Chronic Foot Pain
An Interview with Marjorie Ravitz, DPM
| Marjorie Ravitz, DPM, practices Podiatry in a community setting in suburban Smithtown, N.Y. She is Board Certified in foot surgery and is on staff at four hospitals. This interview describes how a podiatrist can play an integral role in the primary care of patients with chronic health problems, as well as for those patients who suffer from chronic foot pain. |
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Questions
1: Please tell us how you entered the field of Podiatry and describe the prevalence of chronic foot pain.
 2: Describe how your care of a diabetic patient is coordinated with their primary health care provider.
3: Do you teach patients how to do their own foot care, or do you provide their care at follow-up visits?
4: You referred patients back to their primary care provider for treatment when you suspected that the patient had diabetes. What other medical conditions have you detected when chronic foot pain is the presenting problem?
5: Many health care specialists see patients who go from one provider to another, trying to find a quick solution to their pain, when there are other problems not being addressed. Is this something that you see as a Podiatrist?
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-------------------------------------------------------------------------------------------------------------------------- Evelyn Corsini, MSW:
Please tell us how you entered the field of Podiatry and describe the prevalence of chronic foot pain. Marjorie Ravitz, DPM: I attended the New York College of Podiatric Medicine and did a one-year surgical residency. I then joined my father’s Podiatry practice.
Chronic foot pain is very common in the general population at the primary care level; most studies suggest that up to 20% of all adults experience foot pain at some time. The increased prevalence of foot pain is associated with patients who have certain risk factors, such as: over 50 years of age; female; obese; or concomitantly suffering from knee or hip pain. Having chronic foot pain can be a significant detriment to the quality of life.
In addition to the common kinds of foot pain podiatrists treat, such as plantar warts or plantar fasciitis, I also see many patients whose chronic pain is just one part of another co-existing health condition, such as osteoarthritis, other autoimmune diseases, or diabetes. 
EC: Describe how your care of a diabetic patient is coordinated with their primary health care provider. MR: In my community there is very good communication among health care providers, making it possible to refer patients to the specific specialist they need. I see many patients with diabetic peripheral neuropathy. It is not unusual for me to see a patient with a new diagnosis of diabetes who reports that they were referred to “an eye doctor and/or a foot doctor”, but they don’t know why. They are usually not familiar with the term “neuropathy”, so I spend a great deal of time teaching these patients about their condition and how to deal with and care for it. My office staff has developed an excellent library of educational material that we can distribute to patients.
In the case of a diabetic foot, it is critical for patients to learn about future problems that can occur, and stress the importance of becoming a good advocate with regard to their condition. I teach diabetic patients the medical reasons that they need to be vigilant about the care of their feet. I teach them about neuropathy, immunopathy, and angiopathy. I try very hard to put things in terms they will understand. For example, when I ask a patient, "Does it feel like there is a sock on your foot all the time?”, and they say 'yes', they can begin to understand neuropathy. Since these patients have lowered sensation, rather than pain, I have some with wounds that are not healing on their feet, or red, hot, swollen feet, that then led to their diagnosis of diabetes.
EC: Do you teach patients how to do their own foot care, or do you provide their care at follow-up visits? MR: I do both. All of my patients need to learn about daily foot care, but for many of the patients who are elderly or diabetic, it is safer for them to return to me frequently to have their nails cut and their feet checked. Fortunately, Medicare will pay for a Podiatry visit every 9 weeks.
EC: You referred patients back to their primary care provider for treatment when you suspected that the patient had diabetes. What other medical conditions have you detected when chronic foot pain is the presenting problem? MR: I have seen patients with chronic foot pain who I suspect are developing reflex sympathetic dystrophy. In this situation, I will refer the patient to a neurologist for a further assessment. When the diagnosis is established, I often refer the patient to a physical therapist as a way to try to avoid development of a progressive chronic pain condition.
EC: Many health care specialists see patients who go from one provider to another, trying to find a quick solution to their pain, when there are other problems not being addressed. Is this something that you see as a Podiatrist? MR: Yes, I see patients who have gone to many other Podiatrists and sometimes Orthopedists as well. Some of these patients are being treated for depression and others may exaggerate their symptoms or have multiple other problems. While their “presenting problem” relates to their feet, that is sometimes not the core issue. That is why it is so important for me as a Podiatrist, to work closely with other health care providers in the community, to see that my patients are sent to the right person, while those who will benefit from podiatric care are referred to me.
A corresponding version of this article that is appropriate for your patients, titled Be kind to your skin is now available at painACTION.com.
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