“Dr. Hoy helped me with my foot issue. He was even able to diagnose and give me advice on an ankle problem that no physical therapist had been able to crack. Highly recommend.” -Patricia M.
Seattle Foot and Ankle Center practices comprehensive podiatric medicine and surgery. That includes the evaluation, diagnosis, and treatment of musculoskeletal disorders of the foot and ankle, whether surgical or nonsurgical.
Rehabilitation is an important component of foot and ankle care when clinically appropriate. Physical therapy is one way rehabilitation may be delivered, but it is not the default destination for every nonsurgical musculoskeletal foot-and-ankle condition.
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. 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. When additional expertise is needed, that care can be coordinated as part of the treatment plan.
Podiatry Is More Than Surgery and Routine Foot Care
Podiatry is the comprehensive medical and surgical specialty of the foot and ankle. It is not limited to routine nail and skin care, and it is not limited to surgery.
Podiatrists are trained to diagnose and treat musculoskeletal conditions of the foot and ankle using both conservative and surgical approaches. A bunion, hammertoe, tendon disorder, plantar fasciitis, metatarsalgia, ankle sprain, or fracture does not become a different specialty’s condition simply because the treatment is nonsurgical or because surgery may eventually be necessary.
We believe the foot and ankle should be evaluated comprehensively, with treatment determined by the diagnosis rather than by a fragmented referral pathway.
Conservative Care Is Still Podiatric Care—and Is Not Synonymous With Physical Therapy
Podiatric medicine has never been limited to surgery. Podiatrists are trained to manage foot and ankle conditions conservatively and surgically. Exhausting appropriate conservative treatment before considering surgery is a fundamental part of responsible medical and surgical care. Dr. Hoy is Board Certified by the American Board of Podiatric Medicine in non-surgical foot and ankle care.
Conservative treatment does not mean physical therapy. Depending on the diagnosis, conservative podiatric treatment may include activity modification, footwear changes, orthotics, bracing, immobilization, off-loading, medication, injections, shockwave therapy, rehabilitation, physical therapy, or other interventions.
Physical therapy is one treatment modality within this continuum. It does not define all nonsurgical musculoskeletal care.
Activity modification does not mean giving up. Changing footwear does not mean avoiding activity. Orthotics do not inherently “weaken” the foot. These are clinical tools that may be appropriate for particular diagnoses and stages of treatment.
The appropriate treatment depends on what is causing the problem, not simply on whether the condition has been labeled “musculoskeletal” or “nonsurgical.”
Your Visit May Not Begin With Exercises
Patients sometimes arrive expecting that treatment for a foot or ankle problem will begin primarily with exercises. Rehabilitation can be valuable, but exercises are only one component of treatment.
Depending on your diagnosis, your treatment plan may instead begin with protecting an injured structure, modifying activity, changing footwear, addressing abnormal pressure, using an orthotic or brace, obtaining imaging, treating inflammation or pain, or addressing a structural problem. Rehabilitation may be added when it is appropriate.
Our job is not to prescribe a predetermined treatment category. Our job is to determine what your foot or ankle actually needs.
Diagnosis Comes Before Rehabilitation
Rehabilitation is an important treatment—but it should be based on the correct diagnosis.
Physical therapy is one important form of rehabilitation, but rehabilitation may also be prescribed and managed as part of comprehensive podiatric care. Physical therapy has an important role in foot and ankle care, but direct access to physical therapy has changed the referral pathway—not the role of podiatry as the comprehensive medical and surgical specialty of the foot and ankle. When the diagnosis is uncertain or the condition has not been evaluated, starting with a comprehensive podiatric evaluation can prevent a treatment pathway from being determined before the underlying problem is understood.
Many foot and ankle problems are initially treated in physical therapy as “simple” overuse injuries. But pain does not always equal a rehabilitation problem.
- A heel injury may be a stress fracture.
- An ankle sprain may involve tendon tearing or cartilage injury.
- Arch pain may reflect progressive tendon failure.
- Heel pain may actually be a ruptured plantar fascia.
- Foot numbness may be coming from your back, diabetes, systemic disease or nerve entrapment.
Before Rehabilitation Begins, the Diagnosis Should Be Clear
Many referrals simply recommend “Physical Therapy or Podiatry” for foot and ankle pain. While physical therapists are experts in rehabilitation and restoring function, many foot and ankle conditions that appear to be plantar fasciitis, tendonitis, or a simple ankle sprain may actually involve fractures, tendon tears, nerve disorders, arthritis, or biomechanical problems that require different treatment.
