“He was welcoming and listened well to the concerns I presented. I especially liked that I was able to write down my problem before I came in and he addressed them efficiently. I was diagnosed with a much different problem than I had been given before, and Dr. Hoy explained his simple, methodical method for his diagnosis as we went. I felt extremely cared for and like I will be able to make progress on my problem before I see him again. Definitely see Dr. Hoy if you’ve had problems seeing a general practitioner or orthopedist with no luck. It may be that you need a more specialized opinion.” -Samuel S.
Not Every Foot or Ankle Problem Requires an Orthopedic Referral
When you experience a foot or ankle issue, you may find yourself wondering whether to see a podiatrist or an orthopedic surgeon. Many referral orders simply state “Podiatry or Orthopedics.”
The foot and ankle are an anatomic region, and podiatry is the specialty dedicated to that region. A podiatric 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.
Both orthopedic surgeons and podiatrists care for foot and ankle conditions. The difference is where they specialize.
Many people assume that a fracture or surgical problem automatically belongs in orthopedic surgery. Many people with foot or ankle pain assume they need an orthopedic surgeon or visit a walk-in orthopedic clinic.
A fracture, sports injury, deformity, or surgical problem involving the foot or ankle does not automatically require an orthopedic surgeon. Podiatric physicians are trained to diagnose and surgically treat many of these conditions.
In reality, many common conditions—including heel pain, bunions, ankle sprains, stress fractures, tendon injuries, ingrown toenails, diabetic foot problems, and skin lesions—are routinely diagnosed and treated by podiatrists.
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 is Board Certified in Foot Surgery by the American Board of Foot and Ankle Surgery.
Starting with a foot and ankle specialist often leads to faster diagnosis, more focused treatment, and fewer unnecessary referrals.
Podiatry Encompasses Surgical Care
Podiatric medicine and surgery encompasses operative treatment of appropriate foot and ankle conditions, as well as the conservative care that precedes and follows surgery.
Podiatric Surgery Is Not New
Podiatric surgery has a long history in the United States. The profession’s surgical roots extend well before the modern Doctor of Podiatric Medicine degree. Earlier generations of foot surgeons held degrees such as the Doctor of Surgical Chiropody (D.S.C.), bestowed upon podiatrists starting in 1914, reflecting the profession’s longstanding emphasis on surgical treatment of the foot.
In 1942, the American College of Foot Surgeons was founded to establish surgical standards and competency requirements for physicians practicing foot surgery. The organization is now known as the American College of Foot and Ankle Surgeons (ACFAS).
Over the following decades, podiatric surgical education developed through formal residency training, surgical credentialing, hospital privileges, and increasingly comprehensive treatment of the foot and ankle. The profession evolved from its earlier emphasis on forefoot surgery toward broader foot and ankle surgical practice.
Podiatric surgery is therefore a longstanding component of podiatric medicine that has continued to evolve with advances in education, training, technology, and surgical practice.
What Does This Mean for Patients?
The fact that a condition may require surgery does not automatically transfer the patient to orthopedic surgery.
Podiatrists may evaluate, diagnose, and surgically treat conditions of the foot and ankle within their scope, training, experience, and privileges. The same podiatrist may diagnose a condition, attempt appropriate conservative treatment, determine that surgery is indicated when necessary, perform the procedure, and provide postoperative care.
Just as conservative treatment remains podiatric care, surgical treatment remains podiatric care.
Orthopedic surgeons provide important expertise, and referral or co-management is appropriate when a patient’s particular condition requires expertise beyond the podiatrist’s training, experience, or scope of practice. But the mere fact that surgery is indicated does not make a foot or ankle condition inherently orthopedic.
The appropriate question is not:
“Which specialty is supposed to own surgery?”
It is:
“Which qualified physician is best suited to evaluate and treat this patient’s particular condition?”
Podiatric medicine and surgery includes both the conservative management of foot and ankle conditions and the surgical treatment of conditions for which surgery is appropriate.
Podiatry Encompasses Fracture Care
Fracture care has long been part of podiatric medicine and surgery. Podiatric physicians are trained to evaluate foot and ankle injuries, obtain and interpret appropriate imaging, determine whether a fracture requires immobilization, protected weightbearing, reduction, surgery, or other treatment, and follow patients through healing.
What If I Have a Foot Fracture?
A foot fracture does not automatically mean that you need an orthopedic surgeon.
Podiatric physicians diagnose and manage fractures involving the bones of the foot and ankle, including stress fractures, traumatic fractures, and fractures associated with deformity or other foot conditions. Depending on the injury, treatment may include immobilization, protected weightbearing, serial imaging, reduction, or surgical fixation.
