The foot and ankle are an anatomic region, and podiatry is the specialty dedicated to that region. A foot and ankle physician can first evaluate the problem, establish the diagnosis, and determine the appropriate course of care. When additional expertise is needed, that care can be coordinated as part of the treatment plan. Unfortunately, podiatry is often associated with routine foot care and toenail trimming. Musculoskeletal conditions of the foot and ankle have long been part of comprehensive podiatric medicine. Podiatrists diagnose and treat these conditions using both conservative and surgical approaches.
Dr. Hoy provides individualized foot and ankle rehabilitation for appropriate musculoskeletal conditions, including tendon disorders, plantar heel pain, ankle instability, bone stress injuries, and sports-related overuse conditions. Rehabilitation may be provided as part of podiatric care or coordinated with physical therapy when additional or specialized rehabilitation is appropriate. Learn more about Foot & Ankle Rehabilitation.
The historical record shows that surgery was a part of podiatric medicine throughout its history well before the modern Doctor of Podiatric Medicine degree, as demonstrated by its Doctor of Surgical Chiropody degree, bestowed upon podiatrists starting in 1914. While medically necessary at-risk foot care is an important component of podiatric practice, it represents only one part of contemporary podiatric medicine and surgery.
At Seattle Foot and Ankle Center, Dr. J. John Hoy has practiced comprehensive foot and ankle medicine and surgery for 26 years. His practice includes conservative and surgical treatment of foot and ankle disorders, with particular experience in reconstructive foot surgery, sports medicine, biomechanics and deformity, diabetic limb preservation, and wound care.
For referring providers, the more important question is:
When should a patient with a foot or ankle problem be evaluated by a podiatric physician?
A podiatric physician is a physician whose education, residency training, and clinical practice are dedicated to the diagnosis and treatment of conditions affecting the foot and ankle. Early podiatric involvement can help establish a diagnosis, initiate appropriate conservative treatment, identify conditions requiring urgent attention, and determine when surgical or multidisciplinary care is appropriate.
Podiatry Is a Medical and Surgical Specialty of the Foot and Ankle
Podiatric physicians complete four years of podiatric medical school followed by postgraduate residency training in podiatric medicine and surgery. The scope of contemporary podiatric practice encompasses the medical, biomechanical, and surgical management of diseases and disorders of the foot and ankle.
Dr. Hoy is board certified by the American Board of Foot and Ankle Surgery (ABFAS) and board certified by the American Board of Podiatric Medicine (ABPM). His training and 26 years of clinical experience encompass both medical and surgical management of foot and ankle conditions.
Depending on the physician’s individual practice and training, this may include:
- Medical evaluation and diagnosis
- Biomechanics and gait analysis
- Sports medicine
- Diabetic foot and limb preservation
- Wound management
- Fracture and injury care
- Tendon and soft-tissue disorders
- Deformity
- Foot and ankle surgery
- Prevention of ulceration and amputation
- Conservative treatment before surgery whenever appropriate
The common denominator is not nail care. The common denominator is comprehensive foot and ankle medicine and surgery.
Podiatry should not be viewed as a routine foot-care or “nail-trimming” service. It is a medical and surgical specialty devoted to the foot and ankle.
Consider Podiatry Earlier in the Foot and Ankle Referral Pathway
Foot and ankle problems are sometimes managed through fragmented referral pathways.
A patient with heel pain may be sent directly to physical therapy. A patient with a suspected stress fracture may be sent to orthopedics. A patient with a diabetic foot wound may be directed to wound care. A patient with a tendon disorder may see another specialist before the underlying foot and ankle mechanics are evaluated.
Those referrals may be entirely appropriate in individual circumstances. However, many foot and ankle conditions can be evaluated initially by a podiatric physician who can determine the appropriate treatment pathway and coordinate care with other specialists when necessary. For primary care physicians and other referring providers, this can make podiatry an important first-line specialty for many foot and ankle conditions—not simply a destination for routine foot care or surgical cases.
The concern is not that these specialties should be excluded from foot and ankle care. The concern is that a patient may be directed into a specialty pathway before the foot and ankle have been comprehensively evaluated. When the diagnosis is uncertain, referral to a podiatric physician can provide an opportunity to evaluate the entire foot and ankle, establish the diagnosis, begin appropriate treatment, and determine whether additional specialty care is needed.
