Even though they go through a lot of schooling, is the field still a little mystical?
Even though they go through a lot of schooling, is the field still a little mystical?
I don't think so.
I think podiatrists have a somewhat sketchy reputation among runners because (much like primary care doctors) much of their training and practice is not in treating people who are generally active but injured. Therefore many (not all) of them have a limited set of tools to address runners who go to them w/ injuries.
Podiatrists are not quacks, but are very limited in what they can do. Podiatrists are only trained on the lower extremities (everything below the knee, basically). In some states, they are limited to just the foot.
Podiatrists often overstep their abilities and try to treat running issues because they want to expand their market. I got a bad diagnosis from a podiatrist that was very costly to my training. Had I gone straight to an ortho, there wouldn't have been a problem.
Chiros are more likely to be quacks, but can also be excellent at treating soft tissue injuries. The real problem with Chiros is that insurance companies pay them a fraction of what doctors get. So, Chiros will want to see you three times a day for the rest of your life if you have a sore calf muscle.
But, then again, I have been to see some pretty big time sports doctors (team docs for pro sports teams, colleges, etc.), and they generally don't want to spend time with runners unless they get to cut you open. They make more money cutting than they do examining you and working with a PT on an injury.
My experience with podiatrists:
- Patient: "My [insert any anatomical location] is painful."
- Podiatrist: "You need orthotics."
It seems most do not work with runners on finding the true cause of injury or doing any rehab - they just give orthotics and "problem solved..."
I don't think they are qucks, but under no circumstances should you ever let one cut on you. That's what orthopedic surgeons are for.
I love how chiropractors are called quacks, when their method of treatment is to address and correct the problem that is occurring within your body, while allopathic doctors, who pump you full of drugs to merely treat the symptoms of illnesses are the "respected" ones.
A chiropractor has totally saved and restored my mobility twice in my life... once my lower back from a bad snowboarding accident, and once my neck that was injured in a car accident. I didn't have health insurance either time, and the combined cost of all my adjustments was under 1000 dollars.... a very small price to pay to get back on my feet again (literally). The surgery that the original doctor I went to for my neck injury wanted to perform would have cost me about 18k, and wouldn't have been as effective as the 10 chiro sessions I went through.
My 2 cents.....
Um.... allopathic doctors treat diseases every day, not only symptoms. The reason they are more respected is because they base their treatments on science and evidence...not anecdotes. Sorry you couldn't get into medical school, dude. It's ok...most people don't.
Evodevo nailed it.
Even though podiatrists aren't great for runners (I personally prefer to see an orthopedist [he runs as well so that's a plus]), they do base their work off of rigorous science. Chiros probably WOULD base their work off of rigorous studies but unfortunately alternative treatment methods are poorly and infrequently studied.
Chiros may help, but they do base their work off of individual, anecdotal evidence.
As a podiatric surgeon I can tell you with full confidence that orthopedic surgeons are NOT the ones who should be doing surgery on your foot. I have been involved in dozens of revisional foot surgeries (as well as ankles - yes podiatrists do LOTS of ankle surgery, including ankle joint replacements) where we had to correct work that was haphazardly done by an orthopod. Orthopods are great for knees, shoulders and hips but their training is extremely limited when it comes to the foot & ankle. Our residency years are dedicated to that one "limited region" and we are therefore far superior to orthopods in that domain. So when you say we shouldn't be allowed to cut you open, you'll be singing a different tune when you need us to revise the orthopedic doc's work because he's only done 50 foot surgeries while we've done over a thousand.
Graduating here this saturday and starting residency July 1st
As I have said before on these boards...The biggest problem with the field I chose is that there is a disparity in training from podiatrists of the past compared to today, and unfortunately lower standards to get in and so sometimes lower quality people. A lot of classmates came in because they couldn't get into MD programs, where as I, and a very few of my classmates, turned them down and went into this. I have seen a lot of awesome podiatrists, as well as (more than I'd like to admit) some really bad ones, and they ruin the reputation
Scope is limited because specialization is earlier and they don't want to integrate into MD schools and just make it a separate residency because well...money, power, politics, and it is a bit of an odd profession focusing on a body part and not just a system like the standard medical setup.
Majority of states podiatry is foot, ankle and related soft tissue structures. Full prescribing rights, full OR privelages, etc. So yea, a cardiologist isn't going to manage your diabetes, but the flip side is that he can go directly into a endocrinology residency if s/he wanted to switch. Pods would have to start right from square one. I have rotated in the ER, infectious disease, internal medicine, orthopaedics, and on and on this year and did the exact same stuff the other medical students did. Start residency and I won't be on podiatry service for the first 8-9 months, starting out on all the other services, like all other residencies, and patients will know I am their resident doctor and report to my attending like everyone else.
Quacks...definitely not. Unfortunately, some pods have poor or inconsistent training so they clip toenails and push orthotics to make money because it's all they know and it ruins the public perception of things.
I had bunion surgery on 03-30-10. It is helping a LOT. Though my big toe is still quite numb...