Before beginning rehabilitation, it’s important to know exactly what you’re treating. Starting with a podiatric foot and ankle physician helps establish an accurate diagnosis, order imaging when needed, begin appropriate medical treatment, and determine when and how rehabilitation should begin. Rehabilitation may be provided through an individualized podiatric program, physical therapy, or a combination of both. 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.
1. Start With the Foot & Ankle Specialist
Podiatrists are physicians specializing in the comprehensive medical and surgical care of the foot and ankle. Their role is not limited to determining whether surgery is necessary. They evaluate, diagnose, and treat foot and ankle conditions using conservative, rehabilitative, procedural, and surgical approaches as appropriate. Physical therapists bring specialized expertise in rehabilitation and movement and may be an important part of that treatment plan. Podiatrists may also prescribe and manage individualized foot and ankle rehabilitation when appropriate.
Podiatrists are medical doctors (DPMs) who specialize in diagnosing and treating conditions specifically related to the feet, ankles, and lower extremities. Unlike physical therapists, who focus on rehabilitation and movement, podiatrists have advanced training in the medical, surgical, and biomechanical aspects of foot and ankle health.
Why This Matters:
Dr. John Hoy is an expert in foot and ankle anatomy, functions, and conditions. Whether you’re dealing with a simple issue like plantar fasciitis or something more complex like fractures, tendonitis, or arthritis, podiatrists have the expertise to provide accurate diagnoses and a wide range of treatments, including medications, orthotics, and even surgery if necessary.
2. Diagnosis Changes Treatment
When you’re experiencing foot pain, it can be tempting to try to “walk it off” or seek temporary relief with stretching and strengthening exercises. A podiatric physician evaluates the structure and function of all systems of the foot and ankle and can perform or order imaging studies such as X-rays, CTs, and MRIs to accurately diagnose the problem. Treatment may include medications, orthotics, rehabilitation, non-surgical interventions, or surgery, depending on the condition. Physical therapists have specialized expertise in rehabilitation, movement, and functional recovery. Podiatrists diagnose the underlying foot and ankle condition and determine whether treatment should include protection, rehabilitation, orthotics, medication, procedures, surgery, physical therapy, or a combination of approaches. Podiatrists like Dr. Hoy take a holistic approach by thoroughly assessing the condition with diagnostic tools like X-rays, MRIs, and physical exams.
Common examples include:
- Plantar fasciitis symptoms caused by stress fracture
- “Ankle sprains” caused by peroneal tendon tears
- Achilles pain caused by insertional degeneration or rupture
- Flatfoot pain caused by posterior tibial tendon dysfunction
- “Neuroma” pain caused by metatarsal instability
Without identifying the true cause, rehabilitation may be delayed, less effective, or directed at the wrong condition.
Rehabilitation Is One Important Treatment Option
Rehabilitation can be highly effective when it is appropriate for the diagnosis and integrated into an appropriate treatment plan. Physical therapy may be an important component of that rehabilitation when additional or specialized therapy is appropriate.
After diagnosis, rehabilitation can be highly effective for:
- individualized foot and ankle rehabilitation
- post-surgical rehabilitation
- restoring motion after immobilization
- balance training
- strengthening after tendon injury
- gait retraining
- improving flexibility and function
Why This Matters:
A proper diagnosis is essential for effective treatment. Physical therapists provide valuable expertise in rehabilitation and movement. Podiatrists provide the medical and surgical evaluation needed to determine what condition is being treated and which combination of treatments is appropriate.
3. Surgical Expertise for Severe Conditions
Most foot and ankle conditions do not require surgery. When surgery is appropriate, it should be considered as part of the same comprehensive podiatric treatment continuum—not as a transfer to a different specialty simply because the treatment has become surgical.
Why This Matters:
If your condition requires surgery, physical therapists do not have the qualifications to perform such procedures. Dr. Hoy’s surgical training allows him to offer you the best options for a full recovery. Whether it’s a simple procedure or a more complex reconstruction, you’ll benefit from the advanced skills that a podiatrist brings to the table.
4. Rehabilitation Is One Tool—Not the Entire Treatment Plan
A comprehensive podiatric treatment plan may include:
• diagnosis
• imaging
• immobilization
• medications
• injections
• orthotics
• shockwave
• individualized rehabilitation and physical therapy when appropriate
• surgery only when necessary
Dr. Hoy considers all aspects of your foot and ankle health, including biomechanics, posture, gait, and specific injury types. From prescribing custom orthotics to performing advanced therapies like shockwave therapy, a podiatrist offers a targeted solution that goes beyond just managing pain.
Why This Matters:
A personalized treatment plan designed by a podiatrist addresses the root cause of your discomfort, not just the symptoms. When physical therapy is appropriate, a podiatrist can coordinate with the therapist as part of the overall treatment plan. When appropriate, rehabilitation may instead be prescribed and managed as an individualized podiatric program.
