Leading Podiatric Pathology & Diagnostic Science
A Center of Excellence for Podiatric Pathology
Sagis’ Podiatric Pathology division is an entirely physician-led sub-specialty pathology group catering specifically to Doctors of Podiatric Medicine (DPM). Our trusted team of board-certified dermatopathologists has expert training in podiatric skin, bone, molecular, as well as soft tissue pathology. We also deliver the most accurate diagnosis possible in clear and concise reports.
As a fully-recognized, CAP-accredited medical diagnostic laboratory in Houston, we proudly offer consistent, high-quality services to practicing physicians.
Our premier strength is developing strong and collaborative connections with our referring physicians by being readily available for one-on-one consults and second opinions. In addition, we ensure quality reporting through immediate portal access and provide prompt, precise, and reliable diagnoses in the utmost professional manner.
Considering a new podiatric pathology diagnostic partner? Contact us today to learn how we can support your practice and patients.
Bridging the Gap Between Clinical Podiatry & Podiatric Pathology
In essence, continuing education is immensely beneficial to podiatrists and ensures they stay up-to-date with the latest developments in their field. Therefore, our Podiatric Clinical Affairs Board was founded by Dr. Dock Dockery, Dr. Bryan Markinson and Dr. Tracey Vlahovic. This board bridges the gap between podiatric pathology as well as clinical podiatric medicine and surgery by providing same-day online and peer-to-peer access.
As a Center of Excellence in Podiatric Pathology, we also provide professional guidance on a biopsy technique, insight into the pathology of a specimen, clinical clarification of a report, as well as ongoing educational support to current and prospective clients.
Need guidance? Reach out for a personalized consultation with a member of our Board.
We Deliver Quick and Accurate Results Backed by Unmatched Personal Service
Today’s physicians require comprehensive diagnostic information and prognostic data to diagnose disease effectively, prescribe vital therapies, and introduce early treatment options. In addition, our standard podiatric pathology services have a turnaround timeframe of 24-48 hours. However, turnaround times may also be between 48-72 hours in cases requiring immunohistochemical or cytological studies.
We strongly believe that clearly communicating diagnostic information is the cornerstone of comprehensive podiatric care. A precise and accurate diagnosis will enable the best treatment options and result in noticeably improved patient care outcomes. And when additional questions arise, our pathologists take pride in being readily available for one-on-one consultations and second opinions.
Podiatric Pathology Diagnostic Services Include:
- Skin & Soft Tissue Evaluation
- Onychodystrophy / Onychomycosis
- Nail Unit Evaluation
- PCR Wound Analysis
- Bone Analysis
- Cytology
- ENFD
Collaborating With Other Industry Experts to Render the Best Patient Outcome
Accuracy and timeliness of diagnoses are our top priorities. For instance, we take a collaborative approach to each case, leveraging the expertise of our team of experienced pathologists, laboratory technicians, and dedicated support staff. Along with meticulous care and attention to detail, we also work together to process and analyze every specimen we receive. And to enhance our diagnostic capabilities, our cutting-edge lab is also equipped with state-of-the-art technology and advanced imaging techniques.
We go above and beyond to provide exceptional care to our clients and their patients. We understand the importance of going the extra mile, whether collaborating with our world-class partners to gain additional insights or dedicating extra time to review and verify our findings. Our unwavering commitment ensures our clients receive the most comprehensive and accurate diagnoses possible because we believe every patient deserves the highest standard of care.
Sagis Podiatric Pathology Techniques Include:
- PAS, GMS, & FM stains for histology
- Immunohistochemistry
- qPCR & NGS molecular testing
- Culture & Sensitivity
- Immunofluorescence in-situ hybridization
- Cytology
A Podiatric Pathology Team Trusted by Top Industry Leaders
Our board certified dermatopathologists bring together their individual experiences, qualifications, and specialized expertise, fostering a unique environment in podiatric pathology that enables advanced diagnostic innovation and ensures unparalleled accuracy in diagnoses.
