If you have been seeing a dermatologist for a problem involving the skin or toenails, you may wonder what a podiatrist could add to your care.
The answer depends on the problem.
Podiatrists are trained to evaluate disorders of the skin, nails, bones, joints, tendons, ligaments, nerves, and other structures of the foot and ankle. A comprehensive evaluation can sometimes identify a foot or mechanical problem that is contributing to a condition that initially appears to be only a skin or nail problem.
Not every skin or nail problem is purely dermatologic
Foot and toenail problems can have many causes.
For example, changes in a toenail may be associated with:
- Fungal infection
- Repetitive trauma
- Pressure from footwear
- Deformity
- Circulatory problems
- Neuropathy
- Inflammatory disease
- Other medical conditions
Similarly, a painful area of thickened skin may not simply be a skin disorder. It may be caused by a particular pressure point, deformity, abnormal loading pattern, or footwear problem.
A comprehensive podiatric examination can help distinguish these possibilities.
What happens during a podiatric evaluation?
Your podiatrist will examine the affected area and may also evaluate the rest of the foot.
Depending on your symptoms, this can include assessment of:
- Skin
- Toenails
- Foot structure
- Deformities
- Pressure points
- Circulation
- Sensation
- Gait
- Footwear
- Underlying bone and joint problems
The purpose is to determine what is actually causing the problem.
What if the problem really is dermatologic?
Then your podiatrist may recommend dermatologic treatment or referral to a dermatologist when appropriate.
Comprehensive podiatric care does not mean that every skin disorder belongs in podiatry.
Dermatologists have specialized expertise in many skin disorders, and collaboration is appropriate when that expertise is needed.
But it also works in the other direction.
A patient with a foot skin or nail complaint may have an underlying structural, mechanical, neurologic, vascular, or musculoskeletal problem that deserves podiatric evaluation.
Painful calluses, corns, and recurrent skin problems
A recurring callus or corn is a good example of why diagnosis matters.
Removing the thickened skin may provide temporary relief, but if the same location repeatedly experiences excessive pressure, the problem may return.
A podiatrist can evaluate the underlying cause and consider whether treatment should include:
- Footwear modification
- Padding
- Orthoses
- Pressure redistribution
- Treatment of an associated deformity
- Other conservative measures
- Surgery in selected cases
The goal is not simply to remove the visible problem.
It is to understand why it developed.
Toenail problems deserve the same approach
A painful or abnormal toenail may require more than routine nail care.
Depending on the diagnosis, treatment may involve management of infection, trauma, pressure, deformity, or other underlying conditions.
A comprehensive podiatrist can determine whether the nail is the primary problem or a symptom of something else affecting the foot.
You don’t have to choose between specialties
Some patients need both dermatology and podiatry.
For example, a dermatologist may manage a skin disorder while a podiatrist addresses the foot deformity or mechanical problem contributing to symptoms.
The goal is not to determine which specialty “owns” the patient.
The goal is to make sure the patient receives the right diagnosis and appropriate treatment.
Comprehensive podiatry looks at the whole foot
A foot problem may involve much more than the structure that first caught your attention.
A skin lesion may be related to pressure.
A painful nail may be related to footwear or deformity.
A recurrent callus may be related to biomechanics.
A comprehensive podiatric evaluation considers these possibilities rather than assuming that every foot complaint belongs to a single treatment category.
At Seattle Foot and Ankle Center, Dr. Hoy starts with the problem you are experiencing, evaluate the foot and ankle comprehensively, establish the diagnosis, and determine the appropriate treatment. When another specialist’s expertise is needed, we coordinate care rather than ignoring the other parts of the patient’s problem.
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