Background Foot pathology is common in inflammatory arthritis and the role of the podiatrist in the multidisciplinary care team is well established. However, in systemic lupus erythematosus; (SLE) the need for foot health services and service provision for foot disease is unknown.
Objectives We set out to determine the perceived need and uptake of foot care services among people with SLE from the patients' perspective.
Methods We developed and tested a new 40-item item self-administered questionnaire, using a 5-stage development process we utilised patient involvement throughout to ensure face and content validity. This instrument was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland New Zealand. The questionnaire enquired about the occurrence of foot symptoms and their frequency of assessment, the availability of podiatric services and the usefulness of interventions.
Results From 131 responses, (89% women, mean (SD) age 51 (15.1), mean (SD) diagnosis 12.5 (11.1) years): 77% respondents experienced foot pain during the course of their lupus and almost one third (31%) reported difficulty with basic foot care. In total, 45% reported current foot pain and the mean (SD) score on a 10cm visual analogue scale was 4.9 (2.2). Half of the patients had discussed their foot pain with their general practitioner (50%) or rheumatologist (49%) and 35% reported ever having had a foot X-ray. Respondents reported there was no significant difference in the frequency with which their hands and feet were examined. Equally, there was no correlation between the reported severity of foot pain and the frequency of foot examination. Despite the frequency of foot complaints only 32.8% had been seen by a podiatrist. Insoles had been prescribed to less than a quarter of respondents (22%) but only 11% of those receiving foot insoles were continuing to wear them and merely three respondents (2%) indicated their foot symptoms had been resolved by their insoles. Being unable to replace insoles was the most commonly cited reason for not continuing with insole therapy. None of the subjects reported that they had been provided with specialist footwear and 8 subjects (6%) underwent foot surgery.
Conclusions Foot problems appear to be under-recognised in patients with SLE. Health care professionals need to consider a comprehensive foot care plan as part of the holistic management of people with SLE.
Acknowledgements We wish to thank the respondents who took the time to complete the questionnaire and our research assistants - Gemma Crawley, Hilary Otter and Heather Waddington.
Disclosure of Interest None declared