Some fractures may require consultation or co-management with an orthopedic surgeon, particularly when they occur as part of major multisystem trauma, involve injuries outside the foot and ankle, or require expertise beyond the podiatrist’s scope or experience. But an isolated fracture of the foot or ankle does not become an orthopedic condition simply because it is a fracture.
The presence of a fracture does not determine which specialty is appropriate.
The important question is not simply:
“Is it a fracture?”
It is:
“Who routinely evaluates and treats fractures of the foot and ankle?”
Podiatric medicine encompasses the comprehensive medical and surgical care of the foot and ankle, including fractures.
Foot and Ankle Care Should Not Be Divided by Treatment Type
Increasingly, foot and ankle care is divided according to the treatment being considered: physical therapy for nonsurgical musculoskeletal conditions and orthopedics for fractures and surgical conditions. This creates a false division within a specialty that has historically encompassed both.
Podiatry is the comprehensive specialty of the foot and ankle.
Why See a Podiatrist First?
For many isolated foot and ankle problems, beginning with a podiatric foot and ankle physician provides comprehensive evaluation, conservative treatment, and foot-specific surgical expertise while coordinating additional specialty care when needed.
Most orthopedic surgeons care for the entire musculoskeletal system—including the shoulder, spine, hip, knee, elbow, and hand.
Podiatrists devote their education, residency, and daily practice exclusively to the foot and ankle.
For many foot and ankle conditions, seeing a specialist whose training is concentrated entirely on this region may help improve diagnosis, treatment planning, and long-term outcomes.
1. Start With the Specialist Who Treats Feet Every Day
While orthopedic surgeons are trained to treat conditions affecting bones, muscles, ligaments, and joints throughout the body, podiatrists specialize exclusively in the diagnosis, treatment, and prevention of foot and ankle conditions. This means that podiatrists have in-depth knowledge and experience focused entirely on the unique anatomy and biomechanics of the foot and ankle.
The foot contains 26 bones, 33 joints, dozens of tendons and ligaments, major nerve branches, blood vessels, and specialized skin structures—all functioning under body weight with every step.
That complexity often benefits from focused expertise.
Focused Education: Podiatric physicians complete four years of podiatric medical education followed by hospital-based surgical residency focused on foot and ankle medicine, trauma, reconstruction, wound care, and limb preservation.
Comprehensive Care:
A podiatrist also evaluates problems unique to the foot, including:• skin• nails
• biomechanics
• circulation
• diabetic complications
• nerve disorders
• wounds
For conditions like diabetic foot ulcers, Achilles tendonitis, or bunions, a podiatrist’s specialized focus on the foot and ankle makes them the best-equipped professional to provide targeted care and treatment.
2. Less Invasive Care First
One of the key advantages of seeing a podiatrist first is that they prioritize less invasive treatments before resorting to surgery. Podiatrists are experts in non-surgical treatments and can offer solutions such as:
Custom orthotics to correct foot mechanics and alleviate pain.
Physical therapy recommendations to strengthen muscles and improve mobility.
Medications for pain management or inflammation reduction.
Corticosteroid injections to reduce swelling and discomfort in joints or tendons
Extracorporeal shockwave therapy, an evidence-based treatment designed to stimulate healing.
For many foot and ankle conditions, conservative treatment is often the first step regardless of specialty. Podiatrists frequently integrate orthotics, biomechanics, footwear changes, injections, and rehabilitation into treatment planning before surgery is considered. Seeing a podiatrist allows you to explore conservative treatments first, which may resolve the issue without the need for surgery.
3. If Your Foot or Ankle Problem Requires Surgery, Start With a Foot & Ankle Surgeon
If Surgery Is Needed, You Don’t Necessarily Need a Second Referral
One advantage of beginning with a comprehensive foot and ankle physician is that the same evaluation can determine whether your condition requires conservative treatment, further imaging, surgical treatment, or referral to another specialty.
Podiatric surgeons are surgeons.
Podiatric physicians have a long history of surgical treatment of the foot, and modern podiatric residency programs provide postgraduate training in both medical and surgical management of the foot and ankle.
Many Patients Never Need Surgery
Approximately 80–90% of patients seen at Seattle Foot & Ankle Center improve without surgery.
Treatment may include
• imaging
• orthotics
• shockwave
• injections
• immobilization
• bracing
• medications
• rehabilitation
Only when these treatments aren’t appropriate—or don’t provide adequate relief—is surgery recommended.
Both podiatric surgeons and orthopedic foot and ankle surgeons perform foot and ankle surgery. The relevant question is the individual surgeon’s training, board certification, surgical experience, and current scope of practice.
From Forefoot Surgery to Comprehensive Foot and Ankle Surgery
Podiatric surgery initially developed with a strong emphasis on the forefoot, but the scope of surgical practice expanded significantly during the latter half of the 20th century.
