Women's experiences of wearing therapeutic footwear in three European countries

Abstract

BackgroundTherapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women's experiences of the process of being provided with it and wearing it. No previous work has compared women's experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.MethodWomen with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data.ResultsSix themes were identified: feet being visibly different because of RA; the referring practitioners' approach to the patient; the dispensing practitioners' approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women's wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear.ConclusionThis unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an 'intervention'. The participant's experience of their consultations with practitioners has revealed the tension between the practitioners' requirements and the women's 'social' needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention.

Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review

“…Contrastingly, for men it was identified that the replacement of existing foot wear is not as noticeable as it closely resembles the normal footwear (Williams et al, 2007). Women revealed that therapeutic footwear invokes emotions of sadness, shame and anger, resulting in severe restriction of important activities, particularly those involving social participation (Williams et al, 2010). No such information was found in literature about orthotic devices.…”

Guidelines for the Management of the Foot Health Problems Associated with Rheumatoid Arthritis

“…Rheumatoid arthritis (RA) is a chronic systemic disease that commonly affects the feet (Grondal et al, ), and as Shi et al () identified, virtually 100% of patients report foot problems within 10 years of disease onset. The structural and functional changes in the feet often affect gait and mobility (Turner et al, ; Woodburn et al, ; Turner et al, ), impacting negatively on the patient's quality of life (Otter et al, ; Wickman et al, ) and specifically restricting the choice of footwear (Goodacre and Candy, ; Williams et al, , ). For some people with RA, the structural changes are a factor in foot ulcer development (Firth et al, ), with the risk of infection, particularly if the patient's medical management includes the use of immunosuppressive drugs (Otter et al, ; Wilske, ).…”

Older People’s Perceptions of a Multifaceted Podiatric Medical Intervention to Prevent Falls

“…26 In the present trial, 34 participants (25.4%) were considered to have inappropriate footwear and were, therefore, provided with a voucher to subsidize the purchase of new shoes. Most of those who purchased new shoes (92.3%) reported that they were somewhat or very satisfied with them, although nearly a quarter decided not to purchase the shoes.…”