Priority 21 from the Foot Health PSP

UNCERTAINTY: How can foot problems be better represented in the care plan of people with rheumatological disease (e.g rheumatoid or inflammatory arthritis)?  (JLA PSP Priority 21)
Overall ranking 21
JLA question ID 0092/21
Explanatory note This researchable question was developed from a set of raw uncertainties that were comprehensively provided by patients with inflammatory arthropathy, which provides evidence of a strong depth of feeling that these patients have about their foot problems. People with inflammatory arthropathy have a high prevalence of foot problems, often that precedes a diagnosis of inflammatory disease. It is well documented that outside of a podiatric consultation foot problems are rarely acknowledged. Therefore establishing a recognised baseline foot screening/ assessment is crucial to the early management of foot problems in these patient groups. Research is required to understand the best ways in which to ensure the most appropriate approach is defined and then implemented.         
Evidence

No Systematic Reviews found but Foot Health referred to in NICE guidance: NG65 (2017) Spondylarthropathies in the over 16’s: diagnosis and management. Podiatry referral advised on diagnosis for assessment of needs, advice and periodic review. Research recommended re: HCP awareness of spondylarthropathy.  NG100 & QS33 (2018). Rheumatoid arthritis in adults: management & Rheumatoid Arthritis in the over 16’s. Podiatrists to be included as part of MDT (QS 2, 6, 7) 
Health Research Classification System category Generic health relevance
Extra information provided by this PSP
Original uncertainty examples Rh Arthritis feet are not part of regular inspection and should be, hammer toes, bunions etc....why not? ~ I have rheumatoid arthritis and my left foot is affected by this disease and it is not assessed in DAS.  How are rheumatology professionals recording deterioration in foot joints during patient consultations? ~ Why are feet rarely assessed, the focus tends to be on the hands but the feet are debilitating? They are excluded from the DAS for example. ~ How do we access better foot care when the rheumatologist ignores it? 
Submitted by Patient x 16
PSP information
PSP unique ID 0092
PSP name Foot Health
Total number of uncertainties identified by this PSP. 30  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 26 September 2019