The Evidence Files: Telehealth in Podiatry — What Pandemic-Era Research Tells Us

Research shows telehealth works well for follow-up foot care, education, and triage, but can't replace hands-on exams for diagnosis and procedures.

By Dr. Carli Hoover, DPM

The Evidence Files: Telehealth in Podiatry — What Pandemic-Era Research Tells Us

The Future of Foot Care Is On Your Screen

The pandemic forced healthcare to innovate. Suddenly, telehealth—video consultations from home—became essential. Many people discovered that talking to their doctor via video was convenient, time-saving, and often effective. But for podiatry, an exam-heavy specialty, questions arose: Can telehealth truly work when you can't physically examine a foot? What can a podiatrist actually accomplish via video? What are the limitations? The evidence from pandemic-era research provides clear answers. Telehealth isn't appropriate for every podiatric problem, but it IS effective for many—and the research shows where it excels. This guide explains what clinical studies show about telehealth's role in podiatry, when it works well, when in-person care is necessary, and what the future likely holds.

The Rise of Telehealth in Podiatry

Before the pandemic, telehealth in podiatry was minimal. Most people assumed you couldn't diagnose or treat foot problems without being physically present. The pandemic proved that assumption was too simplistic.

Telehealth encompasses various models:

Synchronous (real-time): Video consultations with your actual podiatrist
Asynchronous (store-and-forward): Sending photos/videos for later review
Hybrid: Initial telehealth consultation with follow-up in-person visit

Each has different applications and effectiveness levels, as the evidence shows.

What the Evidence Shows

Patient Satisfaction and Acceptance

Systematic reviews of telehealth adoption during and after the pandemic show remarkably high patient acceptance. Survey data published in podiatric literature indicates 70 to 85% of patients found telehealth appointments convenient and would use them again. Patients appreciated avoiding travel, parking, and wait-room time, especially those with mobility issues.

Clinically, patient-reported outcomes (pain reduction, functional improvement) were comparable between telehealth and in-person visits for certain conditions, suggesting telehealth consultations provided meaningful care.

Diagnostic Accuracy in Telehealth

RCTs comparing telehealth to in-person diagnosis for various foot conditions show nuanced results:

Conditions Where Telehealth Showed Good Diagnostic Accuracy (85-90%):

Toenail fungus (visual assessment of nail characteristics)
Corns and calluses (visible morphology)
Bunions and other foot deformities (visual deformity obvious)
Diabetic neuropathy screening (patient-reported symptoms can be assessed)
Gait analysis limitations (but can observe gait)

Conditions Requiring In-Person Exam (telehealth insufficient):

Suspected fractures (need palpation, possible X-ray)
Acute foot infections or wounds (need direct assessment, culture possibly)
Complex lower-extremity pain (need comprehensive musculoskeletal exam)
Ulcerations needing measurement and debridement
Advanced biomechanical assessment
Orthotic fitting

The evidence suggests telehealth is most useful for follow-up care of established conditions, preliminary triage, and patient education—not for complex diagnoses or procedures.

Telehealth for Follow-Up Care

Systematic reviews of remote monitoring and follow-up care show high effectiveness. For patients already diagnosed with a chronic condition (diabetic neuropathy, fungal toenails, post-surgical follow-up), periodic telehealth check-ins effectively monitor progression, adjust treatment, and catch complications. One study found that remote monitoring of diabetic foot patients via telehealth, combined with in-person visits every 3 to 6 months, achieved outcomes comparable to quarterly in-person care.

Telehealth for Patient Education

Published evidence strongly supports using telehealth for education and counseling. Patients appreciate detailed explanations of their condition, demonstrations of proper stretching or foot care, and discussion of treatment options via video. Engagement and compliance appear to be similar or better than in-person education, possibly because patients feel less rushed.

Triage and Urgent Assessment

Clinical data from pandemic-era podiatry practices show that telehealth was effective for initial triage—determining whether a patient needed urgent in-person evaluation or could be managed remotely. For example, a patient reporting sudden foot pain could be quickly assessed via video; if fracture was suspected, they'd be directed to X-ray. If pain seemed mechanical and improving, remote management might suffice. This use of telehealth reduced unnecessary in-person visits and emergency room utilization.

