A podiatrist is a specialized medical professional focused on diagnosing and treating conditions of the foot, ankle, and related structures of the lower leg. The scope of their practice is defined by these lower extremities, including the ankle joint, the foot’s 26 bones, and associated soft tissues. Since many foot and ankle issues involve the skin and nails, podiatrists are experts in managing common problems affecting the toenails.
The Definitive Answer: Scope of Podiatric Care
Podiatrists do not treat fingernails because their medical training and surgical privileges are strictly limited to the lower limbs. The distinction lies entirely in the anatomical location and the legal boundaries of the medical specialty. While the pathology of a fingernail infection might appear similar to a toenail infection, the specialist’s focus remains below the knee.
Podiatrists frequently manage conditions like onychomycosis, a fungal infection that can affect any nail. However, their expertise is only applied to the toenail and the surrounding foot structures. This boundary ensures patients receive care from a physician who possesses a specialized understanding of the biomechanics and circulatory challenges of the lower extremity.
Common Conditions Podiatrists Treat
Podiatry encompasses a broad spectrum of care, addressing ailments from routine skin and nail issues to complex surgical reconstruction. Toenail issues like onychomycosis, which causes discoloration, thickening, and crumbling of the nail, are commonly treated with oral and topical antifungal medications. Podiatrists also treat onychocryptosis, or an ingrown toenail, which occurs when the nail border grows into the surrounding skin. This often requires a minor surgical procedure to remove the nail edge.
Structural deformities of the foot represent a major part of podiatric practice, including the management of bunions and hammertoes. A bunion is a bony protrusion at the base of the big toe, often pushing the toe inward, which a podiatrist may treat with custom orthotics, padding, or surgical correction. Hammertoes involve an abnormal bend in the middle joint of a toe, with treatment ranging from shoe modifications to tendon release surgery.
Podiatrists also manage chronic conditions that manifest in the feet, such as complications related to diabetes. Diabetic foot care is a major focus, as poor circulation and nerve damage (neuropathy) can lead to non-healing wounds and severe infections. They also treat various causes of heel pain, including plantar fasciitis, which involves inflammation of the thick band of tissue running across the bottom of the foot.
Who Treats Fingernail and Hand Issues?
When a problem affects a fingernail, different specialists are consulted, depending on the nature of the condition. For the majority of non-traumatic nail and skin conditions, such as fungal infections, psoriasis, or unexplained discoloration, the appropriate professional is a dermatologist. Dermatologists specialize in disorders of the skin, hair, and all nails, and can diagnose systemic diseases that may present with nail changes.
For issues resulting from acute injury or trauma, such as a crushed fingertip, a deep laceration to the nail bed, or an associated fracture, the patient is typically referred to a hand specialist. These specialists are often Orthopedic Hand Surgeons or Plastic Surgeons who have completed fellowship training in the anatomy of the hand and wrist. They perform delicate surgical procedures, such as repairing a damaged nail matrix to prevent permanent nail deformity.
The goal of a hand surgeon in a trauma case, such as a subungual hematoma or a fracture of the distal phalanx, is to restore the structure of the fingertip. This often involves careful repair of the nail bed, the tissue upon which the nail plate rests, to ensure the new nail grows back smoothly and adheres correctly. These professionals possess the expertise required for the functional and aesthetic repair of the upper extremity.