When Should You Actually See a Podiatrist?

The foot is where skin disease and joint disease meet, and not always in obvious ways. A skin lesion that looks routine on the arm behaves differently on the sole, where the body's weight presses on it all day. Arthritis that looks well controlled on lab tests can still wear down the joints at the base of the toes. And a nail that looks like a cosmetic problem may have a structural cause underneath.

From Dermatology: When the Foot Changes the Equation

Plantar warts (warts on the sole) that shrug off standard topical therapy are the referral we see most often from dermatology. The thick skin on the sole forms a barrier. Drugstore products, and even the acids we apply in the office, struggle to get through it. We combine approaches, including careful paring of the thickened skin and chemical cautery (an acid that destroys the wart tissue). When a lesion looks unusual, we biopsy it (remove a small sample for testing) rather than guess.

Problem nails come next. Recurrent ingrown toenails that keep coming back. Thick, misshapen nails that need a procedure. Fungal nails that have not responded to antifungal pills or creams. For stubborn fungal nails, laser treatment offers another path, and we are candid that results vary from person to person.

Corns and calluses that return no matter how often they are trimmed usually have a structural cause. A hammertoe. A prominent bone at the ball of the foot. A bone spur underneath. Trimming the callus helps for a while. Addressing the bone spur or the deformity is what tends to last.

From Rheumatology: When Systemic Disease Hits the Foot

Gout (a painful buildup of uric acid crystals in a joint) favors the joint at the base of the big toe. Flares are treated with medicine, usually by the rheumatologist (arthritis specialist) or the family doctor. The chronic consequences are where we help: tophi (hard lumps of those crystals) that make shoes impossible, skin breaking down over the deposits, and stiff joints. Special padded orthotics and roomier shoes come first. Small, superficial deposits can sometimes be removed in the office under local anesthesia. Larger or deeper ones are referred.

Rheumatoid arthritis forefoot deformity (joint damage at the front of the foot) follows a familiar pattern. The joints at the base of the toes slip out of place. Bunions and hammertoes form as the joints erode. Walking becomes more painful year by year. Custom orthotics and roomy, padded shoes carry most patients a long way. When a deformity becomes disabling and needs a full open reconstruction, we refer to a colleague who does that work in a hospital. We do not.

Plantar fasciitis versus enthesitis is a distinction that matters. In the spondyloarthritis family (inflammatory diseases of the spine and joints), heel pain can look like classic plantar fasciitis (an inflamed tissue band under the heel). It may in fact be inflammation where the tendon or ligament anchors to bone. That needs a different treatment plan, and often a rheumatologist's input.

How to Refer

We work with dermatologists and rheumatologists across the region. See our dermatology referral page and rheumatology referral page for specifics, or start at our referral hub.

Learn more from the American Academy of Dermatology and the American Podiatric Medical Association.