Cost-Effectiveness

Economic analyses show that telehealth consultations cost less than in-person visits (no facility overhead for the patient, reduced clinician time for certain visits) and reduced patient costs (no travel). However, some conditions still require in-person care, and hybrid models (telehealth + occasional in-person) were most cost-effective for many chronic conditions.

Limitations and Challenges

Research also identified significant limitations:

Technology Barriers: Not all patients had adequate internet, video capability, or digital comfort. Studies found 10 to 20% of older adults struggled with telehealth technology.

Physical Examination Gaps: Palpation, range-of-motion testing, neurological exam, and biomechanical assessment require in-person contact. Some diagnoses are impossible without these.

Wound Care: Complex wound assessment, debridement, and care require in-person evaluation. Telehealth is insufficient.

Orthotic Fitting: Proper orthotic fitting requires casting, measurement, and fitting—must be in-person.

Privacy Concerns: Some patients were uncomfortable with video consultations at home (family members present, lack of privacy).

When Telehealth Works Well in Podiatry

Based on evidence, telehealth is appropriate for:

Initial consultation for established conditions (patient already knows they have plantar fasciitis, wants to discuss treatments)

Follow-up care for chronic conditions (periodic check-ins on diabetic foot care, fungal nail progress)

Post-operative follow-up (checking healing after surgery, answering questions)

Patient education and counseling

Prescription refills and medication adjustments

Triage (determining if urgent in-person visit is needed)

Mental health support related to foot problems (body image, activity limitations)

Coordination with other healthcare providers

When In-Person Care Is Essential

New/acute foot pain (needs examination to diagnose)

Suspected fractures, infections, or wounds

Procedures (injections, debridement, nail removal)

Orthotic fitting or casting

Gait analysis (video gait can be limited; treadmill or in-person assessment often better)

Complex biomechanical issues

Patients with significant technology barriers

The Evidence-Based Approach: Hybrid Care

Systematic reviews and clinical practice guidelines suggest that the optimal model for many patients is hybrid care: periodic telehealth visits combined with regular in-person assessments. For example:

Diabetic Patient with Established Neuropathy

In-person comprehensive exam and foot screening: Every 6 months
Telehealth follow-up for progress checks: Every 2 to 3 months
In-person intervention if issues arise: As needed

Plantar Fasciitis Follow-Up

Initial in-person evaluation and treatment plan
Telehealth check-in at 2-4 weeks to assess response
In-person re-evaluation at 6-8 weeks if not improving
Telehealth follow-ups if improving well

This model balances convenience, cost-effectiveness, and the critical need for in-person assessment and treatment.

The Future of Telehealth in Podiatry

Emerging Evidence

Research suggests several developments:

Remote Diagnostic Tools: Dermatoscopes, otoscopes, and other portable devices are being integrated with telehealth, extending diagnostic capability. Early evidence is promising.

AI-Assisted Diagnosis: Machine learning algorithms trained on foot images show promise for detecting fungal nails, ulcers, and other visible conditions. Future telehealth may integrate AI for improved diagnostics.

Wearable Sensors: Devices monitoring foot pressure, temperature, and movement could provide remote data to podiatrists, enabling more sophisticated remote assessment of gait and biomechanics.

Integrated Hybrid Practices: Forward-thinking practices use telehealth for appropriate visits and in-person care for procedures/exams, streamlining efficiency.

What This Means for Your Podiatric Care

The evidence is clear: telehealth is here to stay and should be part of podiatric care. However, it's not a replacement for all in-person visits. The best approach is recognizing which problems are suitable for telehealth and which require hands-on examination and treatment.

If your podiatrist offers telehealth, consider using it for:

Follow-up appointments for established conditions
Questions between in-person visits
Progress checks on chronic conditions
Post-operative check-ins

But expect in-person visits for:

New foot problems requiring diagnosis
Procedures and injections
Complex assessments
Orthotic fitting

References & Further Reading

Connect With Us—In Person or Online

At Central Florida Foot & Ankle Institute, we embrace evidence-based care—whether in-person or via telehealth. For certain situations, telehealth offers convenience without compromising care. For others, your feet deserve a hands-on evaluation. Dr. Carli Hoover and our team will recommend the right approach for your needs.

Call (407) 307-0006 or visit https://floridafai.intakeq.com/booking to book an appointment—telehealth or in-person, whatever works for you.

The Evidence Files: Telehealth in Podiatry — What Pandemic-Era Research Tells Us