One of the largest parts of our practice is the treatment of injuries and sports medicine. Dr. Hoy is an independent medical examiner for the State of Washington and is on multiple medical panels to evaluate the treatment progress for workers throughout the State. In this capacity, he reviews hundreds of workplace and other injuries. The practice also sees many, many patients for workplace and sports injuries. Because of this unique expertise, Dr. Hoy finds that many foot and ankle injuries are inadequately treated, primarily because a referral to a podiatric foot and ankle specialist is not made early enough. Dr. Hoy addresses some of the most common misconceptions that lead to improper care.
1) “There is nothing that can be done for a broken foot.”
Many times patients come into the office who were told that they did not have a fracture, but a simple x-ray showed an obvious fracture. The truth of the matter is there is a lot that can be done for a broken foot. At the very least, a podiatric x-ray can be taken to determine if it is a displaced fracture, angulated fracture or gapping. If there is a severe fracture, surgery may be needed to reduce the fracture, or it may need to be closed reduced without surgery. Immobilization is also important for healing. Our office provides methods of properly immobilizing a fracture, including casts and special healing shoes called post-op shoes. We also provide surgical interventions for acute fractures and chronic fractures that have healed wrong. A proper assessment and treatment can prevent problems down the line.
2) “If I can walk, it’s not broken.”
It is possible to weight bear on a fractured foot or ankle. This is why many of the fractures that are diagnosed as mal-aligned and delayed in healing come from those who having been walking on them for weeks or months. There are certain giveaways for a possible fracture, such as a pop, redness, swelling or bruising, but these not necessary for a fracture. Many times fractures can only be diagnosed through imaging studies such as x-rays. If fractures are not dealt with in a timely fashion, it could lead to a malunion, where the bone heals incorrectly, or a non-union, where bone fragments close off unhealed.
3) “They didn’t find a fracture, so they just sent me to physical therapy.”
The podiatrist is the specialist for the foot and ankle and should be consulted first with a foot and ankle injury to ensure the proper diagnosis and referral to physical therapy when necessary, and with more specific instructions for the therapist. Oftentimes emergency room or urgent care physicians will have patients follow up with their primary care physicians. The primary care physicians, in turn, will usually order physical therapy when they do not see a fracture but do not know what the diagnosis is. However, physical therapists cannot order studies such as MRI’s, CT’s to accurately diagnose the pathology, nor perform surgery if needed. Therapy exercises may worsen the injury. The physician who ordered the physical therapy without proper diagnosis or obtaining specialty opinion is responsible for directing the therapist, and this lack of specialty care commonly leads to poor outcomes. Patients should ask to be referred for specialty examination first with a podiatric foot and ankle specialist for a more complete treatment plan which may include physical therapy.
4) “I thought orthopedic surgery was the specialty for fractures and injuries.”
Today’s podiatrists are trained as foot and ankle surgeons. Read a discussion of differences between the two professions. Today, more and more orthopedic groups employ podiatric foot and ankle surgeons for their specialized care. Dr. Hoy works with many orthopedic surgeons on the panels for the State. For the most part, these specialists seek the input of podiatry when it comes to treating the foot and ankle. The profession of podiatric medicine and surgery is the medical profession that exclusively deals with treating the foot and ankle through medical, biomechanical and surgical means. Orthopedic surgery deals with bones and joints throughout the body and is not as specialized. Because of this, it is important to seek the proper care so that the injury is not minimized or written off in importance.
Foot and ankle injuries can be treated properly if they are detected early enough and seen by the right specialist. For these reasons, it is highly recommended to have injuries checked out early by calling our office, to prevent problems down the line with the improper healing of fractures or soft tissue injuries, such as to skin, ligaments, tendons or nerves.