Podiatrist or orthopedist?
March 23, 2011 11:01 PM   Subscribe

Should I go to a podiatrist or foot/ankle orthopedist for this particular arthritis/toe problem?

I have hallux limitus or something similar--limited movement in my big toe connected to arthritis. This isn't a self-diagnosis, but rather something that a foot doctor of some kind (can't remember which) mentioned to me many years ago when I went to see him about a related issue. He said I had arthritis in the toes on my right foot and so my toes couldn't bend all the way back, which is why I have problems when I am running, with calluses building up on the outside of my big toe. He said he could make me some orthotics, but at the time, $300 was a fortune, so I declined.

I wear mostly comfortable, supportive shoes (especially Dansko clogs), which helps. I have other related foot issues and suspect my plantar fasciitis last winter was probably related to this (though thankfully that is now gone).

It's finally gotten to the point where I want to go back to the doctor to see if there's any way it could be better, or at least not get worse. I'd go to a podiatrist, but I wonder if the arthritis part might warrant an orthopedist who specializes in feet and ankles. But then I'm concerned an orthopedist might be more likely to suggest surgery, which I'd like to avoid.

I have good insurance and can get a second opinion. But I'd like to get some input on where to go first.

By the way, I did see this question, but it's a bit broader than mine.

(I'm in Portland, Oregon, in case anyone has a local doc to recommend.)
posted by bluedaisy to Health & Fitness (9 answers total) 2 users marked this as a favorite
Yeah, the orthopedist rather than the podiatrist. You might want a D.O. instead, but many people lump them in the same quack category that chiropractors and holistic healers occupy. They're fully-licensed physicians though.
posted by clarknova at 11:21 PM on March 23, 2011 [1 favorite]

I'd go to a podiatrist, but I wonder if the arthritis part might warrant an orthopedist who specializes in feet and ankles.

If you have pain, and the podiatrist isn't treating it well enough for your liking, there is no problem in seeing an orthopedic doc for it. Do this.

But then I'm concerned an orthopedist might be more likely to suggest surgery, which I'd like to avoid.

They'll suggest it if it is necessary. Turns out you can't have elective surgery unless you consent to it.

I am all in favor of clarknova's suggestion above. Two of the best orthopedic surgeon's I have seen (in both surgical skill and bedside manner) were DOs and not MDs.

IANAD and TINMA. I base my thoughts on having seen too many people get surgery on everything.
posted by Mister Fabulous at 11:39 PM on March 23, 2011

My advice is to go to a podiatrist at a good teaching hospital. The Medical College of Virginia (MCV) is where I encountered podiatry. The DPM I found there knew feet better than any orthopedist likely would. Some orthopedists do a lot of work on feet, but many are out of their depth with feet. They may be loath to admit it, but I think it is true.

A saying: Orthopedists work on the hips and the knees, and the feet are beneath them.

Podiatrists (good ones) will give conservative therapies most often. My podiatrist made me a pair of orthotics for my numbness problem, and it worked like a charm. He came to this conclusion after a sophisticated tape job indicated that this conservative treatment would be effective.

The key is to find a good podiatrist. The teaching hospital environment is the best place to find one.
Try to get a referral from your GP or another doctor at the hospital. I found no podiatry dept or sub-department at MCV. A referral did the trick.
posted by noonknight at 11:53 PM on March 23, 2011

IANAD, just accident-prone and rickety.

Since you mention arthritis and have the medical coverage, maybe a rheumatologist can help you with the underlying issue, too.

FWIW, both my podiatrist and orthopedist have always mentioned "last resort" in the same breath as "surgery". They're both top-notch, but I take my feet to the podiatrist and my shoulders to the ortho. If your concern is running-related you can find both who specialize in sports medicine. Mine happen to, even though my issues have never been sports-related. (Unless fracturing your foot while playing Wii Baseball counts as a sports-related injury.)
posted by Room 641-A at 12:17 AM on March 24, 2011

IANAD. Just got dx'ed with this a month back when I visited the podiatrist. Same symptoms, the first I noticed was limited flexibility of the big toe when doing forward walking lunges. I asked about therapies -- surgery to clean out the joints (cheilectomy) was presented as a fairly straightforward option, unlike Room 641-A's experience.

The limitation of flexibility is starting to cause pain and affect my gait, and I'm pretty active, so I'm likely going to go in for surgery unless I find any red flags regarding the operation and its success rate. Here's a foot surgery textbook if you have a strong stomach and are interested in the details of cheilectomies.
posted by benzenedream at 1:51 AM on March 24, 2011

It's not an either/or choice; the orthopedic department at my hospital has at least one podiatrist on staff and refers patients to him as appropriate. You might want to look at a large multispecialty clinic to find something like this in your area; Portland should be large enough to have several options.

As for the comment about DO's, they are pretty much indistinguishable from MD's in this area (the SE US). I have worked with a number of DO's in many different specialties and some of them are excellent, most are good, and a few were not so hot; just like MD's.
posted by TedW at 5:56 AM on March 24, 2011

I had something very similar to this corrected by a podiatrist. A few years ago it just got to be too painful walking. I was also building up big callouses on the outside of my foot by overcompensating and walking on that part instead of how I should have been. Apparently my Dad, aunt and uncle had all had the same sort of thing in their big toe region, a bone growth that closes off upward flexion movement.

Went and saw a podiatrist, and scheduled surgery a week later. He went in and removed parts of the bone growth so that my toe could move again. A few years out and I'm fine. I can walk normally again and without pain.
posted by sanka at 5:59 AM on March 24, 2011

Arthritis, I'd see an orthopedist, because they have brilliant ones here in NYC. That's not necessarily relevant to you, though.

I was never offered surgery for an arthritic knee; I was offered physical therapy with potential injections to lubricate the joint if things got worse. Previous injuries, seen orthopedists 8+ times, never offered surgery. They are surgeons, but so are, say, OB/GYNs. Ethical, competent docs won't push useless surgery.
posted by the young rope-rider at 9:03 AM on March 24, 2011

I have hallux rigidus (also discussed in your link) in my right foot, and there are things I cannot do anymore without a lot of pain and without exacerbating the situation to the extent that I would eventually need surgery (and which would involve a very long rehabilitation period (> a year) according to my doctor). Among the things I do not do anymore are (i) wear high heels (which isn't a bad thing, really), (ii) wear soft soled shoes like 'sneakers' (e.g., I wear day hikers with a more rigid sole in the gym), (iii) run (unless I have to, and then under protest from both my knees and my foot).

For this problem, and I cannot overemphasize this, you need to see an orthopedist and preferably one who specializes in feet.

Feel better and good luck!
posted by cool breeze at 3:38 PM on March 24, 2011

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