Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 25:10:4.
doi: 10.1186/s13047-017-0188-3. eCollection 2017.

The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study

Oonagh Wilson  1   2 , John Kirwan  3 , Emma Dures  1 , Enid Quest  4 , Sarah Hewlett  1
Affiliations

The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study

Oonagh Wilson et al. J Foot Ankle Res. .

Abstract

Background: Although foot problems are common in rheumatoid arthritis (RA), the consequences of foot problems from the patient perspective have not been fully explored. The aims of this study were to explore the experience of foot problems and decisions to access foot care services or not in patients with RA.

Methods: Semi structured, one-to-one interviews with patients recruited from 2 UK rheumatology units, purposively sampled for self-reported foot problems and a range of personal/disease characteristics. Inductive thematic analysis was used, with rigour provided by multiple independent analysers. Emerging themes were discussed and agreed by all authors.

Results: Twelve patients participated: 7 female; mean age 56 years (29-72); mean disease duration 12 years (2-27), 5 had accessed foot care services. The 'Impact' of foot problems was substantial and formed the underpinning theme, comprising three organising themes: 'Foot symptoms'; 'Consequences'; and 'Cost'. Foot symptoms such as pain and numbness required self-management, and affected daily life (walking, working) leading to social and emotional costs. The global theme, 'Decision to access foot care or not', also comprised three organising themes: 'Access perceived unnecessary' (no problem, can cope); 'Access hindered by patients' perception'; and 'Access supported by patient and clinician'. Decisions to access foot care or not were complex and influenced by patient beliefs regarding possible treatments and how to access these, and hindered by patient perceptions that their feet were ignored by rheumatology clinicians. Positive experience of foot care encouraged continued utilisation but negative experiences contributed to patients' decisions to discontinue foot care services.

Conclusions: Foot problems are important issues for patients and impact on many aspects of their physical, social and emotional lives. Patients who had accessed foot care services prioritised their foot problems as an important health care need. However, for others who would like foot care services, personal knowledge and values, and perceived barriers in clinical practice, appear to interact to inhibit foot care access. The extent which these interactions affect overall access to foot care in RA patients in general now needs to be quantified to help to inform and improve the effectiveness of the organisation and delivery of foot care.

Keywords: Foot care; Foot problems; Patient experience; Qualitative methods; Rheumatoid arthritis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Overview of experience and impact of foot problems in RA
Fig. 2
Fig. 2
Decision to access foot care or not (Global theme)
See this image and copyright information in PMC

References

    1. van der Leeden M, Steultjens M, Ursum J, et al. Prevalence and cause of forefoot impairment and walking disability in the first eight years of rheumatoid arthritis. Arthritis Care Res. 2008;59(11):1596–1602. doi: 10.1002/art.24188. - DOI - PubMed
    1. Michelson J, Easley M, Wigley FM, Hellmann D. Foot and ankle problems in rheumatoid arthritis. Foot Ankle Int. 1994;15(11):608–613. doi: 10.1177/107110079401501106. - DOI - PubMed
    1. Otter S, Lucas K, Springett K, et al. Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study. Clin Rheumatol. 2010;29(3):255–271. doi: 10.1007/s10067-009-1312-y. - DOI - PubMed
    1. Spiegel JS, Spiegel TM. Rheumatoid arthritis in the foot and ankle—diagnosis, pathology, and treatment: The relationship between foot and ankle deformity and disease duration in 50 patients. Foot Ankle Int. 1982;2(6):318–324. doi: 10.1177/107110078200200603. - DOI - PubMed
    1. Turner DE, Helliwell PS, Siegel KL, Woodburn J. Biomechanics of the foot in rheumatoid arthritis: identifying abnormal function and the factors associated with localised disease ‘impact’. Clin Biomech (Bristol, Avon) 2008;23(1):93–100. doi: 10.1016/j.clinbiomech.2007.08.009. - DOI - PubMed