I believe that we all want to provide the best possible care for our patients. We spend years gaining our base knowledge and our entire careers adding to and building upon that education and training. We offer as many services and procedures as we can. We hire the best staff and support that we can, and we work with many other specialists to give our patients the best care and outcomes possible. These relationships evolve over time as one finds and comes to rely upon a “go-to” person or people in each specialty. For me, one of the most important of these relationships is the one I have developed with my local physical therapists.
Physical therapy is a natural complement to podiatric medicine and surgery. Depending on your practice, the location of the practice and the abilities of your local physical therapists, there may be some (or even a lot of) overlap between our specialties. Many physical therapists are making or prescribing orthotics for patients, or utilizing similar devices for limb length issues. Physical therapists may also be able to do pelvic and/or hip work on patients with a suspected limb length discrepancy as it applies to the diagnosis for which these patients are receiving therapy, whether they were referred by podiatry or not. More and more physical therapists are becoming involved in wound care as well, especially in underserved communities. Many times, patients in these distant locations are unable to travel to places where they can receive care from multiple providers and physical therapists are responsible for even more care.
Being a part of a large orthopedic practice that also has multiple physical therapy locations, there are many occasions in which physical therapists refer a new patient to me. The patients may have a primary diagnosis regarding their spine, a sports injury or even post-operative care of their knees or hips. At times, these concerns may lead to podiatric issues or the original diagnosis may have had an associated lower extremity aspect to it. Many times, physical therapy evaluation will also involve a comprehensive gait assessment, which may also turn up concerns. Our physical therapists do an amazing job of recognizing these concerns and helping the patients get appropriate podiatric treatment and care. These are patients who may never have thought to seek care from a podiatrist previously.
As streamlined as this process is in my group, I already enjoyed these mutually beneficial relationships in a previous private podiatry practice. I fully believe this is because of the time and energy I placed into learning about the physical therapists who were in close proximity to both my office locations as well as my patients’ homes. I visited the different offices and had multiple conversations with the physical therapists before, during and after treatment. I would call and discuss cases with physical therapists, especially if the diagnosis or expected treatment plan was unique.
I often ask my patients specifics about their physical therapy care. This helps me learn where patients are most comfortable and also receiving the greatest benefit. In every case, I have found the physical therapists with whom I speak to be engaging and encouraging as well as extremely willing to work together to provide the best possible care to our patients.
Although many physical therapy practices have multiple providers, I have found it worthwhile to discuss what each therapist really prefers to do. Those that are truly interested in foot and ankle or gait disturbances may be more willing to work with a podiatrist to form a comprehensive treatment plan. In my experience, these physical therapists also seem to be the most collaborative, knowledgeable and make the patient feel the most at ease. The patients who can see that their podiatrist is familiar with this very educated, knowledgeable and proficient physical therapist often have the best outcomes in my experience. They can feel that their podiatrist has made the effort to make sure they are receiving the best care possible. This often motivates patients to push harder and farther than they may with someone who seems to just be going through the motions.
All of the relationships I have built have taken time. This is obviously something that is easier to do when we first come out of residency and training. However, I strongly encourage finding the time to reach out and meet these physical therapy providers. Knowing the skill, level of care, responsiveness and willingness to collaborate as necessary of local physical therapists can substantially improve comprehensive patient care.
Dr. Hook is a Trustee of the New York State Podiatric Medical Association (NYSPMA), Chair of the NYSPMA Public Education and Information Committee, and a sub-Chair of the American Board of Podiatric Medicine Membership Committee in the Crisis Communication and Audit division. She is in private practice at Syracuse Orthopedic Specialists in Syracuse, N.Y.