How to choose an orthopedist or podiatrist if you have diabetes
It is important to have a comprehensive foot inspection done annually by a health care professional and more frequently if you have foot problems. You may not have an orthopedist or podiatrist. But, if you are a person with diabetes, they should be a critical part of your health team.
Orthopedists and podiatrist are both medical specialists. Podiatrists mainly focus on the feet, ankles and lower legs. They also treat and care for diabetics, people with circulation problems and the elderly. Orthopedists can work on all parts of the musculoskeletal system. They can do general orthopedics or specialize in different parts of the body or groups of people. Both are board certified and able to perform surgery.
Finding the right provider will take some time and research, and it is best done before an emergency arises. So, start your search well before you’re due for a checkup.
Things to consider when making your selection include:
- The doctor’s skills and credentials, safety precautions and technology utilized.
- Proximity of the office to your home or workplace.
- Office hours, accepted insurance plans, fees, payment policy and ability to accommodate emergencies.
- A comfortable office environment.
- You want a health care team you like. They should be willing to listen to your concerns, answer your questions, and explain what they’re doing and why.
- If possible, you also want an orthopedist or podiatrist who has experience working with people with diabetes.
An obvious place to begin your search is to ask your friends. Your doctor, Certified Diabetes Educator or pharmacist may also have a list of orthopedists or podiatrists who work with people who have diabetes.
- Call the department of orthopedics at a nearby hospital or university medical center.
- Contact a state or county association of orthopedist or podiatrists. These groups may have lists of foot care professionals with specific information on specialty and experience.
- Find an orthopedist or surgeon
Contact your insurance company or health plan to learn whether it has a list of foot care professionals who are covered under your plan.
Compare your list to the list of providers with whom your insurance company does business. Unless you can personally afford a doctor who does not participate in your insurance plan, there’s no point in finding a great orthopedist or podiatrist who doesn’t take your insurance.
After you’ve narrowed down your list, hit the Internet. Many orthopedist or podiatrists also have websites which will give you information on where they went to school, how long they’ve been in practice, the types of services they offer, if they attend regular conferences or have continuing education, what their treatment philosophy is, even pictures of their office and facilities.
When you call the office, does the receptionist sound professional and courteous? Ask if they are accepting new patients and ask if they have experience working with patients who have diabetes? Are they able to answer your questions? If they seem reluctant to answer your questions that could be a sign of potential trouble in the future; best to move on to your next choice.
When you schedule your appointment be sure to ask what their cancellation policy is. If you do have to cancel your appointment, be sure to do it in the appropriate time frame or you may be charged – not a good way to start a relationship!
The doctor will provide you with intake forms that record your medical history. This may include information about any medical conditions or illnesses you have (or had), medicines you take and allergies you have.
Be sure to tell them you have diabetes, how long you’ve had it, how you control it, your current A1C level, as well as problems (dental or physical) you’ve had recently. If you have had any foot problems, such as:
- Ulcers indicate the location, time to heal, wound care necessary for healing
- Infections: type, bacteria involved, medical treatment necessary
- Amputations: type, time to heal, modalities used in healing process
- Surgeries/Injuries: type, location
Your doctor should follow up on these issues every visit.
Your orthopedist or podiatrist should have your physician's name and phone number so they can contact your physician with any concerns or questions about your treatment.
The doctor will examine your feet paying attention to several areas:
- Structural deformities
- Skeletal
- Vascular
- Skin
- Nerve health.
The doctor will determine if there are any structural abnormalities, such as hammertoes or bunions or bony prominences. They will also make sure you have a full range of motion in your feet and ankles.
They will examine the surface of your feet to see if the skin is in good shape, free of calluses and corns, cracks, dry skin, ulcers, abnormal pigmentation, infections - both fungal (e.g. Athlete’s Foot) or bacterial. They should also examine the areas between your toes and also check your nails for thickness, curvature, coloration and appropriate self care.
An examination to check for the loss of sensation in your feet is conducted with a tuning fork, Biothesiometeror a 10 gram monofilament. The doctor should also check your reflexes particularly at the Achilles tendon.
The doctor will check your feet and ankles for signs of vascular disease by inspecting skin color, looking for temperature differentials and various pulse points.
Video foot exam
If your exam is normal your doctor should provide you with some education about things to look for, as a person with diabetes. If your examination is abnormal your doctor will either treat the condition or refer you to another specialist, such as a vascular surgeon.
Sources
International Consensus on the Diabetic Foot, 2003. International Working Group on the Diabetic Foot (consultative section of the International Diabetes Federation)
University of Texas Health Science Center-San Antonio Texas-Department of Orthopedics-Division of Podiatry
Scott & White Clinic / Texas A&M University System Health Science Center-Department of Surgery, Division of Podiatry
American Diabetes Association: Clinical Practice Recommendations. Diabetes Care. 2004; 27[S1]:63-64.
Updated June 3, 2011
