BackgroundAlthough 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.MethodsSemi 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.ResultsTwelve 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.ConclusionsFoot 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-017-0188-3) contains supplementary material, which is available to authorized users.

BackgroundFoot symptoms in rheumatoid arthritis (RA) derive from a combination of inflammation, altered foot mechanics, deformity and secondary skin lesions. Guidelines recommend regular review of patients’ feet, but the extent to which the general population of RA patients report foot symptoms and access foot care has not been established. The aims of this study were to determine the prevalence, impact and care of foot problems in all patients with RA in one geographical area and identify factors associated with accessing foot care.MethodsCross-sectional survey of a random sample of patients with RA, who resided within a single community-based National Health Service (NHS) podiatry service. The questionnaire collected demographic data (age, gender, local deprivation score), clinical data (disease duration, arthritis medications, disability (Health Assessment Questionnaire (HAQ)), current foot problems, foot care accessed (podiatry, orthotics and/or orthopaedics) and care received, measures of impact (Foot Impact Scale) and ability to work.ResultsOf 1003 total eligible patients in the target population, 739 were posted survey packs. Of these 413 (56%) replied. Responders and non-responders had similar age (63.5 yr. vs.61.5 yr), gender (74.1%F vs. 75.2%F), and highest deprivation category (13.3% vs.15.9%). Of the responders 92.1% reported current foot problems: articular 73.8%, cutaneous lesions 65.4%, structural 57.6%, extra-articular 42.6%. Responders’ median (IQR) disease duration 10 (5–20) years, HAQ 1.5 (0.75–2.0), FISIF 10 (6–14) and FISAP 16 (7–23) and 37.8% reported impacts on work. While 69.5% had accessed foot care there were differences in the route of access (by gender and whether independent or NHS provision) and were older (64.9 yr. vs 60.4 yr. p = 0.001), had longer disease duration (12 yr. vs 7 yr. p < 0.001) and had a greater proportion of females (72.2% vs 61.7% p = 0.04) than those who had not accessed care.ConclusionsCurrent foot problems were reported by 92.1% of the study sample and substantially impacted on life and work. While overall access to foot care was higher than anticipated, routes of access differed and extent of current problems suggests the provision of effective, timely and targeted care is a pressing need.Electronic supplementary materialThe online version of this article (10.1186/s13047-017-0229-y) contains supplementary material, which is available to authorized users.

The use of monofilaments in assessing sensation levels in the RA foot is repeatable and reproducible over a six-week period and requires only a short time to perform. The frequency of reduced sensation in the feet of patients with RA was greater than previously reported. Future studies should assess relationships with disease duration and inflammatory status.

BackgroundData about the frequency of foot problems in rheumatoid arthritis (RA) can be obtained through self-report or clinical examination. The level of agreement between these two approaches has not been established in RA.ObjectivesTo measure levels of agreement between self-report and clinical examination of foot problems in RA.MethodsA random sample of RA patients who had self-reported foot problems in a questionnaire underwent a structured foot examination and clinical interview conducted by a single observer (podiatrist). Data collected included: patient demographics and clinical characteristics; whether they had accessed foot care (AFC) services (podiatry, orthotics and/or orthopaedics); impact of foot problems (Foot Impact Scale: Impairment/Footwear (FISIF) and Activities/Participation (FISAP) subscales); and presence of foot problems on examination. Extent of agreement between self-report and clinical examination was measured by the kappa statistic (k).ResultsOf 235 patients invited to participate, 110 (47%) attended; 65 AFC (59%); 77 Female (70%); mean (SD) age 63.1 (11.2) years; median (IQR) disease duration 8.5 (1, 51) years; HAQ 1.25 (0.375, 2.00); FISIF 9 (5, 13); and FISAP 15 (3, 22).The overall frequency of reported and examined foot problems were: toe deformities - 66% and 69%; hallux valgus - 35% and 33%; pes planus - 26% and 56%; callus - 56% and 53%; corns - 12% and 12%; blisters - 5% and 2%; thickened toe-nails - 57% and 45%: ingrown toe-nails - 16% and 15%; joint swelling - 28% and 65%; nodules - 23% and 16%; numbness - 27% and 19%.High agreement occurred for: corns (98%, k=0.913); ingrown toe-nails (97%, k=0.893); and hallux valgus (98%, k=0.959); nodules (92%, k=0.724); callus (84%, k=0.670); toe deformities (86%, k=0.67); and thickened toe nails (80%, K=0.606). Fair agreement was detected for numbness and pes planus (79%, k=0.418 and 76%, k=0.377) but only chance agreement for joint swelling (49%, k<0.01).ConclusionsOverall, high levels of agreement were detected between self-report and clinical examination for many foot problems, suggesting self-report can be utilised with a high degree of confidence. However, levels of agreement for more complex foot problems (e.g. pes planus) were only fair and patients substantially under-reported features of disease activity (e.g. joint swelling), indicating that clinical examination is required for these features.Disclosure of InterestNone declared