Physical Therapy vs. Podiatry for Foot Injuries and Problems

Physical therapists and podiatrists are two groups of providers that render treatment to patients with foot and ankle injuries or problems.  We will explore what a podiatric physician and surgeon can offer in addition to a physical therapist for foot and ankle injuries and problems.

Physical therapists evaluate quality of function and movement and utilize methods of strengthening and balance to restore function.  A podiatric physician also evaluates the structure and function of all systems of the foot and ankle and perform or order imaging studies such as x-rays and MRIs if needed to diagnose the problem, and various treatments to address the problem, including physical therapy.

If there are fractures, dislocations or tendon tears, initial immobilization for a certain period of time is needed to help the weight bearing structures to heal.  Podiatrists believe there is a time for activity and therapy, but there is also a time for immobilization, not strengthening and activity from day one.  They will prescribe the proper immobilization if resting the injured part is needed, or strengthening and activity if that is needed.  Physical therapists often promote early activity.  In the case of injury or surgery, there are many cases where early strengthening and balance exercises may be damaging.  It is advisable to seek the opinion of a podiatrist to make sure that one is ready for strengthening and activity.

Patients may have structural problems that lead to painful conditions.  For example, a patient may have a flat, pronated or collapsed arch which may lead to overuse of certain tendons, pain on the bottom of the foot, or deformities such as bunions.  Physical therapists rely on training the foot to move a certain way.  Podiatrists, on the other hand, may correct for these structural problems with biomechanical devices such as custom molded functional orthotics.  Like eyeglasses or contact lenses which modify the angles of light coming into the eye, orthotics modify the angles of gait to lessen the load on certain structures so that pathologic conditions do not progress.

It may take years of physical therapy to come close to the correction a custom orthotic can give.   It is very difficult to replicate and sustain correct neutral joint angles, and it may be too much to expect of the structures, which carry the whole body weight.  One may learn to squint to see, but it is much better to have a pair of glasses or contact lenses to see 20/20.  It is advisable to seek the opinion of a podiatrist to determine if biomechanical correction is indicated.

Thirdly, while physical therapists work on strengthening and balance around injured structures for injuries, one of the most effective modalities that sports medicine podiatrists employ is extracorporeal shockwave therapy, which works to debride and repair damaged tendons and ligaments naturally whether they are acutely injured, or if there is a chronic injury with pain present for a long time.  Further, podiatrists may prescribe medication and perform surgical correction if necessary to address severe conditions such as fractures, tendon ruptures or deformities.  It is advisable to seek the opinion of a podiatrist to determine if these treatments can be helpful.

Physical therapy is important for strengthening after a period of needed immobilization to get back to sports or activities, or if there are weak muscles that need to be strengthened for balance or proper gait. However, physicians and surgeons such as podiatrists should be consulted to treat injuries and foot conditions, as they can assess and treat them, using radiography, immobilization, custom orthotics, medication, extracorporeal shockwave therapy, refer to physical therapy and perform surgery if necessary.

Dr. J. John Hoy is a double board certified podiatrist and foot surgeon who has been in practice since 2000.  He is an Associate of the American Academy of Podiatric Sports Medicine.

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