If you have foot or ankle pain, you may wonder: Should I see a podiatrist or a physical therapist?
The answer depends on what is causing your pain and what kind of care you need.
Physical therapists play an important role in treating many musculoskeletal conditions, particularly when rehabilitation, strengthening, mobility, balance, or movement retraining is needed. Podiatrists, however, are physicians specializing in the diagnosis and medical and surgical treatment of conditions affecting the foot and ankle.
When the cause of foot pain is unclear, symptoms keep returning, or you have not improved with self-care, the first step is often a comprehensive foot and ankle evaluation.
Once the diagnosis is established, physical therapy and rehabilitation may be an important part of the treatment plan.
At Seattle Foot and Ankle Center, Dr. J. John Hoy takes a diagnosis-first approach: determine what is causing the problem, then develop treatment based on the specific condition.
Dr. Hoy provides individualized foot and ankle rehabilitation based on the diagnosis, stage of the condition, and functional goals. Learn more about Foot & Ankle Rehabilitation.
Podiatrist or Physical Therapist: What’s the Difference?
The distinction is easiest to understand by considering the different roles each professional can play.
What Does a Podiatrist Do?
A podiatrist is a physician specializing in the foot and ankle.
A podiatrist can evaluate foot and ankle pain, establish a diagnosis, order and interpret appropriate diagnostic studies, provide medical treatment, prescribe orthotics or bracing when indicated, perform procedures, and perform foot and ankle surgery when necessary.
A podiatrist can evaluate problems such as:
- Heel pain and plantar fasciitis
- Achilles and other tendon disorders
- Stress injuries and fractures
- Bunions and hammertoes
- Neuromas and nerve-related foot pain
- Arthritis and joint problems
- Recurrent ankle sprains and instability
- Sports and overuse injuries
- Biomechanical and gait-related problems
- Diabetic and high-risk foot conditions
- Wounds and other conditions affecting the foot and ankle
Most importantly, a podiatrist can determine what condition you actually have before deciding which treatment is appropriate.
What Does a Physical Therapist Do?
Physical therapists specialize in rehabilitation and movement.
Depending on the diagnosis, physical therapy may address:
- Muscle weakness
- Loss of mobility
- Balance and proprioception
- Joint stiffness
- Tendon loading and strengthening
- Movement and gait patterns
- Neuromuscular control
- Recovery following injury or surgery
- Return to running or sports
- Functional limitations
For many foot and ankle conditions, these are valuable components of recovery.
The question is not whether physical therapy is useful.
It is.
The question is whether rehabilitation is the appropriate first step for the particular problem—and that often depends on having an accurate diagnosis first.
When Should I See a Podiatrist First?
A podiatrist may be the better first choice when you are not sure what is causing your foot pain.
Consider starting with a podiatric evaluation if:
- You have unexplained foot or ankle pain
- Pain has persisted despite rest or changing shoes
- Symptoms keep coming back
- You have swelling, bruising, or significant tenderness
- You suspect a stress fracture or other injury
- You have recurrent ankle sprains
- You have a visible deformity such as a bunion or hammertoe
- You have numbness, burning, or other nerve symptoms
- Pain is interfering with walking or exercise
- You have already tried treatment without improvement
- You are not sure whether you need physical therapy, orthotics, medication, a procedure, or another treatment
In these situations, the priority is establishing the diagnosis.
Diagnosis Comes Before Rehabilitation
Foot pain is a symptom, not a diagnosis.
Heel pain, for example, can have multiple causes. Similarly, pain around the ankle could result from a tendon problem, ligament injury, stress injury, arthritis, nerve irritation, or another condition.
Those problems may require very different treatments.
If the diagnosis is uncertain, starting rehabilitation without first determining what is wrong may not be the most efficient approach.
A diagnosis-first evaluation provides a framework for deciding what should happen next.
What If My Primary Care Physician or Urgent Care Refers Me Directly to Physical Therapy?
Sometimes a primary care physician or urgent care clinician may refer you directly to physical therapy when you have foot or ankle pain, particularly when the problem appears to be musculoskeletal and there is no obvious need for emergency care.
Physical therapy can be very helpful for many foot and ankle conditions. However, a therapy referral does not necessarily establish the underlying diagnosis.