By the 1980s, podiatric surgical practice had increasingly expanded into rearfoot procedures. By the early 1990s, podiatric surgical residency programs routinely incorporated ankle surgery, reflecting the profession’s broader development into foot and ankle surgery.
The profession’s surgical literature reflected the change as well. By the early 1990s, approximately 40% of articles in the Journal of Foot Surgery addressed rearfoot and ankle surgery.
The history is important because it demonstrates that modern podiatric surgery cannot accurately be defined simply as forefoot or bunion surgery.
Podiatric surgeons are trained to perform a variety of surgeries specific to the foot and ankle, including:
Reconstructive surgeries for deformities like bunions and hammer toes.
Fracture fixation to repair broken bones in the foot.
Tendon and ligament repairs for injuries such as torn tendons or sprained ligaments.
Skin and nerve surgeries, including neuromas and removal of lesions.
This includes procedures involving:
- forefoot deformity correction
- tendon balancing
- nerve decompression
- diabetic limb preservation
- ulcer-related bone resection
- reconstructive salvage
- metatarsal osteotomies
- revision surgery
Orthopedic foot and ankle surgeons also perform complex foot and ankle surgery. However, podiatric surgeons focus their entire training and surgical volume on this anatomical region. Podiatrists undergo intensive training that focuses exclusively on the foot and ankle, ensuring that they have a deep understanding of foot-specific conditions and the most effective surgical techniques.
4. Foot Problems Often Involve More Than Bones
Many foot problems involve multiple body systems at once.
Examples
heel pain + nerve entrapment
diabetes + wounds
arthritis + deformity
fracture + osteoporosis
callus + abnormal biomechanics
skin lesion + melanoma
A painful foot problem may involve:
- nerve compression
- skin lesions
- ulceration
- tendon dysfunction
- gait imbalance
- vascular compromise
- biomechanical overload
These overlapping systems are central to podiatric evaluation.
Podiatrists offer a comprehensive approach to foot and ankle care, addressing both symptoms and underlying causes of your condition. This means that podiatrists not only treat bone and joint problems but also manage skin conditions, nerve issues, and vascular concerns that are unique to the foot and ankle.
For example:
If you have a foot ulcer, a podiatrist will address both the wound care and the circulation issues that may be hindering healing.
If you suffer from persistent foot pain, a podiatrist will assess biomechanical issues such as arch problems or gait abnormalities and provide solutions like custom orthotics or physical therapy.
Foot problems can involve much more than bones and joints. A comprehensive foot and ankle evaluation may also require assessment of skin, circulation, sensation, biomechanics, tendon function, wounds, and systemic conditions such as diabetes.
5. Foot and Ankle Conditions Treated by Podiatrists
Many patients are surprised that podiatrists treat far more than bunions and toenails.
Podiatrists specialize in treating a wide range of foot and ankle conditions, including:
Sports Injuries & Overuse Conditions
- Ankle Sprain
- Stress Fracture
- Tendon injuries (including overuse and acute tears)
- Plantar fasciitis and Achilles tendonitis
- Heel pain and heel spurs
- Foot and ankle tendon disorders
Structural Foot Problems
- Bunion
- Hammertoes
- Flat feet and high arches
- Foot alignment and biomechanical problems
- Progressive deformities affecting gait and footwear
Nerve Conditions
- Morton’s neuroma
- Tarsal tunnel syndrome
- Peripheral neuropathy (including diabetic neuropathy)
Diabetic Foot Care & Limb Preservation
- Diabetic Ulcer
- Diabetic foot infections
- Charcot Foot
- Neuropathy-related foot complications
- Wound care and infection prevention
- Limb preservation strategies
Skin, Nail & Soft Tissue Conditions
- Ingrown toenails and nail surgery
- Warts
- Skin lesions and melanoma evaluation
- Foot and ankle infections
- Soft tissue masses and inflammation
Bone & Joint Infections / Complex Conditions
- Osteomyelitis (bone infection)
- Complex post-traumatic or chronic infections
- Severe deformity related to infection or neuropathy
A podiatrist can also provide preventive care to help you avoid future foot and ankle issues, especially if you have conditions like diabetes or poor circulation that increase the risk of complications.
6. One Foot & Ankle Specialist From Diagnosis to Treatment
Your evaluation doesn’t have to begin with a decision about whether you need a surgeon.
At Seattle Foot & Ankle Center your care may include
diagnosis
digital X-rays
orthotics
office procedures
shockwave
injections
wound care
surgery if necessary
coordination with physical therapy
coordination with vascular surgery
coordination with endocrinology
7. Orthopedic Surgeons and Podiatrists: Complementary Roles
Orthopedic surgeons play an essential role in treating major trauma, hip and knee disorders, spine conditions, and complex musculoskeletal injuries.
