When Should I Call My Podiatrist?

Over the years, I have noticed that many of my patients hesitate to call my office for an appointment, wondering if the problem they have will just get better by itself.  Sometimes, that is the correct thing to do – wait a few days to see if it gets better.  If it does get better, then you’ve saved yourself from having to come in to see the doctor.  However, there are some instances when waiting a few days (or weeks) can be dangerous, and you can end up with a very serious problem that could have been treated without too much difficulty had it been addressed sooner.  I would like to discuss a few instances where waiting to see the doctor is a poor choice.

If you have diabetes, and notice any redness, blistering, warmth or open sores on your feet, I personally want to see you ASAP.  We will make room for you on the schedule.  We will stay late.  If for some reason, we can’t see you, we may even recommend you go to the emergency room at the hospital.  It is shocking how fast a little blister on the foot can progress to a large, infected ulcer (sore), leading to possibly loss of the leg itself.  If you have had a past history of a foot ulcer, or have poor circulation, you are at even greater risk.  Please don’t wait to call!

Any injury that causes significant pain, you really should have it looked at.  Often, patients will say that they didn’t think they needed to be seen after an injury because they could still walk.  The ability to walk or move the injured part of the foot, they reason, means it is not broken.  While this may sound reasonable, it is in many cases not so.  I have seen many fractures over the years that were dismissed as a simple sprain just because they could still walk.  Your suspicion for a fracture should be higher if you see significant swelling, pain that persists beyond a few days, or see bruising around the injured site.  And, when you come to my office, I may believe there is a fracture based on my exam of you, but even I won’t know for sure in most cases until an x-ray is taken.  Fractures that are not addressed can lead to poor healing, or in some cases, lack of healing at all.

Ingrown toenails are something that patients will put up with for weeks, and in some cases, months before coming in to see me.  And it is true that mildly ingrown toenails will sometimes work themselves out.  However, I have found that a lot of patients delay coming in to have the ingrown toenail treated because of fear of the minor surgery to remove the ingrown nail.  Let me put that fear to rest.  The vast majority of patients who have ingrown toenails removed say to me afterwards that the procedure was not anywhere near as painful as they had feared, and they express relief at how much better the toe feels afterwards.  Contrast that to the patient I am currently treating.  He has a severely ingrown, infected toenail that has been literally festering for years.  In his case, the infection has gone into the bone, and he now is scheduled to have his toe amputated to remove the infected bone.  This is not something that happens frequently, but had I been able to address his ingrown toenail when it first became an issue, he would have been relieved of years of pain, and he would not be losing his toe.

Finally, heel pain is a problem that patients tend to procrastinate treating.  If a patient were to begin to feel the symptoms of heel pain (also known as plantar fasciitis), I would recommend first using over the counter arch supports.  If the symptoms are not improving in a week or so, I would recommend having the patient into the office to see me to verify the diagnosis, and begin more aggressive treatment of the condition.  Plantar fasciitis is a condition that can almost always be treated successfully using conservative measures.  I have found that those patients who do go on to require surgery, their symptoms have been present for longer periods of time, often without any treatment being received at all.

The list I have provided in this blog is certainly not conclusive.  In short, if a patient feels any concern at all about their feet, I recommend having them come in for an evaluation.  It may be that nothing is wrong.  If that’s the case, you’ll have peace of mind.  However, if something more serious is amiss, we can get you on the road to a full recovery.

How Long is "Too Long" When You Are Waiting to See Your Doctor?

Few things about seeing a doctor are more frustrating than having to wait for long periods of time before you’re seen. In my mind, having to wait for 10 to 20 minutes is acceptable. If you find yourself waiting for more than 30 minutes, that’s too long. Several years ago, I myself waited over an hour and a half before I saw the doctor! Why is it that doctors make their patients wait so long? Does it have to be this way? What can you do to help?

After more than twenty years of running my own office, I have some thoughts as to why we as doctors run behind schedule at times. Let me say that running on time is something we take very seriously at Concord Foot and Ankle Clinic. I don’t like having to make people wait on me any more than they like waiting. And most days, I can proudly say, we see patients on time. But there are “those days…”

First and foremost, seeing a doctor is not like getting the oil changed in your car. We can’t always know ahead of time how long each patient will take to be treated adequately. So, reason #1 for falling behind is because a patient who we expected to have a simple visit turns out to be much more involved and takes more time than expected. An example of this would be a diabetic patient, seen for toenail care, and during the course of examination and treatment, I discover an ulceration, or a sore on the foot. Suddenly the 10 to 15 minute visit ends up taking me 45 minutes! And sadly, patients scheduled after the one needing the extra attention, end up paying the price by having to wait longer to be seen. I have found most patients are very understanding when I explain that an earlier patient during the day required extra care, causing me to run behind schedule. They seem to understand that it could just as easily be them needing the extra care the next time around.

Reason #2: We sometimes fall behind schedule in our office because one or more patients do not show up on time for their appointments. When they do show up, they invariably show up the same time as the next patient. In that case, no matter which patient I see first, the two will take longer than the allotted time for the one patient, putting me behind schedule.

Reason #3: This has to do with patients coming to the office unprepared. For new patients, we send out forms to be filled out ahead of time to streamline the process of checking them in. If they forget the forms, or bring them in not filled out, it affects how long others have to wait.

Reason #4: There are days when I perform surgery, that for a variety of reasons, my case starts late, or perhaps ends up taking longer than I had anticipated. Normally, my office schedules in a “fudge factor” following surgery to account for any delays before patients are scheduled in the office, but sometimes, the delay is more than we had planned.

Reason #5 has to do with overbooking the schedule. This is sometimes the fault of the doctor’s office, and sometimes is unavoidable due to urgent conditions that can’t wait to be treated. In the example I gave above, I was being seen for a fracture in my arm. I was being squeezed into an already full schedule. However, I had to have the fracture treated that day, not next week. And although I did not like waiting, I understood the reason for the long wait.

So what can you do to help? First, show up to your appointment on time and prepared. When you make the appointment, communicate with the scheduler all the reasons you need to be seen so that adequate time can be allotted for your visit. If it appears that the doctor is behind schedule, ask for an estimate of how long the wait will be, and if necessary, reschedule the appointment. Another great idea is to schedule your appointments for the first thing in the morning, or the first patient after lunch. If you find that a particular office is ALWAYS behind schedule, ask to speak to the office manager. Explain your displeasure in having to wait so long to be seen, and if the problem cannot be resolved, it may be time to start shopping for a new doctor.