New paper targets prevention of foot and lower limb diseases

The study by Dr Peter Roberts, Senior Lecturer in Podiatry, and colleagues across nursing and podiatry and published in the Journal of Foot and Ankle Research, focuses on the role podiatrists have in preventing the progression of venous diseases such as varicose veins and varicose eczema. These conditions can lead to painful ulcers that have damaging effects beyond the kind of foot problems usually associated with podiatry.

Research for the paper saw cooperation between podiatry and nursing academics across the School of Human and Health Sciences, including the acclaimed Institute of Skin Integrity and Infection Prevention (ISIaIP) and its Director, Professor Karen Ousey.

“This research highlights an opportunity for podiatry to contribute more overtly towards prevention, which is really important in the current healthcare crisis. We don’t want to just put fires out, we want to stop them starting,” says Dr Roberts, who joined the university from the NHS in 2008.  

“Traditionally, podiatry is quite light on research and evidence base. The interest for this project came from the fact that we are very much seen as foot-focused and quite insular in the way that we are not seen as interested in anything else. There is a ‘bubble’ around the foot, but in actual fact we have skills way beyond the foot which are more holistic and encompassing of the lower limb.

“But, we do not know particularly what goes on in podiatry with venous disease. It is such a huge medical problem that causes pain, disability, it takes a long time to heal and is very expensive to heal if wounds occur. So it is an important condition to spot and give help for as early as possible."

Issues such as varicose veins and oedema, lead waste products to collect in the lower limb causing irritation like eczema, that can then ulcerate and leave patients with a significant health burden.

“It is at that point, if we cannot prevent that ulcer, then that wound is a real problem,” Dr Roberts adds. “Karen and her team do an awful lot of work on all aspects of wound management and prevention. Because it is not just about putting bandages on, it is about promoting health.  But we didn’t have a full understanding of podiatrists’ activity in this area despite their opportunity and expertise. The wound can last 12 months or more, and cost thousands of pounds in health care resources to get it to heal. 

"There is a great deal of nursing and medical research into the best ways to manage these wounds when they occur but comparatively little about how to prevent them in the first place.  There is also very little on the role that allied health professionals can play."

Dr Roberts observed both NHS and private practitioners over a four-month period, with the resulting paper - The role of podiatry in the early identification and prevention of lower limb venous disease: an ethnographic study – that was co-authored with Professor Ousey, Dr Caroline Barker and Dr Sarah Reel.

“Karen has a tissue viability nursing background and my clinical background in podiatry included diabetic foot care and peripheral arterial disease. We had come across each other when I started here in 2008 and she always had good links with the podiatry team.

“The opportunity for an interdisciplinary approach with venous disease was important because the management of venous leg ulceration was always very much seen as a nursing role, and so this was a chance with Karen onboard to get a bit more information and the nursing perspective.  This was helpful in gaining an understanding of why podiatry, as a lower limb profession, was missing from all the venous literature and guidance.”

Dr Roberts hopes to build on the findings in the paper by exploring how lower limb venous diseases are assessed and prevented by podiatrists overseas in comparable countries including Canada, South Africa and Australia.

“What the paper did show was that there was interest from some big names in the profession who retweeted and flagged this as up as work that needs doing. Next, we will do an international expansion, taking the paper and its findings and speaking to podiatrists in New Zealand, Australia, Canada and South Africa as they are places with fairly equivalent professional standing and qualification. We want to see how things are done there, see if there is anything that we can all learn from each other and if there are any practices we can share.”