Podiatry Education and Training
At Sagis, we believe that continuous podiatric educational opportunities are crucial in enhancing patient care. Our podiatry education team and Podiatric Clinical Affairs Board empower podiatry residents and practicing physicians with educational dinners, lectures, and various biopsy workshops. Let’s reshape the future of foot and ankle medicine – together.
Explore our educational resources and opportunities below!
We are here to help
Frequently
asked questions
If your question isn’t addressed below, please contact us
About Podiatric Pathology
What is podiatric pathology?
Podiatric pathology is a subspecialty of diagnostic pathology focused on the microscopic and molecular evaluation of tissue from the foot, ankle, and lower extremity. Specimens include skin, nail, bone, soft tissue, and wound samples. A podiatric pathologist works in close collaboration with the referring DPM to render accurate diagnoses that guide treatment decisions specific to the lower extremity.
What conditions does Sagis diagnose through podiatric pathology?
Our board-certified dermatopathologists evaluate a wide range of lower extremity conditions, including onychomycosis and other nail dystrophies, melanoma and non-melanoma skin cancers, inflammatory and autoimmune skin diseases, verruca, tinea, vasculitis, and dermatitis. We also evaluate soft tissue tumors, bone pathology including osteomyelitis, and perform PCR-based wound analysis to identify bacterial pathogens and antibiotic resistance. For diagnostically complex or ambiguous cases, our team reviews collaboratively before issuing a final report.
Why should a podiatrist send specimens to a dedicated podiatric pathology lab rather than a general lab?
Lower extremity pathology has unique clinical and histologic nuances that general pathologists may not encounter regularly. Nail unit histology, plantar skin anatomy, and the differential diagnosis of acral melanoma all require subspecialty familiarity. General pathologists who see other high-volume specimen types are less likely to recognize subtle findings in podiatric tissue. Sagis is purpose-built for podiatric pathology, and our board-certified dermatopathologists bring focused expertise in lower extremity diagnosis to every case.
Working With Sagis
How does a podiatric physician or clinic set up service to submit specimens to Sagis?
Setting up service is simple. Contact your local sales representative to establish your account by finding your territory rep using our Find My Sales Rep Map or by submitting our Become A New Client form. After setup is complete, you can easily order specimen supplies, requisition forms, and courier services through your rep or directly via our Supplies & Requests portal.
What specimen types does Sagis accept for podiatric pathology?
We accept biopsies, nail clippings, shave excisions, punch specimens, excisions, fine needle aspirates, bone samples, and wound swabs. Our testing panels cover onychodystrophy and onychomycosis (PAS, GMS, FM, PCR), nail unit evaluation, skin and soft tissue evaluation, PCR wound analysis, bone analysis to confirm osteomyelitis, cytology, and epidermal nerve fiber density (ENFD). Our Specimen Collection Guide details proper collection procedures and techniques. Our videos on Submitting A Specimen provide detailed instructions to ensure accurate results and smooth lab processing for each specimen type.
What makes Sagis different from other labs that process podiatric specimens?
Sagis is dermpath-owned and purpose-built for podiatric pathology. Our board-certified dermatopathologists specialize in lower extremity tissue and bring subspecialty depth that high-volume reference labs cannot match. We use PAS staining as our standard protocol for nail and skin specimens, which is the gold standard for detecting dermatophytes and significantly more sensitive than H&E staining alone. Referring physicians have direct access to our dermatopathologists for one-on-one consults and second opinions, and our reports are written to be clear, concise, and actionable.
Is Sagis accredited?
Yes. Sagis is a CAP- and CLIA-accredited medical diagnostic laboratory based in Houston, Texas. We also hold a Clinical Laboratory Permit from the New York State Department of Health. These accreditations reflect a rigorous commitment to quality, accuracy, and consistency in laboratory testing and reporting.
