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When to Consult a Podiatrist

Should You Seek Advice on Insoles and Shoes from a Podiatrist or Pedorthist?

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Updated August 25, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

People experiencing foot pain and problems often seek relief with over-the-counter insoles. They may go a step further and visit a shoe fitting store that has a pedorthist to get a custom shoe fitting and insole recommendation. We asked three podiatrists to comment on the limitations of these methods and when it is best to see a podiatrist instead.

Our Experts:

  • Dr. Brian Harley, Chief of Podiatry, Wellstar Windy Hill Hospital, Marietta, Georgia
  • Dr. Lisa Klemeyer of the Aesthetic Family & Podiatry in Sarasota, Florida
  • Dr. Andrew J. Schneider, Tanglewood Foot Specialists

Q: When should a patient consult a podiatrist vs. visit a pedorthist to have shoe modifications/inserts recommended?

Dr. Klemeyer: "Any time someone has actual lower extremity symptoms of pain, numbness, tingling, burning, or loss of function for a week or more warrants a visit to the foot doctor. The best case scenario is when the pedorthist and podiatric physician can work together to optimize the patients biomechanics."

Dr. Schneider: "If someone has an acute injury, swelling, bruising, or sudden pain, a podiatrist should always be the first stop. A podiatrist will be able to diagnose the problem with x-ray, ultrasound, and other modalities and get the patient on the road to recovery fastest. A podiatrist can prescribe medication, administer injections, prescribe custom orthotic devices, and -- when necessary -- perform surgery to resolve a particular foot problem. A pedorthist can be consulted when there is a persistent ache or pain when walking or running. The pedorthist then will be in a good position to recommend a particular shoe, insert, or combination to improve the gait, foot efficiency, and reduce the level of pain."

Dr. Harley: "I would recommend that the patients be first evaluated by the podiatrist to truly diagnose what the problem may be. We do often see issues with improper shoes or inserts, but we also see underlying causes of pain and discomfort [that] shoes/inserts alone will not treat. I will refer patients to the pedorthist once the diagnosis of an appropriate condition is made in which shoe modifications, inserts, or even custom braces are indicated."

Q: What conditions are appropriate for the level of expertise that can be performed by a pedorthist at a shoe fitting store?

Dr. Schneider: "Pedorthists are not licensed to diagnose acute issues. However, they are skilled at recommending the appropriate shoes to fit a particular foot type. They also are able to recommend and produce insoles, both off-the-shelf and custom, to support a person's foot properly. For those who wear a custom orthotic from a podiatrist, the pedorthist can recommend the best shoe to maximize the effectiveness of the orthotic device."

Dr. Klemeyer: "Having a pedorthist on site ensures that the customer will be able to purchase a 'best fit' shoe or over-the-counter arch support. This helps with shoe performance and shock absorption. The pedorthist can also carry out prescription items such as diabetic therapeutic shoes and accommodative inserts, custom shoes, and custom modifications to shoes. Again, if a person considers themselves to have a "condition," I would advise working with the podiatric physician in conjunction with the pedorthist."

Dr. Harley: "So many people buy their shoes based on the looks and ignore the comfort of the shoe. I tell my patients that the sales representative is the most important person to consult when looking at shoes for specific issues. The pedorthists are trained in most of the common foot conditions that we see on a regular basis including: flat feet, painful arches, painful heels, bunions, hammertoes, diabetes, arthritis, etc.

"The pedorthist is also trained and casting and molding custom inserts to better fit the patients/customers. They should not be fooled by online "custom" orthotics which are not truly custom, just to save some money. With orthotics and braces, you get what you pay for. You get not only a quality product, but the training behind it which allows the pedorthist to diagnose the problem, determine which materials are needed, and fabricate the inserts properly."

More: How Pedorthists Do a Foot Analysis

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