Frankly, for most running injuries, you are not likely to get great advice from most MDs or podiatrists. The reasons are many, but the 2 biggies are that the vast majority of training and practice is spent on non-running issues, and a lack of comparative trials for high-level performance issues. Plus, mpst will not understand that running less is ok temporarily, but not a valid long-term solution for most serious runners.
Want to know which blood pressure meds work well for preventing strokes in hypertensives, or whether open gall-bladder surgery is more dangerous than laproscopic surgery? That they can tell you, based on large randomized trials. Want to know the best way to treat knee pain in a runner? There the evidence all becomes of a far lesser quality- case series, expert opinion, "in my experience...", worked for a friend, etc. Plus, since most injuries get better with time, many things may seem to work, when really it is just the time and rest doing the job.
Back to podiatrists: I deal with infectious diseases, so I find them very helpful to refer patients to who need their diabetic foot ulcers cleaned up, or to get me a sample of bone so I know what to treat. But if its a serious infection, involving more than the toe (which they can snip off as well as anyone), I would far rather have the orthopedists on board. There is an accronym often repeated among the orthopedists: APFU. Another podiatry F up.
softie wrote:
Even though they go through a lot of schooling, is the field still a little mystical?
To call the field "mystical" is absolutely insane. We work through the same principles that regular allopathic physicians follow based on anatomy, physiology and biomechanics. Our training, after undergrad, involves 4 years of medical school (the first 2.5 years are identical to allopathic medical school except we don't take a course in psychology, we then go on internal medicine, vascular surgery, neurology, infectious disease and reconstructive foot/ankle surgery rotations) followed by 3 years of reconstructive foot and ankle surgical residency training. The pods of maybe 20-30 years ago didn't have this training but nowadays young podiatrists are without a doubt the most qualified person for you to see if you have a foot or ankle problem.
dd wrote:
There is an accronym often repeated among the orthopedists: APFU. Another podiatry F up.
Funny because we have similar acronyms for all the screwed up ankle fractures and foot surgeries that we revise after a cocky orthopod got to them and screwed them up due to their poor attention-to-detail/anatomy.
Check out this website
http://www.asuankle.com/"Another Screwed Up Ankle" which covers many orthopedic screw ups.
If we want to have a pissing contest, I know of a few infectious disease docs that said the patient needed amputations, or the patient had nec fasc or whatever and needed to go to surgery immediately...when all it was is irritation from bandages, vascular issues, etc.
There are good and bad doctors in EVERY field. Ortho, infectious disease, podiatry, all fields. I don't like to admit but refer to my earlier post and yea, maybe podiatry has a bit more.
Many orthos are great, I also know the ones that care MOST about patients and not the never ending who-has-the-biggest-balls contest, will readily have great relationships with pods.
Orthopaedic literature (or hard science as someone referred to it as) has even stated that an average ortho coming out is deficient in foot and ankle surgery. This is coming from them. FA fellowship spots go unfilled many times because it isn't needed to do the surgery and it is an additional year after 5 and most specialize to spine, knee, hip, and so forth.
In the end, when you can pick your doctor, it is hard to find a good one, when you do, keep them.
I should clarify, I actually get along well with our podiatrists and orthopedists, who I think are both very good. But I have heard both sides vent their grief about the others, and certainly there have been times where both could make a strong case to being right. But usually, it just happens to be that they both have to operate on some pretty sick patients, and bad outcomes happen. The orthopedists generally get the last word, since if something bad happens, and the badness moves north, it comes to their real-estate.
No pissing contest desired, I realized after my post that it may have come off snarky, sorry about that. I agree that all specialties have their undesirables, including ID. I'm just dealing with a guy that was treated with 3 months of IV antibiotics for a pretty clearly non-infected shin ulcer by some ID doc in florida, so yes, I'm well aware my field isn't immune to quacks. Your last line is one that all patients would do well to remember.
So, apologies for tone of first post, have a good night.
I find medicine frustrating at times because everyone steps on everyone else's toes and it is lost with what is best for the patient
carpal tunnel-plastics, ortho, ortho hand specialist, etc.
interventional radiology, cardiology, or vascular etc.
There are great people in all areas that are capable of great things, and most people are just good, and a few are poor. Poor gets a lot more publicity than good or great. I understand it does for a reason, as no one wants a doctor performing poorly and we are held to higher standards.
appreciate the post, nice change of tone for letsrun haha
If any of my posts came off as negative, I apologize as it is not my intention but with my previous post, I am frustrated with the politics of medicine because it didn't get into it for that. I also know politics are involved in everything and inescapable.
Overall I have had a great time traveling around and learning from various doctors.
EVERY doctor is a QUACK if they are trying to treat an injury they don't know what the CAUSE is.
Some injuries are very hard to diagnose. Virtually all running injuries are caused by overuse with the majority originating from the hips. Some even originate in the neck and back and the pain is referred to the lower legs.
My feeling is that a great MASSAGE therapist is your best asset to keep you running uninjured and help when you do get an overuse injury.
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