflammation.
- Recurring foot issues like plantar fasciitis or shin splints failing to resolve with standard podiatry treatments may benefit from a trained athletic trainer’s rehab program.
- Severe overpronation, high arches or other biomechanical abnormalities might be better managed by custom orthotics from an orthotist rather than an over-the-counter generic insert.
- Partial or total amputation requires a skilled prosthetist to maximize mobility and function.
- Foot and ankle arthritis could improve with occupational therapy joint protection strategies, assistive devices and modifications for daily activities.
Podiatrists remain essential for surgical management of foot and ankle conditions, high-risk foot complications of medical problems and infections requiring antibiotics. However, patients should consider consulting physical therapists, massage therapists, acupuncturists, athletic trainers, orthotists, prosthetists, pedorthists and occupational therapists to address biomechanical causes of pain, maximize non-surgical treatment options, optimize mobility or improve ability to perform functional tasks involving the feet and ankles.
Benefits of a Multidisciplinary Approach
Combining podiatry care with other practitioners for foot and ankle problems provides multiple advantages:
Addressing Root Causes
Podiatrists excel at surgical procedures and recognizing serious foot conditions. However, they may not have the skills of a physical therapist to correct muscle imbalances contributing to problems like plantar fasciitis or Achilles tendinitis. A coordinated treatment approach that combines podiatry and physical therapy has the greatest chance of alleviating pain long term by resolving mechanical causes.
Avoiding Unnecessary Surgery
Alternative approaches like orthotics, massage, acupuncture and physical therapy can sometimes eliminate or postpone the need for podiatric surgery. While appropriate in some cases, foot and ankle surgery carries risks of complications like infections and nerve damage. Non-surgical options managed by other providers may provide similar benefits with less risk.
Improved Function
After injury or surgery, physical therapists, athletic trainers, occupational therapists and prosthetists play crucial roles in restoring mobility, strength, balance, coordination and ability to perform daily foot and ankle functions. A podiatrist initiates treatment, but proper rehabilitation requires a collaborative approach.
Specialization
No single provider can have expertise in all domains involving the foot and ankle. A team approach allows access to providers with targeted advanced training in areas like biomechanics, orthotics, braces, prosthetics, sports medicine, manual therapy, therapeutic exercise, gait analysis, footwear modifications, assistive technology and rehabilitation.
Holistic Care
Alternative medicine providers like massage therapists and acupuncturists address the whole person, not just isolated symptoms. They provide education on lifestyle factors like diet, exercise, stress management and proper footwear that podiatrists may overlook. A comprehensive outlook focuses on long-term wellbeing and prevention.
Insurance Coverage
Physical therapy, occupational therapy, massage therapy, acupuncture and custom orthotics from certain providers may be covered services under health insurance plans. This can make alternative treatments more financially accessible when combined with podiatry care.
Selecting the Right Provider Team
Building an integrated foot and ankle care team requires choosing appropriate specialists. Use these tips to find the right practitioners:
- Ask your podiatrist to recommend experienced physical therapists, occupational therapists, massage therapists, acupuncturists, orthotists or prosthetists they collaborate with routinely.
- Look for therapists and alternative medicine providers with advanced certifications related to the feet and ankles.
- Seek orthotists credentialed by the American Board for Certification in Orthotics, Prosthetics and Pedorthics.
- Find prosthetists certified by the American Board for Certification.
- Select pedorthists certified by the American Board for Certification.
- Verify massage therapists have training in myofascial techniques, neuromuscular therapy or orthopedic massage.
- Check provider reviews online and ask for referrals from past patients.
- Interview potential team members about their experience treating your specific condition.
- Communicate with your insurance company about coverage for each provider.
- Ensure the podiatrist will communicate and collaborate directly with the other practitioners.
Assembling a cohesive healthcare team for optimal foot and ankle treatment requires research and diligence. But comprehensive multidisciplinary care is well worth the effort for enhancing outcomes.
Podiatry vs. Orthopedics for Foot and Ankle Care
While podiatrists specialize in foot and ankle care, orthopedic doctors also treat conditions involving the lower extremities. What are the differences and when is one preferable to the other?
Training and Specialization
After medical school, podiatrists complete a 3-4 year surgical residency focused on the foot and ankle. Orthopedic surgeons undergo 5 years of post-graduate training covering the entire musculoskeletal system. While orthopedists can perform foot and ankle surgery, podiatrists have more specialized expertise. However, orthopedic surgeons are better equipped to address connections between foot/ankle problems and issues affecting other joints or the spine.
Scope of Practice
Podiatrists diagnose and treat disorders exclusively affecting the ankles and below. Orthopedic doctors address conditions throughout the entire body’s muscles, bones, joints and ligaments. Podiatrists have a narrower domain, allowing greater concentration on foot and ankle care.
Surgical Procedures
Both podiatrists and orthopedic surgeons can provide surgical treatment for foot and ankle issues like hammertoes, bunions, fractures, sprains and arthritis. However, podiatrists typically have more extensive surgical experience and training specific to the foot and ankle.
Non-Surgical Care
In addition to prescribing medications and orthotics, podiatrists may provide treatments like wound care, physical therapy, and soft tissue mobilization. Orthopedic doctors focus more on surgery and less on conservative management. For non-operative treatment, podiatrists often provide more comprehensive options.
Collaborative Care
Podiatrists frequently work closely with orthopedists when foot and ankle disorders have connections to other lower body joints. They may co-manage treatment of conditions like plantar fasciitis related to knee, hip or back issues. Orthopedic doctors consult podiatrists when the foot or ankle is the primary problem.
Insurance Coverage
Health insurance plans often group podiatry and orthopedics into different categories. Check benefits to see if one field has better coverage than the other for services needed.
When to See Each Provider
Here are some general guidelines on choosing between podiatry and orthopedics:
- See a podiatrist for isolated foot and ankle problems without connection to other joints.
- Visit an orthopedist for conditions also affecting knees, hips or spine along with the feet/ankles.
- Use a podiatrist as the lead specialist for primary disorders of the feet and ankles.
- Select an orthopedist if the main issue centers on joints above the ankles.
- Consult a podiatrist first for bunions, hammertoes, heel pain, diabetic foot care or infections.
- See an orthopedist initially for ankle sprains or fractures that may require surgery.
Both fields offer expertise in foot and ankle care. Understanding their distinct roles helps identify the most appropriate provider for specific problems.
Conclusion
Podiatrists remain a cornerstone of treatment for many foot and ankle conditions. However, incorporating other specialists like physical therapists, massage therapists, orthotists and athletic trainers into care can enhance outcomes. A coordinated, multidisciplinary approach addresses complex foot and ankle disorders from multiple angles for more effective long-term relief. While podiatrists focus on surgical interventions and serious foot conditions, alternative providers help resolve biomechanical causes of pain, optimize mobility, maximize non-operative options and improve overall foot and ankle function. With appropriate diagnosis and oversight from podiatrists, other practitioners help fill gaps in foot and ankle care for more comprehensive treatment.