Podiatric and Orthopedic Surgeons: Different Training, Overlapping Expertise
Orthopedic foot and ankle surgeons and podiatric foot and ankle surgeons both provide surgical care. There is substantial overlap between the conditions they treat.
The distinction is not that one specialty performs surgery while the other does not.
Both do.
The educational pathways are different, and individual physicians develop different areas of expertise based on their residency training, board certification, fellowship training, surgical volume, and current practice.
For a problem isolated to the foot or ankle, a physician whose practice is concentrated on that anatomical region can provide focused evaluation and determine whether conservative care, surgery, or referral to another specialist is appropriate.
Thinking About Visiting a Walk-In Orthopedic Clinic?
Walk-in orthopedic clinics can be an excellent option for many musculoskeletal injuries.
However, if your pain is isolated to the foot or ankle, seeing a podiatrist may provide more specialized evaluation from the start.
Many conditions that appear to be simple sprains are actually:
stress fractures
tendon tears
ligament injuries
arthritis
nerve disorders
skin conditions
diabetic complications
Dr. Hoy can diagnose these conditions, order imaging when necessary, begin treatment immediately, and coordinate additional specialty care if required.
Considering Bunion or Hammertoe Surgery?
Many patients searching for an orthopedic surgeon are actually looking for a surgeon who specializes in bunions, hammertoes, neuromas, or forefoot reconstruction.
These procedures are among the most commonly performed surgeries by podiatric foot and ankle surgeons.
Before scheduling surgery, a comprehensive evaluation can determine whether conservative treatment remains appropriate or whether surgery offers the best long-term outcome.
When Should You See a Podiatrist First?
Consider podiatric evaluation first for:
- Heel pain
- Achilles pain
- Plantar Fasciitis
- Ankle Sprain
- Ankle instability
- Stress Fracture
- Flat feet / flatfoot
- Arthritis
- Bunion
- Hammertoes
- Neuroma / Morton’s neuroma
- Tendon injuries
- Diabetic wounds
- Foot infections
- Wart
- Skin lesions and melanoma evaluation
- Calluses (including recurrent calluses)
- Toenail disorders (including ingrown toenails and nail conditions)
- Sports injuries / runner’s injuries / work injuries
- Chronic foot pain
- Nerve pain / neuropathy
- Heel spurs
Foot & Ankle Surgery and Trauma
- Foot fractures
- Ankle fractures
- Stress fractures
- Fracture fixation
- Dislocations
- Tendon injuries
- Ligament injuries
- Forefoot reconstruction
- Revision foot surgery
- Diabetic limb-salvage procedures
Working Together with Orthopedic Surgeons
Orthopedic surgeons are important colleagues, but referral should be based on the patient’s clinical needs—not on a presumption that fractures or surgical conditions automatically belong to orthopedics. Orthopedic surgeons and podiatric foot and ankle surgeons share the goal of providing excellent musculoskeletal care. We appreciate opportunities to collaborate on patients with isolated foot and ankle conditions, while recognizing that many patients with multisystem trauma, proximal lower-extremity injuries, or complex orthopedic disorders benefit from orthopedic expertise. By working together, we can help ensure patients receive timely, specialty-focused care tailored to their individual condition.
Frequently Asked Questions
Not necessarily. Podiatrists are trained to evaluate and treat fractures of the foot and ankle, including determining whether a fracture can be managed conservatively or requires surgical treatment. Depending on the location, severity, complexity, associated injuries, and the podiatrist’s expertise, orthopedic consultation may be appropriate.
A fracture is not automatically an orthopedic condition simply because it is a fracture. The appropriate specialist depends on the injury and the expertise required to treat it.
Not necessarily. Podiatrists are physicians who specialize in the medical and surgical treatment of the foot and ankle. Many foot and ankle conditions can be treated surgically by a podiatrist with appropriate training and experience.
We determine whether surgery is appropriate, whether the condition is within our surgical expertise, and whether another specialist’s expertise would provide a better option for a particular patient.
Start With the Foot & Ankle Specialist
Choosing the right specialist early can shorten recovery, reduce unnecessary referrals, and help you receive the most appropriate treatment from the beginning.
At Seattle Foot & Ankle Center, Dr. J. John Hoy provides comprehensive medical and surgical care for foot and ankle conditions—from diagnosis through recovery. Whether your treatment involves custom orthotics, shockwave therapy, injections, office procedures, rehabilitation, or surgery, your care is coordinated in one place with a focus on helping you return to normal activity as quickly and safely as possible.
If additional specialty care is ever needed, Dr. Hoy coordinates with orthopedic surgery, vascular surgery, infectious disease, endocrinology, physical therapy, and your primary care physician.
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