Podiatry should be part of the referral pathway—not a specialty patients reach only after other treatment pathways have failed. Do not bypass the foot and ankle physician simply because a condition appears to belong to another specialty. A foot and ankle problem may ultimately require physical therapy, orthopedics, vascular care, wound care, dermatology, or another specialty. The important question is whether the patient has first received an appropriate foot and ankle diagnosis and treatment plan.
Referral to podiatry does not mean that the patient needs surgery. It means the patient is being evaluated by a physician whose practice is focused on the foot and ankle.
When to Consider Referral
Consider referral to a podiatric physician when a patient has:
- Persistent foot or ankle pain without a clear diagnosis
- Recurrent symptoms despite initial treatment
- Suspected stress fracture or other foot injury
- Tendon or ligament disorders of the foot or ankle
- Plantar heel pain that is persistent or recurrent
- Forefoot pain, neuroma, or sesamoid disorders
- Bunions, hammertoes, or other progressive deformity
- Biomechanical or gait-related problems
- Sports-related foot or ankle conditions
- Diabetic foot concerns
- Peripheral neuropathy affecting the feet
- Peripheral arterial disease affecting the feet
- Foot wounds or ulcers
- Charcot neuroarthropathy
- Recurrent ulceration or pressure areas
- Painful or limiting deformity
- Conditions that may require surgical evaluation
- A foot or ankle problem for which the appropriate referral destination is unclear
A referral does not commit the patient to a particular treatment. The purpose of the evaluation is to establish the diagnosis and determine the appropriate next step.
Evaluation Does Not Mean Surgery
Referral to a foot and ankle surgeon does not mean that surgery is the expected outcome.
Comprehensive podiatric evaluation commonly begins with diagnosis and conservative treatment. Depending on the condition, treatment may include:
- Activity modification
- Footwear modification
- Over-the-counter or custom orthotics
- Bracing
- Physical therapy when appropriate
- Stretching and strengthening programs
- Medication
- Injection therapy
- Extracorporeal shockwave therapy (ESWT)
- Wound care
- Offloading and preventive care
Surgery is considered when conservative treatment is unsuccessful, when structural correction is indicated, or when the condition requires operative management.
The objective is not to perform surgery. The objective is to determine what the patient needs.
At-Risk Foot Care Is Medical Care
Routine foot care can be medically necessary for patients with diabetes, peripheral neuropathy, peripheral arterial disease, previous ulceration, amputation history, or other qualifying conditions.
However, the procedure itself is only one component of appropriate podiatric care.
A comprehensive evaluation may also assess:
- Circulation
- Protective sensation
- Skin integrity
- Pressure areas
- Deformity
- Footwear
- Gait and biomechanics
- Risk for ulceration
- Early signs of infection or tissue breakdown
For high-risk patients, recognizing a problem before an ulcer, infection, or amputation develops may be more important than the routine procedure performed during the visit.
Conditions We Evaluate and Treat
Many patients are surprised to learn that podiatric physicians routinely evaluate and manage:
- Charcot neuroarthropathy
- Diabetic foot complications
- Foot wounds and ulcers
- Foot deformities
- Sports injuries
- Heel pain
- Bunions
- Hammertoes
- Neuromas
- Achilles tendon disorders
- Stress fractures
- Arthritis
- Flatfoot
- High-arched feet
- Tendon disorders
- Peripheral neuropathy
- Peripheral arterial disease affecting the feet
- Ingrown toenails
- Balance-related foot problems
- Forefoot reconstruction when indicated
Every podiatrist develops an individual practice focus, so services vary among physicians. Patients should ask about the experience and clinical interests of the podiatrist they are considering.
What the Referring Provider Can Expect
The goal of a referral is to answer a clinical question and establish an appropriate treatment pathway.
Depending on the presentation, evaluation may include:
- A focused history and physical examination
- Review of prior imaging and diagnostic studies
- Weight-bearing or other appropriate radiographs when indicated
- Biomechanical assessment
- Vascular and neurologic assessment when appropriate
- Diagnosis and differential diagnosis
- Initial conservative treatment
- Surgical assessment when indicated
- Recommendations for follow-up or coordination with the referring provider and other specialists
When additional specialty care is appropriate, the patient can be directed to the appropriate provider rather than being managed within podiatry simply because the problem involves the foot.
Why Refer to Dr. J. John Hoy?
