Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

Abstract

Background The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems. Methods An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the Medical Research Ethics Committee of University of Malaga (CEUMA‐91‐2015‐H). Results Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD‐related foot and ankle problems (the Netherlands, the UK and Malta). The professions providing care varied, depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities by orthopaedic surgeons and orthotist/prosthetists; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings. Conclusions Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD‐related foot and ankle problems.

The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study

“…In the Netherlands, multidisciplinary recommendations for managing foot problems in people with RA have been developed [ 23 ]; however, service structures to deliver this are fragmented. Care and training fragmentation was also identified in a pan-European, identifying only three countries, the Netherlands, the UK and Malta, has having any semi-specialised provision [ 24 ]. All in all, there is a lack of focused podiatric clinical care and guidelines for caring for patients with rheumatic condition-related foot and ankle problems.…”