Podiatrist or Orthopaedist?

Discussion in 'General Fitness' started by Joe, Oct 26, 2003.

  1. Joe

    Joe Guest

    Hello all,

    I recently posted about a slight pain in the side of my left knee since running my first marathon
    (Chicago). I decided I'm going to call a doctor about it this week. Would it be better to see a
    podiatrist or an orthopaedist? As well as getting my knee looked at, I'm thinking I should also
    possibly get some advice on any biomechanical problems I may or may not have. Again, would the
    podiatrist be better or orthopaedist? Thanks.

    Joe
     
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  2. Dot

    Dot Guest

    Joe wrote:
    > Hello all,
    >
    > I recently posted about a slight pain in the side of my left knee since running my first marathon
    > (Chicago). I decided I'm going to call a doctor about it this week. Would it be better to see a
    > podiatrist or an orthopaedist? As well as getting my knee looked at, I'm thinking I should also
    > possibly get some advice on any biomechanical problems I may or may not have. Again, would the
    > podiatrist be better or orthopaedist? Thanks.
    >
    > Joe
    >
    >

    Why not a physical therapist? Your local practitioners may be different, but podiatrists generally
    look only at feet. Orthopedist may provide a bigger picture than podiatrist.

    What some people here, including myself, have found is that the "best" doctor / practitioner may be
    the one that has the interest in finding the cause of the symptom - regardless of their discipline.
    I've had better luck with biomechanical issues with a PT vs podiatrist, othopedic surgeon, or GP. He
    was the only one that took the time to evaluate my gait and identify a bunch of things that were out
    of whack - some structural, some functinal. If there's some inherent bone deformities involved, then
    orthopedist may be more appropriate. YMMV depending on what's available to you.

    Good luck.

    Dot

    --
    "Success is different things to different people" -Bernd Heinrich in Racing the Antelope
     
  3. Doug Freese

    Doug Freese Guest

    Dot wrote:

    > Joe wrote:
    >
    >> Hello all,
    >>
    >> I recently posted about a slight pain in the side of my left knee since running my first marathon
    >> (Chicago). I decided I'm going to call a doctor about it this week. Would it be better to see a
    >> podiatrist or an orthopaedist? As well as getting my knee looked at, I'm thinking I should also
    >> possibly get some advice on any biomechanical problems I may or may not have. Again, would the
    >> podiatrist be better or orthopaedist? Thanks.
    >>
    >> Joe
    >>
    >>
    >
    > Why not a physical therapist? Your local practitioners may be different, but podiatrists generally
    > look only at feet. Orthopedist may provide a bigger picture than podiatrist.
    >
    > What some people here, including myself, have found is that the "best" doctor / practitioner may
    > be the one that has the interest in finding the cause of the symptom - regardless of their
    > discipline. I've had better luck with biomechanical issues with a PT vs podiatrist, othopedic
    > surgeon, or GP. He was the only one that took the time to evaluate my gait and identify a bunch
    > of things that were out of whack - some structural, some functinal. If there's some inherent bone
    > deformities involved, then orthopedist may be more appropriate. YMMV depending on what's
    > available to you.

    I don't know if it varies from state to state but in NY you can not go to a PT without an MD
    referral. In fact most HMO's will not let you go to a specialist(podiatrist or orthopedic) without
    first seeing a GP. Maybe Alaska is less structured with this.

    Regardless, if you have a GP and one that you like and trust start with him/her. If you're not happy
    ask for a referral and then try a specialist or PT.

    No shingle hanging over my door but it sounds like to have strained your ITB(iliotibial band). See
    http://www.time-to-run.com/injuries/thebig5/itb.htm and see if it's a match.

    --
    Doug Freese "Caveat Lector" [email protected]
     
  4. Dot

    Dot Guest

    Doug Freese wrote:
    >
    > I don't know if it varies from state to state but in NY you can not go to a PT without an MD
    > referral. In fact most HMO's will not let you go to a specialist(podiatrist or orthopedic) without
    > first seeing a GP. Maybe Alaska is less structured with this.

    Right, sorta. I spaced that out from my active consciousness (it was definitely in my subconscious).
    My understanding (which could be wrong, and I swear they change things on a monthly basis) is that
    *in Alaska* you don't need a doctor's referral to see a PT, BUT most insurance companies require a
    referral to pay for the services. In my case, the insurance did pay with a referral, but there are
    things where insurance doesn't cover it anyway (like orthotics), so it may not make a difference in
    some cases. It makes a difference whether it's work related or not (they pay *less* for work-related
    injuries). The letter of referral is only valid for 30 days, I think (definitely some insanely short
    time, if you're looking at doing rehab exercises and coming back every few weeks for reappraisal).
    My GP, a mtn runner and biker, wasn't even aware that somebody with the capabilities of my PT
    existed out in the valley where we are. I found the PT through the running shoe store in town - just
    looking for a gait analysis for a shoe fitting.

