If you think podiatrist and you think “they cut nails and calluses” you are missing a majority of what podiatry is today. Trimming of toenails and calluses may be what some refer to as the ‘bread and butter’ of podiatry, but the profession has evolved over many decades.
Today, it is important to know that a Podiatric physician and surgeon is both a physician and a surgeon. Our services are much more widespread and our expertise has been honed over years of schooling, residency and clinical practice.
The podiatrists of today complete a 4 year college degree. We then take medical school entrance exams, apply to Podiatric medical school and interview with these schools. If selected, we move on to 4 years of medical school, with a majority of later classes focusing on the care and treatment of lower extremity conditions. Then, if we make it through their 4 years of medical school, we complete a surgical residency, where we train alongside veteran podiatrists. During this time, we perform a great number of surgical procedures. We perform procedures which in practice are performed in the office, such as small biopsies, draining cysts and joints, injections for various conditions and various procedures for ingrown and/or painful toenails and casting and creation of custom orthotics. We also perform many procedures of the foot and ankle that are done outpatient. This includes bunions and hammertoes, flatfoot reconstruction, repair of tendons, removal of bones and tumors and repair of fractures.
After completing surgical residency (this is now 11 years after high school), we are finally ready to enter the real world and start seeing patients of our own. Some podiatrists choose to sub specialize. Of course we already are well versed in conditions of the feet and ankles, but some choose to see primarily pediatric patients. Some podiatrists specialize in sports medicine, others in surgery, others still in the geriatric population, some in wound care and diabetic limb salvage.
You may be surprised by all of the possibilities, or maybe you aren’t if you have seen or known a podiatrist before.
So, of course we as podiatrists CAN cut toenails and we do from time to time, as part of what is called “at risk care”. This is more involved than your toenails being cut at a salon. For one thing, before you can have nail care performed, your Podiatric physician will use their skills in physical exam to evaluate your feet thoroughly. The pulses in your feet are evaluated. We pay close attention to and document findings in terms of hair growth on your feet and toes, deformities you may have, whether your strength is intact to your feet and ankles, we look for calluses that you have and whether these calluses present with discoloration. We evaluate your neurological status. In the feet, this means that we pay close attention to how you walk when you are getting back into the treatment room from the entrance. We assess whether your nerves can communicate information to your brain about fine point discrimination, proprioception and vibration to name a few. This exam seems to be done quickly, as we do this on a regular basis. However, the information we obtain through this exam provides critical information that helps us to determine how frequently your feet should be re-evaluted by a podiatrist and whether you qualify for at risk care.
Cutting toenails and trimming calluses can be done by a tech at a nail salon. However, they will not be aware of your underlying health. If a nail is trimmed improperly or a callus is over trimmed, they are not in a position to provide care thereafter. A podiatrist is the person who is qualified to identify whether you are or are not “at risk.”
So, why all the discussion, can’t you just cut my toenails? If in your physical exam, there are gross deficiencies in your circulation (blood flow) or sensation in your feet, this tells us something important. It tells us as your physician that if you experience a wound or injury to the skin, you will have difficulty healing it. If you have difficulty healing it, it is more prone to be open to air longer. The longer a sore is open, the more bacteria, fungus and yeasts it is exposed to and this increases risk of infection of the skin, subcutaneous tissues and even bone. If you have a pebble in your shoe and have intact sensation, your brain will tell you to look in your shoe and fix the problem. If your sensation does not provide this feedback to your brain, walking on a pebble all day will wear a sore into your foot and these wounds take a long time to heal. Any open wound can result in the need for hospitalization and/or amputation of a portion of the foot.
What about if I can’t reach my toes? Unfortunately for those who have healthy feet, but have other difficulties in cutting their nails, the rules in place by medicare do not deem nail trimming and callus care as medically necessary simply because you have difficulty doing it. On these same lines, patients with rheumatoid arthritis, Parkinson’s or other conditions limiting their grip (as in to hold a pair of nail trimmers) do not qualify for at risk care based on the difficulty to hold trimmers alone.
What about if I am on blood thinners? My PCP told me not to cut my own nails… Well, again, if this is the ONLY reason for the nail trimming, the medicare guidelines do not allow for insurance paid for nail trimming. If you have underlying medical conditions limiting blood flow to your legs and happen to also be on a blood thinner, you may qualify.
Although these regulations come from Medicare, they are used across nearly all insurances. Whether you have medicare or other private insurance, these companies follow the same guidelines. That isn’t to say that your podiatrist agrees or disagrees with these guidelines, but they are guidelines we are obligated to follow.
So if you want to have your nails trimmed, a full evaluation with your podiatrist can tell you whether you qualify as it is based on medical necessity.
If you qualify for nail care, this may seem like a relief for you, but bear in mind that means that you are at risk. You are at risk of developing foot ulcerations, infections and needing hospitalizations and surgery - possibly amputations due to the decline in health of your feet. The entire purpose of at risk care is to reduce the likelihood of suffering these outcomes due to your underlying conditions.
If you have an ingrown nail, no matter your age or health, this is NOT the same thing as at risk care. Ingrown toenails are a condition that pose other issues and may require care from your podiatrist. In some cases, trimming the corner down can relieve pressure and pain. Some in office procedures may be required to rid your toe of infection or to remove the painful nail border (either temporary or permanently).
If you have questions about whether or not you qualify for regularly scheduled nail trimming, call for an appointment to be evaluated today.