Dr. J. John Hoy has provided comprehensive foot and ankle care for 26 years. His practice combines medical, biomechanical, rehabilitative, and surgical approaches rather than limiting care to a single procedure or treatment category.
His clinical experience includes reconstructive foot surgery, forefoot surgery, sports medicine, biomechanics and deformity, diabetic limb preservation, wound care, and conservative treatment of foot and ankle disorders. Dr. Hoy is board certified by ABFAS and board certified by ABPM.
The goal is to evaluate the patient comprehensively, establish the diagnosis, and determine the appropriate treatment—whether that means conservative care, rehabilitation, preventive care, wound management, coordination with another specialist, or surgery.
Referral Does Not Have to Be Complicated
If you are uncertain whether a foot or ankle problem belongs in podiatry, referral for evaluation can be appropriate.
The question does not have to be:
“Does this patient need surgery?”
It can simply be:
“Would a foot and ankle physician help establish the diagnosis and treatment plan?”
If the answer may be yes, an evaluation can provide the additional clinical perspective needed to determine the next step.
An Office-Based Comprehensive Foot and Ankle Practice
Seattle Foot and Ankle Center is a Seattle-based, office-based practice providing comprehensive foot and ankle medical and surgical care. Dr. J. John Hoy has been practicing comprehensive podiatric medicine and surgery for 26 years and is board certified by ABFAS and board certified by ABPM.
Dr. Hoy’s practice emphasizes accurate diagnosis, conservative treatment whenever appropriate, biomechanics and deformity, sports medicine, diabetic limb preservation, wound care, and appropriate reconstructive and forefoot surgery.
The goal is to provide patients with a comprehensive evaluation and a clear treatment pathway rather than treating an isolated symptom or procedure.
The Goal Is Better Patient Care
The goal of comprehensive podiatric care is not to replace other healthcare professionals or to perform surgery whenever possible. It is to ensure that patients with foot and ankle problems receive timely evaluation by a physician whose practice is focused on these conditions.
Depending on the diagnosis, the appropriate treatment may be conservative care, preventive care, wound management, rehabilitation, collaboration with another specialist, or surgery.
Podiatric care may also involve coordination with primary care, endocrinology, vascular medicine, wound care, physical therapy, orthopedics, or other specialists when their expertise is needed.
The goal is not to keep every foot and ankle problem within podiatry. The goal is to identify the right diagnosis, involve the right expertise, and establish the right treatment plan as early as possible.
Podiatry Should Be Better Integrated Into Foot and Ankle Care
Modern podiatric medicine has evolved far beyond the traditional public perception of routine foot care. Podiatric physicians receive extensive medical and surgical education and postgraduate residency training focused specifically on the foot and ankle. Yet podiatry is still sometimes bypassed in referral pathways because of outdated perceptions of the profession.
That disconnect matters. Patients should not have to discover that a podiatric physician can provide comprehensive foot and ankle medical and surgical care only after being redirected through multiple specialties. Podiatry should be appropriately integrated into the healthcare system as a recognized medical and surgical specialty of the foot and ankle.
The goal is not to increase referrals for the sake of referrals. The goal is to make sure patients reach the appropriate foot and ankle physician early enough to receive an accurate diagnosis and an appropriate treatment plan.
Referring a Patient
If you have a patient with a foot or ankle condition that would benefit from focused evaluation, we welcome referrals from primary care, family medicine, internal medicine, endocrinology, vascular medicine, wound care, physical therapy, sports medicine, and other healthcare professionals.
Patients may also be referred when the diagnosis is uncertain, symptoms are persistent or recurrent, conservative treatment has not produced the expected improvement, or surgical evaluation is being considered.
Referral for evaluation does not presume surgery. It provides the patient with access to a physician whose practice is focused on the foot and ankle. If you are a referring provider in Seattle and are uncertain whether a patient’s foot or ankle problem requires podiatric evaluation, we welcome the referral. A diagnosis-first referral is appropriate even when surgery is not being considered.
Seattle Foot and Ankle Center
Dr. J. John Hoy, DPM
Comprehensive Foot and Ankle Medicine and Surgery
In pain? Don’t wait. Early treatment leads to faster recovery. Urgent appointments available. Read about Conditions We Treat. Request an Appointment 5am-5pm M-F or online. Call: 206-682-8741 or Contact Us. If you like our content, please link it to your website and Collaborate With Us. Thank you.