5. Prevent Future Foot and Ankle Problems
Many recurring injuries are not “bad luck.” They often result from persistent biomechanical overload, footwear mismatch, instability, or untreated deformity. Sometimes the best treatment isn’t another exercise—it’s removing the abnormal force causing the injury.
Podiatric evaluation helps identify these drivers before they become chronic.
Foot and ankle issues often don’t occur in isolation. Many conditions, such as plantar fasciitis, flat feet, or heel pain, are caused by imbalances in posture, gait, or even footwear. A podiatrist is trained to spot these underlying issues and offer solutions that not only treat your current symptoms but also help prevent future problems. Many conditions, like plantar fasciitis or flat feet, result from biomechanical issues. Podiatrists can immediately correct these problems using proper footwear and custom orthotics, which restore alignment and prevent further injury. These interventions address mechanical and structural factors that may need to be treated alongside rehabilitation.
Why This Matters:
Rehabilitation can address strength, movement, and functional capacity, while podiatric evaluation can identify structural, biomechanical, footwear, and loading factors that may need to be addressed alongside rehabilitation. By examining your walking patterns, footwear, and overall foot health, Dr. Hoy can offer preventive care that minimizes the risk of recurring injuries, ensuring long-term foot health.
6. Comprehensive Care for a Wide Range of Conditions
Whether you’re dealing with a common issue like a bunion, or more complex conditions like neuropathy, diabetic foot care, or Achilles tendinitis, podiatrists are equipped to offer specialized care. Podiatrists treat a broad spectrum of foot and ankle issues, from minor ailments to more severe, chronic conditions. Advanced treatments, such as extracorporeal shockwave therapy, medications, or surgical correction, may be employed to address tendon, ligament, or structural injuries—ensuring both acute and chronic conditions are treated effectively.
Some foot conditions cross multiple medical categories at once.
For example:
• Skin problem + abnormal pressure
• Neuropathy + diabetes
• Heel pain + inflammatory arthritis
• Tendon injury + flatfoot deformity
• Stress fracture + osteoporosis
One diagnosis often leads to another. A podiatrist evaluates these together rather than in separate referral silos.
Why This Matters:
Physical therapy may be one component of treatment; comprehensive podiatric care addresses the entire foot and ankle condition and determines which combination of treatments is appropriate. If surgery, medication, or advanced therapy is needed, a podiatrist can offer these interventions as part of a comprehensive care plan.
Signs You Should See a Podiatrist
Consider seeing a podiatrist first if you have:
- swelling that is worsening
- pain lasting more than 2–3 weeks
- difficulty bearing weight
- bruising after injury
- recurrent ankle sprains
- visible deformity
- numbness or burning
- diabetic foot wounds
- pain that returns despite therapy
- pain at night
- popping sensation
- sudden swelling
- fever
- redness
- worsening numbness
- thick callus
- diabetic foot
- recurrent injuries
- previous failed PT
In many cases, rehabilitation works best when based on a clear diagnosis and appropriately integrated with the rest of the treatment plan. Physical therapy may be part of that rehabilitation when appropriate.
For injuries such as fractures, dislocations, or tendon tears, initial immobilization may be required to allow proper healing. Physical therapy without proper immobilization can worsen the condition. Podiatrists understand anatomy and healing requirements, prescribing immobilization, activity modifications, or rehabilitation as appropriate.
A podiatric evaluation establishes the diagnosis and overall treatment plan. Rehabilitation may then be prescribed directly as part of podiatric care, provided through physical therapy, or coordinated between the two when appropriate. If you have weak muscles or require rehabilitation after surgery or immobilization, Dr. Hoy may recommend physical therapy as part of your treatment plan. In fact, podiatrists often prescribe exercises themselves or work closely with physical therapists to ensure optimal recovery.
Physical therapy is an important tool, often prescribed or coordinated by a podiatrist. This ensures exercises are appropriate for your specific condition and are integrated with other treatments, such as orthotics, immobilization, or surgery, for optimal recovery.
The Best Rehabilitation Starts With the Right Diagnosis
Starting with the right diagnosis can save time, reduce frustration, and improve recovery. As foot and ankle specialists, podiatrists have the training and expertise to accurately diagnose your condition and create a comprehensive, personalized treatment plan that may include conservative therapies, surgical options, or both.
At Seattle Foot and Ankle Center, Dr. J. John Hoy believes rehabilitation is one of the most valuable treatments available—for the right diagnosis and at the right stage of recovery.
By beginning with a comprehensive foot and ankle evaluation, patients receive an accurate diagnosis, appropriate imaging when necessary, and a personalized treatment plan that may include individualized rehabilitation, physical therapy, custom orthotics, shockwave therapy, injections, surgery when needed, or coordination with other specialists.