How quickly will I receive results?
Turnaround time varies by specimen type. Skin, soft tissue, and onychomycosis results are typically available within 48 to 72 hours of specimen receipt. ENFD analyses are returned within two weeks of testing. Swab and aspirate specimens should be sent to Sagis STAT due to specimen stability requirements. You can access finalized results through our secure online portal, and our team is available for same-day consultation if you have questions about a report.
How do I submit a clinical photo with a case?
Use our Clinical Photo Submission Form. The form is HIPAA-compliant, encrypted, and designed for fast submission. You can capture a photo with your device or upload an existing image from your library. Include measurements, a gross visual description of the lesion, and the patient’s clinical history in the visual description field. Once submitted, the photo accompanies your case and is referenced in the resulting pathology report. We can also provide a QR code sticker for each patient room if that works better for your clinic workflow.
Biopsy & Specimen Collection
How can I get guidance on biopsy technique?
Sagis offers several resources to support you. Our Specimen Collection Guide walks through collection procedures by specimen type, including skin, nail unit, soft tissue, and fine needle aspiration. Step-by-step biopsy videos cover punch biopsy, saucerization, wound swab collection, and fine needle aspiration. If you want hands-on guidance or have a specific clinical question, you can also request a consultation with our Podiatric Clinical Affairs Board. Your Sagis representative can connect you, or you can reach us directly at (877) 697-2447.
Is performing a biopsy within my scope of practice as a DPM?
Absolutely. Direct access to our dermatopathologists is one of the things that sets Sagis apart. We are readily available for one-on-one consultations, whether you have a question before submitting a specimen or need to discuss a finalized report.
Does it make a clinical difference whether I biopsy or treat empirically?
It does, particularly for nail dystrophy. Studies show that up to 50% of dystrophic nails are not caused by fungal infection. Psoriasis, lichen planus, trauma, and conditions such as subungual squamous cell carcinoma and melanoma can present identically to onychomycosis on visual exam. Clinical visual diagnosis of onychomycosis has a reported accuracy of only 50% to 60%. Treating empirically without a confirmed diagnosis risks exposing your patient to months of systemic medication, including oral antifungals with potential hepatotoxicity, for a condition they may not have. A nail biopsy with PAS-stained histopathology confirms the diagnosis before you write the prescription and identifies non-fungal pathology that no other test will catch.
What should I do if I'm concerned about a pigmented lesion on the foot?
Biopsy it promptly. The foot is the most common site for acral melanoma, and delayed diagnosis is associated with significantly worse outcomes. Podiatrists are both qualified and well-positioned to perform this biopsy because of their expertise in foot anatomy and pathology. An in-office punch biopsy at the time of concern gets your patient a tissue diagnosis in days rather than weeks. If the result does require a referral, you become the referring provider with a confirmed diagnosis already in hand.
Will biopsying add significant time to my patient encounters?
A punch biopsy on the foot, once integrated into your workflow, typically takes five to seven minutes including anesthesia. The more meaningful comparison is total time with the patient across their full treatment course. Empiric treatment for unconfirmed onychomycosis averages three to six months before reassessment, which means multiple additional encounters. A confirmed diagnosis at the first or second visit compresses the treatment timeline and reduces total chair time over the life of the case.
Testing & Diagnostics
How does Sagis handle onychomycosis testing?
Sagis processes nail specimens using PAS-stained histopathology, which is the most sensitive single test for detecting dermatophytes in nail tissue, outperforming KOH preparation, culture, and PCR alone. A proper nail unit biopsy read by a dermatopathologist also evaluates for non-fungal nail pathology, including psoriasis, lichen planus, trauma-related changes, and malignancy. Sagis accepts nail clippings, nail unit biopsies, and shave specimens, and we provide clear, actionable results with a typical turnaround of 48 to 72 hours.
What is PCR wound analysis and when should I use it?
