Conway McLean, DPM, Journal columnist

Who best cares for a painful body part, be it an elbow, an ankle, or shoulder? After all, this is the age of specialization, where every possible body part has a physician dedicated to treating it. Certainly there’s a local elbow doctor in your neighborhood. We have hand specialists, leg vein specialists. even foot specialists.

Although there are some drawbacks to this approach, as a generalization, it means the specialist’s training can go deeper into the subject, giving the practitioner a better understanding of the part, and any maladies unique to it. As you might expect, greater familiarity and experience with all the treatment options is another benefit of this dedication. But there are drawbacks.

We have become disconnected from the rest of the body. The internist doesn’t know what the rheumatologist is doing. The knee doctor never looks at the alignment and function of the foot or ankle, even though they form the foundation for the knee joint. And yet, in effect, the foot bone is connected to the knee bone (although not directly), which is how many podiatrists have reduced knee pain.

Interestingly, most people haven’t a clue what kind of problems a podiatric physician cares for. Because podiatrists treat an area of the body rather than an organ system (dermatologists for skin, neurologists for nerve, etc.), we are multi-specialists. We treat many skin problems, so we practice dermatology. Podiatrists also care for a variety of nerve problems, so we must be neurologists. Other “hats” worn by your average podiatrist include infectious disease, orthopedics, sports medicine, and the list goes on.

What about a podiatrist’s education? The length of schooling is the same as your family doctor, four years after an undergraduate degree. Podiatric residencies are three years, equivalent to an internal medicine doctor or a family practice physician. During podiatric residency programs, all residents must rotate through all the major medical specialties, from cardiology to internal medicine, emergency medicine to orthopedics.

Having a physician specializing in the foot and ankle just makes sense. The motions and movements, the mechanics and machinations, of the human foot are unique in the animal kingdom. It is truly one of a kind, a marvel of bio-engineering. But problems with someone’s foot and leg architecture, any deviation from perfect alignment, perhaps an arch that’s too low or too high, will lead to problems. A physician learned in human lower extremity mechanics will be best equipped to treat these problems, and not just the symptoms.

Biomechanics is the term used to summarize the complex workings of the foot and lower leg, allowing us to stand and walk, carrying us safely to our next destination. It turns out that numerous painful medical conditions are the result of faulty biomechanics. Inappropriate motion, occurring inside a closed space (i.e. a shoe), walking ten thousand steps a day for many years, will typically result, eventually, in some painful problem. Indeed, many common foot maladies are found primarily in seniors.

A common question is who to see for a wound that isn’t healing? Most ulcers of the skin benefit from the services of a physician specializing in these types of problems. And because most of these skin ulcers occur below the knee, many podiatric physicians specialize in their treatment. Ulcers developing on the bottom of the foot can occur when the sufferer has lost normal feeling in their feet. Healing these is an art form and science especially suited to podiatric care. As are venous ulcers, found in the upper ankle area.

The question remains: who best to see for some non-resolving foot pain. Many will go to their family doctor, where they have a relationship, having known the “doc” for years. But familiarity does not equate to expertise. Many problems of the foot and ankle don’t have obvious answers. Often times, pain from this part of the body seems to come out of nowhere, lacking any clear-cut preceding event or injury. The cause unknown, the structure uncertain.

Some biomechanical malfunction will eventually result in stress to some soft tissue structure, perhaps a tendon, a ligament, or a muscle. Sufficient stress can result in inflammation and the associated pain. Such ubiquitous complaints as heel pain have a biomechanical cause the great majority of the time. By improving an individual’s body mechanics, the cause can be addressed, leading to pain relief. And without drugs or surgery.

Certainly, Podiatric Medicine is famous for its care of certain “routine” problems of the feet, common components of the (modern) human condition. The list would include corns and calluses, and probably ingrown nails. These are extremely common problems, and though they aren’t (generally) life threatening, they certainly can make everyday life unpleasant. There is a high density of nerves in the toes making these conditions notably symptomatic.

The sum total of medical information is vast, growing exponentially, far too much for any one individual. Modern medicine has trended in the opposite direction, with specialists learning a lot about a little. Narrowing one’s focus, exploring the intricacies of a particular aspect of medicine is the order of the day. But this direction comes with some risk. Care has become fragmented, whereby continuity of care is impaired.

As the cliche says, the left hand doesn’t know what the right hand is doing. This leads to repetitive therapies or prescriptions, increasing the likelihood of complications. The digitizing of all medical records over the last several decades was a perfect opportunity to create a more cohesive system, functioning as a unit. Unfortunately, it was left up to private vendors, pitching their wares, each system having its own language, its own quirks. Predictably, they don’t communicate.

As the primary support structure for the human body, the human foot is amazing in all it can do.

The complexities of its form and function are a marvel, to be both studied and admired. Consequently, the problems occurring with this part of the human anatomy tend to benefit from specialized care. But it’s important to never lose sight of the fact these structures are attached to a body. This is a vital lesson to all health care providers. We may each have our particular specialty, focused intently on our area of expertise, but it’s always about the person.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.