Rehabilitation Is Part of Foot and Ankle Care—Not the Definition of It
Rehabilitation is an important part of modern foot and ankle care, and we provide individualized rehabilitation when appropriate. We also work with physical therapists when additional or specialized rehabilitation is appropriate.
But comprehensive podiatric care does not begin with the assumption that every nonsurgical musculoskeletal problem belongs in physical therapy.
We evaluate the foot and ankle, establish the diagnosis, and determine the appropriate treatment. That may include conservative care, rehabilitation, physical therapy, procedures, or surgery.
Treatment modality does not determine professional ownership. The foot and ankle remain the specialty we are trained to diagnose and treat.
Take the first step toward healthier feet and ankles. Trust Dr. John Hoy to provide the expert care you deserve.
Working Together with Physical Therapists
Physical therapists play a vital role in restoring strength, mobility, balance, and function following injury or surgery. We value collaborative care and frequently incorporate rehabilitation into comprehensive treatment plans. When patients present with persistent pain, uncertain diagnoses, or symptoms that are not improving with therapy, we provide specialized medical evaluation and determine whether the diagnosis or treatment plan needs to change. When physical therapy is appropriate, we coordinate rehabilitation as part of the overall podiatric treatment plan.
Frequently Asked Questions
If you have a new, persistent, worsening, or unexplained foot or ankle problem, a comprehensive podiatric evaluation can establish the diagnosis and determine whether rehabilitation or physical therapy is appropriate. Rehabilitation may be prescribed directly as part of podiatric care, provided through physical therapy, or combined with other treatments.
A physical therapist can clinically identify or suspect plantar fasciitis and begin appropriate rehabilitation within their scope of practice. A podiatric physician can establish the medical diagnosis, evaluate for alternative causes, determine whether imaging is appropriate, and develop the overall treatment plan.
Usually no.
However, an X-ray is often important before or at the start of treatment if there is concern for:
Stress Fracture
Significant trauma
Persistent heel or midfoot pain
Deformity (bunions, arthritis changes)
A podiatrist determines whether imaging is needed before PT begins safely.
Yes—potentially.
If a stress fracture is not diagnosed early, continued loading (even “gentle rehab”) can worsen it.
That’s why suspected Stress Fracture cases should be:
Diagnosed first
Often immobilized or offloaded before rehab begins
Yes. A podiatrist can prescribe physical therapy when appropriate and may also provide or manage an individualized foot and ankle rehabilitation program directly.
Post-surgical rehab
Plantar Fasciitis
Achilles tendinopathy
Ankle sprains
Gait abnormalities
Strength and balance deficits
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.
Yes, especially if:
Pain or swelling is significant
You cannot bear weight normally
It is not improving after 5–7 days
You have repeated sprains
A podiatrist can evaluate for:
Ligament tears
Occult fractures
Syndesmotic (“high ankle”) sprains
Instability requiring bracing or rehab
Ankle Sprain is often underestimated and benefits from early structured management.
Yes—but with limitations.
For Bunion deformity:
PT can reduce pain
Improve toe mobility
Strengthen intrinsic foot muscles
Improve gait mechanics
However, PT cannot reverse the structural deformity. If the bunion is progressive or painful, a podiatrist evaluates whether orthotics, injections, or surgery are appropriate.
It depends on the plan:
Many PPO plans: No referral required
Some HMO plans: Referral required (often PCP or specialist)
Medicare: typically requires physician involvement for plan-of-care certification
Workers’ comp / injury cases: often require physician oversight
Even when not required, many insurers still expect documentation of a medical diagnosis for PT coverage.
Not necessarily. Physical therapy may be an important part of your treatment, but it is not automatically required for every foot or ankle problem. Your treatment plan depends on the diagnosis and may include activity modification, footwear changes, orthotics, bracing, immobilization, medication, procedures, physical therapy, surgery, or a combination of treatments.
Because podiatric medicine includes both conservative and surgical treatment of foot and ankle conditions. Nonsurgical does not mean non-podiatric. A podiatrist can determine whether your condition is best treated with conservative care, rehabilitation, physical therapy, a procedure, surgery, or another approach.
Yes. Rehabilitation is part of comprehensive foot and ankle care. Depending on the diagnosis and treatment needs, Dr. Hoy may provide an individualized rehabilitation program that includes therapeutic exercise, progressive strengthening and loading, balance and movement training, gait retraining, and graded return to activity. When additional or specialized therapy is appropriate, rehabilitation may be coordinated with a physical therapist.
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.
Proprioception from Chicago Health SMB Brands on Vimeo.
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.