PCR (Polymerase Chain Reaction) wound analysis is a molecular diagnostic technique that detects and quantifies bacteria in a wound sample with high sensitivity and specificity. It identifies the specific pathogens responsible for infection, including fastidious and anaerobic organisms that culture often misses, and flags antibiotic resistance genes to guide treatment selection. Our published clinical data demonstrate 98.3% sensitivity and 96.9% specificity. PCR wound analysis is most valuable for chronic or non-healing wounds, wounds that have not responded to empiric antibiotic therapy, and cases where identifying the precise pathogen and resistance profile will change your treatment approach.
What is ENFD testing and what does it evaluate?
Epidermal Nerve Fiber Density (ENFD) testing is a skin biopsy-based diagnostic tool used to evaluate small fiber neuropathy. A 3mm punch biopsy is taken and processed in Zamboni’s fixative, then examined by both a neuromuscular neurologist and a board-certified dermatopathologist. The test measures intraepidermal nerve fiber density and checks for small vessel vasculitis or other histologic abnormalities. ENFD is indicated for patients with sensory neuropathic complaints, normal nerve conduction studies, and no large fiber involvement, a presentation consistent with isolated small fiber neuropathy. Results are returned within two weeks of testing.
Does Sagis perform immunohistochemistry and special stains?
Yes. When a case requires additional workup, we perform immunohistochemistry (IHC), direct immunofluorescence (DIF), PAS staining, GMS staining, Fontana-Masson staining, and other special stains in-house to support the most accurate diagnosis possible.
Reports & Physician Support
How will I receive results?
Results are available through our secure online portal, which provides immediate access to finalized reports. Sagis can also work with most EMR systems for electronic reporting. Critical or unexpected findings are communicated directly and promptly. If you have questions about a report, our dermatopathologists are available for same-day consultation.
What makes Sagis reports more useful than what I've received from other labs?
Sagis reports are written for clinicians, with clear diagnostic conclusions and clinical context. Our board-certified dermatopathologists specialize in lower extremity specimens, including nail unit histology and plantar skin pathology, areas where general pathologists have limited exposure. We use PAS staining as our standard protocol, and our reports include the diagnostic detail you need to treat with confidence. If you have a question about a result, you can reach our dermatopathologists directly for a same-day consult.
Can I consult directly with a dermatopathologist about a case?
Absolutely. Direct access to our dermatopathologists is one of the things that sets Sagis apart. We are readily available for one-on-one consultations, whether you have a question before submitting a specimen, need guidance on site selection or collection technique, or want to discuss a finalized report.
Does Sagis offer second opinions on podiatric pathology cases?
Yes. We provide second-opinion consultations on outside cases, including challenging nail unit lesions, pigmented acral lesions, inflammatory conditions, and rare neoplasms. If you have a case that warrants another look, we welcome the opportunity to review it.
Education & Support
What educational resources does Sagis offer for podiatric physicians?
Sagis offers a range of resources to support practicing DPMs. Our Specimen Collection Guide, biopsy technique videos, and specialty-specific collection guides are all available on our website. Our Podiatric Clinical Affairs Board provides same-day peer-to-peer access and ongoing educational support. Sagis also hosts biopsy workshops and provides in-service training for clinical staff. CPT coding resources for biopsy encounters are also available through your Sagis representative.
What is the Podiatric Clinical Affairs Board?
The Podiatric Clinical Affairs Board was founded by Sagis to bridge the gap between clinical podiatry and podiatric pathology. Co-chaired by G. Dock Dockery, DPM, Bryan C. Markinson, DPM, and Tracey C. Vlahovic, DPM, the board provides same-day online and peer-to-peer access for practicing physicians. As a Center of Excellence in Podiatric Pathology, Sagis and the board offer professional guidance on biopsy technique, insight into specimen pathology, clinical clarification of reports, and ongoing educational support to current and prospective clients.