Foot and ankle pain can have many different causes, including tendon and ligament injuries, stress injuries, arthritis, nerve problems, fractures, deformities, biomechanical problems, and other conditions that may require a more specialized foot and ankle evaluation.
If the diagnosis is unclear, a podiatrist may be the more appropriate first step.
A podiatrist can evaluate the foot and ankle, determine the likely source of the problem, and decide what type of treatment is appropriate. Depending on the diagnosis, that treatment may include physical therapy, home exercises, footwear changes, orthotics, bracing, shockwave therapy, medication, imaging, or other care.
This does not mean that a referral to physical therapy was inappropriate. It means that the right treatment depends on the right diagnosis.
For example, rehabilitation may be an excellent treatment for tendon problems, ankle instability, certain overuse injuries, and many biomechanical conditions. But other problems may require imaging, immobilization, a change in activity, orthotic support, or treatment directed at a structural or neurologic condition.
If you were referred directly to physical therapy but your foot or ankle pain is persistent, recurrent, worsening, associated with significant swelling or difficulty bearing weight, or simply has not been clearly diagnosed, a comprehensive foot and ankle evaluation may be appropriate.
The goal is not to choose between podiatry and physical therapy. The goal is to start with the right diagnosis and then use the treatment—or combination of treatments—that best fits the condition.
When Is Physical Therapy the Right Choice?
Physical therapy can be an excellent treatment when rehabilitation is appropriate for the diagnosis.
For example, a patient recovering from an ankle injury may benefit from progressive strengthening, balance training, proprioceptive exercises, and return-to-sport progression.
Someone with a tendon disorder may benefit from a carefully progressed loading program.
A runner recovering from an overuse injury may need strength training, movement modification, and a gradual return-to-running program.
In these situations, physical therapy can be an important part of successful treatment.
The diagnosis tells us what needs to be rehabilitated.
What If I’ve Already Seen a Physical Therapist?
If you have completed physical therapy and your foot pain has not improved, that does not necessarily mean physical therapy was the wrong treatment.
It may mean that the problem needs to be reassessed.
Persistent symptoms can occur when:
- The original diagnosis was incomplete or incorrect
- There is an underlying structural problem
- A tendon or ligament injury requires additional evaluation
- A stress injury has not been recognized
- Foot mechanics are contributing to continued symptoms
- The rehabilitation program needs to be modified
- Another condition is causing the pain
A foot and ankle evaluation can help determine what is happening and what should come next.
What If My Podiatrist Recommends Physical Therapy?
That is often a sign that the treatment plan is being tailored to the diagnosis.
Not every foot problem needs an orthotic.
Not every foot problem needs medication.
Not every foot problem needs surgery.
And not every foot problem needs treatment directly in a podiatrist’s office.
Sometimes the best treatment is rehabilitation.
For example, a patient with ankle instability may benefit from progressive strengthening and neuromuscular training. A patient with a tendon disorder may need a structured loading program. An athlete returning from injury may need a carefully progressed return-to-sport plan.
In these situations, physical therapy can complement podiatric care rather than compete with it.
What About Orthotics?
Orthotics are another example of why diagnosis should come first.
Some foot and ankle problems may benefit from an orthotic or brace. Others will not.
An orthotic should not simply be prescribed because someone has “foot pain.” The examination should determine whether altered foot mechanics are contributing to the patient’s symptoms and whether an orthotic is likely to help.
Depending on the situation, an over-the-counter device may be sufficient. In other cases, a custom orthotic may provide the level of control needed.
The diagnosis determines whether an orthotic belongs in the treatment plan.
What About Shockwave Therapy?
Shockwave therapy can be useful for selected chronic tendon and soft-tissue conditions, including some cases of plantar heel pain.
But shockwave therapy is not a diagnosis and should not be used simply because someone has persistent foot pain.
An evaluation should first determine whether the condition is appropriate for shockwave treatment.
This is another example of why treatment should follow diagnosis rather than the other way around.
A Better Question: What Does My Foot Pain Need?
Instead of asking only, “Should I see a podiatrist or physical therapist?”, consider asking:
“Who can determine what is causing my foot pain, and what treatment does that diagnosis require?”
Sometimes the answer is a podiatrist.
Sometimes the answer is physical therapy.
