Best foot forward? … not for people with arthritis
Painful foot problems suffered by people with arthritis are seriously neglected and are subject to huge and unacceptable regional variations, according to a team of foot care experts.
Only a quarter of patients who need foot health care have adequate access to NHS services, and only half of all hospital rheumatology departments in the UK are able to access adequate basic foot care services for their patients.
“People with musculoskeletal problems often have complex needs, and it is easy for foot health problems to be overlooked,” explained Dr Redmond, Arthritis Research Campaign senior lecturer in musculoskeletal disease at the University of Leeds. But for many people, foot problems mean isolation, inability to work and shop, and increased dependency on social and health services.
“Only a third of people are able to access the foot health services they require and fewer than one in ten hospital rheumatology departments have a formal means of referring patients on for specialist foot care.”
Now the team of experts led by Dr Redmond has produced a set of widely agreed national standards aimed at family and hospital doctors and other health professionals in a bid to provide better and more standardised foot health care around the country.
“We know that podiatry/chiropody services are patchy, and that eligibility can be a problem, but foot health care can be provided by different members of the health care team, including podiatrists, consultants, GPs, nurses, orthotists, physiotherapists and occupational therapists,” said Dr Redmond.
“The standards are not about professional boundaries, they are about addressing the needs of a patient group with a high level of foot problems. When people are able to access professional care relevant to their needs they have a better quality of life and reduced demand for more complex and expensive health services. At the moment that is simply not happening around the country.”
Jan Lewis, aged 53, from Letchworth, is unable to look after her feet because her hands are so badly affected by severe rheumatoid arthritis. She suffers painful foot problems but has never been offered any foot care on the NHS by her GP, rheumatologist or specialist nurse and has to pay privately to see a podiatrist once a month. “I know there are regional differences in being able to get expensive anti-arthritis drugs but I didn’t realise it applied to other services as well,” she said.
Sixty-one-year-old Kath Burrows, who also has rheumatoid arthritis, could barely walk because of pain and swelling in her feet. But after seeing an NHS podiatrist who fitted her with proper insoles, she is now able to walk around her home town of Rossendale, Lancashire and has regained her independence as well as rediscovering the joy of walking for pleasure. “Podiatry has made a huge difference to what I can and can’t do,” she said.
A series of consensus statements, the standards of care represent the views of patients and professionals alike.
“For the first time, there are now widely agreed statements outlining expectations for the level of foot health standards that should be provided,” added Dr Redmond. “We believe that implementing them will make a real difference. There can be no justification any more for health care commissioners and providers to continue to treat foot health as the poor relation in service planning.”
The standards of care for people with musculoskeletal foot health problems are to be distributed widely to all primary care trusts, GPs, and all those involved in planning, delivering and receiving foot care. Best practice examples are provided throughout to illustrate how they can be put in practice.
Funded by medical research charity the Arthritis Research Campaign, the standards were developed in consultation with a number of professional and service user organisations including the British Society for Rheumatology and the Arthritis and Musculoskeletal Alliance.
The standards document is supported by an implementation package, both of which are available online at www.prcassoc.org.uk/standards-project
Key points in the standards:
- People with foot symptoms should be provided with information that helps them to understand the relationship between their musculoskeletal condition and their foot problems.
- People should be provided with the information and assistance required to look after their own foot health needs as far as is practicable and safe.
- Foot health care can be provided by many different members of the health care team, including podiatrists, consultants, general practitioners, nurses, orthotists, physiotherapists, occupational therapists and others.
- All people with musculoskeletal foot problems should receive an assessment of their foot health needs.
- People should receive professional care relevant to the complexity of their needs.
- People who experience a change in disease status should have their foot health needs reassessed.
- Mechanisms should be in place for timely referral to professionals with the necessary skills and expertise as required.
