Finding Synergy in Collaboration With Physical Therapy

Created in partnership with the American Association for Women Podiatrists.

Welcome back to Podiatry Today Podcasts, where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. Today's episode is created in partnership with the American Association for Women Podiatrists, and our guest with us today is Alyssa Carroll DPM. Dr. Carroll is an Associate of the American College of Foot and Ankle Surgeons, and she's also the co-vice president of the American Association for Women Podiatrists. She practices in Raleigh, North Carolina and is going to speak to us today about how she finds synergy with her physical therapy colleagues. Welcome and thank you so much for being with us today, Dr. Carroll.

Thank you for having me.

So for your practice, how does physical therapy work into your typical practice algorithms and under what circumstances might you refer a patient for physical therapy?

Yes. So I would say from the beginning, PT has always been an integral part of my practice. Getting my education through Temple University as students, we did a rotation with physical therapists and you really can see what they're capable of doing in vast amount of scenarios with each patient. So different circumstances. Really, I mean, truly we can range anywhere from post-op to someone who just really I always, the phrase that I use to patients all the time is hitting the reset button. So someone that needs that really good stretch plantar fasciitis in that Achilles posterior muscle group chain and anything in between really. I mean, most of the biomechanical issues that are going to walk through the door can benefit from some type of physical therapy even if it's just at home.

You mentioned post-op scenarios. Has there ever been a case where you've sent a patient for PT preoperatively for things like weight training or assistive device training?

Absolutely, and that's a great point. So even pre-op, especially in some of our patients we know are going to be some degree of partial or non-weight bearing, so crutch training is a great example and preoperatively. Yeah, I mean if it's, especially some of our more elite athletes and things like that and they really want to be in and out or off the field I should say, or whatever their sport is as quickly as possible, I always say, let's get ahead of the game, get them optimized, and then their post-op course is going to be a lot faster.

So one thing I've always found really interesting is the different ways in which podiatrists interact with and collaborate with physical therapists. And a lot of times that starts with the prescription itself.

When you're writing that PT prescription, do you have any particular pearls or things that you really want that PT to know that you think are important to communicate?

Well, so the answer is definitely yes, but I think very simply, the more specific, the better. And I think any of our physical therapy colleagues that we work with would agree, and I think you can't just write, evaluate, and treat modalities, [inaudible 00:03:17]. That's not going to give them an idea of what you kind of have in mind. So each patient is going to have a very specific set of guidance that they're going to need for that physical therapy to really benefit them and get the optimal outcome. So for example, with my insertional Achilles tendonitis patients, like I am always writing soft tissue mobilization specifically, or if the PT happens to have graft in certification, making sure I specify that.

I think one thing that at least feedback that I've heard that PTs are very anxious to know are if there are any weight-bearing restrictions. Certainly depending.

And to that point, really spelling out what that should look like and if you want PT to go ahead and take the lead on helping a patient transition out of a CAM or, okay, our goal is to be assuming there's bone consolidation, this is where we want to be with weightbearing status and this is the plan forward. So you're exactly right, and that's a really, really important area to be very specific about.

So what types of impact have you noticed on your practice by having this very comprehensive collaboration available to you?

I would say that I couldn't imagine my practice without PT at this point. I mean, that's how big of an impact it has on my day-to-day practice. I try to tell patients the PT is just something that you really have to buy into. You have to go, you have to do the work, but if you do it's a lot of work now for a huge payoff later. So I really think, again, pro-op, post-op just any kind of biomechanical issue, equinus, I mean the list goes on and on. There's really, I have a very low threshold for putting someone in PT or at the very least encouraging them to do it at home and getting the resources that they need to do the range of motion strengthening exercises. But yeah, the outcomes that I'm seeing now that I'm consistently using specific PTs for specific problems, I mean it's a huge, huge difference.

Do you feel like there's some education that needs to be put out there from us to the patients as far as what the benefits of PT are? Have you found any misconceptions on their end about what it's going to be like or what's involved?

Yes. So I think all of us probably can picture the patient sitting in the room saying, I've been to PT before. They pointed me in a corner and told me to do stretches. Why can't I just do that at home? That's the number one negative feedback, instant resistance that I get from a patient. And I think this is where taking those extra five minutes to really explain to the patient what the expectations are. Me personally, I'm very picky about PT and the physical therapist and I tell patients I spent a lot of time either picking this place for you or getting to know this therapist and this is why you need to go to them and this is what I would expect, and by the way, if you go there and that's not your experience, let me know. Give me that feedback too, because I want to make sure that you are getting the physical therapy that you need and if it's somewhere where you're going and you think you can just do it at home, it's not the right place. Otherwise, I would just have you do exercises at home.

 I think definitely educating patients on different modalities that might be part of their treatment plan or just to explain listen and an evaluation in and of itself could give you a lot of really helpful information. And usually if you kind of get them to commit just to that evaluation, then they realize the value of everything that's going to be coming from that point forward. So I think you hit on some really good points there.

So that being said, I think everybody here agrees that that PTs are an integral part of foot and ankle treatment algorithms, but what one thing, based on your experience, do you feel that podiatrist can do to help improve their outcomes in collaborating with physical therapists?

I think the most important thing to do is to set aside time to get to know the physical therapists in your area. And I think I felt like I had a pretty good knowledge base about what our physical therapists or DPTs do, but even just spending time and it could be part of your marketing or however you want to make time for it, but just spending a few minutes with those therapists, you'd be shocked how many specialize in certain things, what their background is.

I have a local PT here in Raleigh who used to be a dancer, so my dancers, that is a perfect match. They're going to understand all the nuances that come along with that. I have another PT who, she does lower extremity, but she also has a lot of spinal training too. I had a patient that came in very complicated, but she also had scoliosis, so that was a good match. I think if you can make those connections, that will really go a long way, not only in patients going to PT and finishing throughout the whole course of it, but we as podiatrists are going to have a much better resource base and knowledge base to give to our patients.

And by getting to know those physical therapists, they get to know you and your work as well and what you do well. So hopefully it also turns into a reciprocal sort of marketing initiative as well.

I think that's something where that afternoon that you spend doing it will really, really be beneficial in a lot of ways down the road. Like you said, both ways as far as resources, or excuse me, referrals and just treatment plan, being on the same page and kind of knowing the communication. And if I write something, they're going to be familiar with what exactly I'm trying to say. Again, trying to be as specific as possible, but also kind of understanding what my practice style is like.

Absolutely, and those are some really important things to think about, whether you're just starting out in your practice or whether someone's been practicing for a long time. It's always good to sort of have a gut check on how am I doing this, and is it really serving my practice and my patients in the best way possible?

But thank you so much for giving us some really great food for thought on this topic today. Thank you, Dr. Carroll, for being with us. And thank you to the listeners for joining us today. We hope you'll tune into this episode and others of Podiatry Today Podcast on podiatrytoday.com. SoundCloud, Apple Podcasts, and your favorite podcast platforms.