Often, the best care involves both.
A podiatrist can establish the diagnosis and determine whether medical, biomechanical, rehabilitative, procedural, or surgical treatment is appropriate. When rehabilitation is indicated, physical therapy can provide the specialized exercise and movement-based care needed to restore function.
That is not fragmented care.
That is coordinated care based on a diagnosis.
Why Start With a Foot and Ankle Evaluation?
The foot and ankle are a specialized anatomical region with many possible causes of pain.
Two people can have pain in exactly the same location and require completely different treatments.
One may need rehabilitation.
Another may need an orthotic.
Another may have a stress injury that requires activity restriction.
Another may have a structural deformity.
Another may need treatment for a nerve or joint problem.
And occasionally, surgery may be the appropriate treatment.
The goal of an evaluation is to determine which situation applies to you.
Foot and Ankle Care in Seattle
At Seattle Foot and Ankle Center, Dr. J. John Hoy provides comprehensive evaluation and treatment for foot and ankle conditions, including musculoskeletal and sports injuries, biomechanics and deformity, heel pain, orthotics, shockwave therapy, high-risk foot care, and foot surgery.
Treatment begins with understanding the problem.
When rehabilitation is appropriate, it can be incorporated into the overall treatment plan. When another treatment is more appropriate, the plan can be adjusted accordingly.
Still Wondering Whether You Need a Podiatrist or Physical Therapist?
If you have persistent, recurring, or unexplained foot or ankle pain, you do not have to figure out the diagnosis yourself.
Start with a comprehensive foot and ankle evaluation.
Dr. J. John Hoy can evaluate the problem, establish the diagnosis, and determine whether your treatment is best managed with rehabilitation, orthotics, other conservative care, a procedure, surgery, or a combination of approaches.
The right treatment starts with the right diagnosis.
Schedule a Foot and Ankle Evaluation
Frequently Asked Questions
Neither profession is universally “better.” Podiatrists and physical therapists provide different types of care. A podiatrist can diagnose and medically treat foot and ankle conditions, while physical therapists specialize in rehabilitation and movement. For unexplained or persistent foot pain, a podiatric evaluation can establish the diagnosis and determine whether physical therapy should be part of the treatment plan.
A direct referral to physical therapy can be appropriate for certain musculoskeletal problems, but physical therapy does not replace a diagnostic evaluation when the cause of foot or ankle pain is uncertain.
If your symptoms persist, recur, worsen, or have not been clearly diagnosed, a podiatrist can perform a comprehensive foot and ankle evaluation and determine whether rehabilitation is appropriate or whether another type of treatment is needed.
In many cases, physical therapy may ultimately be an important part of your treatment plan. The important point is that treatment should follow diagnosis.
If you do not know what is causing your foot pain, starting with a comprehensive foot and ankle evaluation can be helpful. Once the diagnosis is established, physical therapy may be recommended if rehabilitation is appropriate.
Yes. Depending on the condition, a podiatrist may recommend physical therapy as part of the overall treatment plan. Rehabilitation can address strength, mobility, balance, tendon loading, neuromuscular control, gait, and return to activity.
Physical therapists are trained to evaluate movement and musculoskeletal problems within their scope of practice. However, some foot and ankle conditions require medical diagnosis and management. If symptoms are persistent, unusual, worsening, or not responding to rehabilitation, a comprehensive medical foot and ankle evaluation may be appropriate.
If your symptoms have not improved, the diagnosis and treatment plan may need to be reassessed. A podiatrist can evaluate for structural problems, tendon or ligament injuries, stress injuries, nerve conditions, joint problems, biomechanical factors, and other potential causes.
Yes. Podiatrists treat many foot and ankle sports and overuse injuries. Treatment may include activity modification, rehabilitation, orthotics or bracing, shockwave therapy for appropriate conditions, and other conservative or surgical treatments depending on the diagnosis.
Not necessarily. Orthotics are appropriate for some conditions but are not a universal treatment for foot pain. An examination can determine whether altered foot mechanics are contributing to your symptoms and whether an orthotic is appropriate.
Absolutely. In many cases, coordinated care is beneficial. A podiatrist can establish the diagnosis and medical treatment plan, while a physical therapist can provide specialized rehabilitation when indicated.