    Our insurance coverage almost has to be a little more flexible than most since it covers employees
    throughout the state - including bush villages.

    I'm guessing it may depend on what you see a PT for (or chiropractic, for that matter, since they
    sometimes do gait analyses). There's a couple PT's that I'm aware of that are associated with
    running shoe stores (Seattle, sw Va or eastern Tenn, iirc) that do gait analyses, but I'm not
    getting the impression that a doctor's referral is needed for these. *My* PT did a basic gait
    analysis plus some other basic PT-type evaluations, which are probably worthwhile for someone new to
    longer running - head injuries off at the pass before they get started.

    >
    > Regardless, if you have a GP and one that you like and trust start with him/her. If you're not
    > happy ask for a referral and then try a specialist or PT.

    And a little outside homework might be beneficial also if GP is not knowledgeable in that area. At
    least it was in my case.

    Another reason for seeing a GP first is that there may be issues beyond the obvious that a PT would
    not be trained to spot (but not sure if a GP could or not either).

    Dot

    --
    "Success is different things to different people" -Bernd Heinrich in Racing the Antelope
     
  5. Doug Freese

    Doug Freese Guest

    Dot wrote:

    > The letter of referral is only valid for 30 days, I think (definitely some insanely short time, if
    > you're looking at doing rehab exercises and coming back every few weeks for reappraisal).

    Again this may differ from state to state or HMO to HMO but referrals can be short or up to 6
    months. It's up to the GP to set the time span.

    > Our insurance coverage almost has to be a little more flexible than most since it covers employees
    > throughout the state - including bush villages.

    Next thing you going to tell me is Alaska has indoor plumbing. :)

    > And a little outside homework might be beneficial also if GP is not knowledgeable in that area. At
    > least it was in my case.

    Agree big time especially with older vets that did their education before exercise was voluntary and
    reads Condensed Readers Digest, big print, to keep medically current. In addition we also know that
    GP's in HMO's are often spanked for using too many referrals.

    > Another reason for seeing a GP first is that there may be issues beyond the obvious that a PT
    > would not be trained to spot (but not sure if a GP could or not either).

    A good GP "should" know his limitations and pass you on to a specialist but we know there are too
    many cases were it is not true. Where is Josh to help pontificate on this topic. ;)

    --
    Doug Freese "Caveat Lector" [email protected]
     
  6. Dot

    Dot Guest

    Doug Freese wrote:
    > Dot wrote:
    >
    >
    >> The letter of referral is only valid for 30 days, I think (definitely some insanely short time,
    >> if you're looking at doing rehab exercises and coming back every few weeks for reappraisal).
    >
    >
    > Again this may differ from state to state or HMO to HMO but referrals can be short or up to 6
    > months. It's up to the GP to set the time span.

    In this case, I was under the impression that it was either state reg or the receiving physical
    therapist's company. However, this was never an issue, that I remember, with my AT/PF/shoulder 5 yr
    ago (maybe 6 mo of treatment) - BUT that physical therapy operation was the "default" PT that the GP
    recommended - a few doors down in same medical facility and paperwork may have flown more easily.
    The GP *did* set a maximum number of sessions (6) this time, although I'm not sure he ever talked
    with PT, and the treatment ended rather abruptly - although I did have an exercise program to follow
    for eternity. I know what you are going to say, and yes, I'd definitely consider other options, but
    not sure where or who, but keeping ears open.

    >
    >
    >> Our insurance coverage almost has to be a little more flexible than most since it covers
    >> employees throughout the state - including bush villages.
    >
    >
    > Next thing you going to tell me is Alaska has indoor plumbing. :)

    Shhhh! This is a well-kept secret that we use to help control the population a little. See how well
    the threat of bears dealing with course-cutters deals with the number of race participants ;)

    >
    >> Another reason for seeing a GP first is that there may be issues beyond the obvious that a PT
    >> would not be trained to spot (but not sure if a GP could or not either).
    >
    >
    > A good GP "should" know his limitations and pass you on to a specialist but we know there are too
    > many cases were it is not true. Where is Josh to help pontificate on this topic. ;)

    The problem occurs when the injury/disease doesn't fit classical cases or is something unusual where
    the doctor may not recognize limitations. Let's face it, there's a lot of things with similar
    symptoms. I'm saying this from the experience a friend had (using some of the original doctors, PT I
    did with my first situation 5 yrs ago). While we have many specialists up here (including
    Anchorage), there are probably many fields that aren't covered.

    Dot

    --
    "Success is different things to different people" -Bernd Heinrich in Racing the Antelope
     
  7. While you're there, have a proctologist check to see the source of your oily discharge.
     
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