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      A survey of people with foot problems related to rheumatoid arthritis and their educational needs

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          Abstract

          Background

          Up to 50% of people with rheumatoid arthritis (RA) have foot symptoms at diagnosis, hence early foot health intervention is recommended and this should include patient education. This study identifies, for the first time, the foot health education (FHE) needs of people with RA.

          Methods

          An online survey of people with RA ( n = 543) captured quantitative data in relation to the aims, methods of delivery, content, timing and accessibility of FHE.

          Results

          The majority concurred about the aims of FHE. Verbal delivery and websites were the most common methods. Written and verbal FHE were perceived to be the most effective methods. The point of diagnosis was the preferred time to receive it. Lack of access to FHE included minimal focus on foot health during consultations by both health practitioners and patients with RA. Participant gender, age, disease duration and living situation had a statistically significant influence on the results.

          Conclusion

          Foot health education is rarely considered within the medical consultation. There is a lack of patient and/or health professional awareness of this need with a detrimental impact on foot health. Patients require health professionals to identify their foot education health needs. Tailored foot health education should begin at initial diagnosis.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13047-017-0193-6) contains supplementary material, which is available to authorized users.

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          Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study.

          Kate Springett, Angela Lucas-Herald, Adam Young … (2010)
          Foot involvement is a major feature of rheumatoid arthritis (RA). Most epidemiological studies of the RA foot report radiological changes and results of clinical examination. This study aimed to determine the prevalence of foot symptoms, frequency of foot assessment and access to foot care from the perspective of people with RA. A questionnaire was sent to 1,040 people with RA throughout the UK enquiring about foot symptoms, their anatomical distribution (via validated mannequins) availability of podiatry services and perceived usefulness of interventions for alleviating foot symptoms. Altogether 585 useable replies were received; 93.5% of respondents reported having experienced foot pain, and 35.4% reported current foot pain as the presenting symptom. Most (68.2%) reported moderate or severe foot pain daily. Pain was most prevalent in the forefoot and/or ankle. The main predictive factors for reporting current foot pain were longer disease duration (mean 13 vs 10.3 years, p = 0.009), higher BMI (25.6 vs 24.1 p = 0.001) and the prevalent foot symptoms foot stiffness and numbness (both p < 0.0001). Age, gender and current treatment were not significantly associated. Most (82%) had discussed foot symptoms with their rheumatologist, and only 64% had seen a podiatrist. Reported current adherence to prescribed orthoses was 55.8% and to prescribed shoes was 29.5%. Foot symptoms are ubiquitous in RA and frequently severe. Most patients had discussed their symptoms with their rheumatologist, and only 64% had specifically seen a podiatrist. Despite the remarkable progress in development of new treatment modalities for RA, foot pain remains a common and disabling symptom. Our findings support the need for wider access to specific foot care services and evidence-based, patient-centred interventions.
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            The foot: still the most important reason for walking incapacity in rheumatoid arthritis: distribution of symptomatic joints in 1,000 RA patients.

            Lollo Gröndal, Birgitta Tengstrand, Birgitta Nordmark … (2008)
            Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability. 1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity. In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part. After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.
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              Rheumatoid arthritis patients' experiences of wearing therapeutic footwear - A qualitative investigation

              Anita Williams, Christopher Nester, Michael Ravey (2007)
              Background Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not. Method Ten females and three males with RA and experience of wearing specialist footwear were recruited from four National Health Service orthotic services. Semi-structured interviews were carried out in the participants own homes. A hermeneutic phenomenological analysis of the transcripts was carried out to identify themes. Results The analysis revealed two main themes from both the female and male groups. These were the participants' feelings about their footwear and their experiences of the practitioner/s involved in providing the footwear. In addition, further themes were revealed from the female participants. These were feelings about their feet, behaviour associated with the footwear, and their feelings about what would have improved their experience. Conclusion Unlike any other intervention specialist therapeutic footwear replaces something that is normally worn and is part of an individual's body image. It has much more of a negative impact on the female patients' emotions and activities than previously acknowledged and this influences their behaviour with it. The patients' consultations with the referring and dispensing practitioners are pivotal moments within the patient/practitioner relationship that have the potential to influence whether patients choose to wear the footwear or not.
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                Author and article information

                Contributors
                Andrea S. Graham: 0161 295 6416 , a.s.graham@salford.ac.uk
                John Stephenson: j.stephenson@hud.ac.uk
                Anita E. Williams: a.e.williams1@salford.ac.uk
                Journal
                Journal ID (nlm-ta): J Foot Ankle Res
                Journal ID (iso-abbrev): J Foot Ankle Res
                Title: Journal of Foot and Ankle Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1757-1146
                Publication date (Electronic): 6 March 2017
                Publication date PMC-release: 6 March 2017
                Publication date Collection: 2017
                Volume: 10
                Electronic Location Identifier: 12
                Affiliations
                [1 ]ISNI 0000 0004 0460 5971, GRID grid.8752.8, Centre for Health Science Research, , University of Salford, ; Frederick Road, Salford, UK
                [2 ]ISNI 0000 0004 0460 5971, GRID grid.8752.8, Directorate of Prosthetics, Orthotics and Podiatry, , University of Salford, ; Frederick Road, Salford, UK
                [3 ]ISNI 0000 0001 0719 6059, GRID grid.15751.37, , School of Human and Health Sciences, University of Huddersfield, ; Queensgate, Huddersfield UK
                Article
                Publisher ID: 193
                DOI: 10.1186/s13047-017-0193-6
                PMC ID: 5340002
                PubMed ID: 28286569
                SO-VID: f286cc40-06a1-493f-8ba6-8af6e89feb20
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 November 2016
                Date accepted : 28 February 2017
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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