Priority 3 from the Foot Health PSP

UNCERTAINTY: How important are specialised tests (such as diagnostic ultrasound imaging/advanced vascular and gait/functional assessment) learned at post-graduate level, in the diagnosis of foot health problems? (JLA PSP Priority 3)
Overall ranking 3
JLA question ID 0092/3
Explanatory note With the widening scope of more specialised practice for Health Professionals involved in the assessment and management of lower limb pathology, the effectiveness and appropriateness of advanced clinical assessment techniques requires a robust evidence base in order to develop the most clincially effective assessment protocols and inform the patient clincial pathway:  "podiatrists are so important in the assessment and diagnosis of vascular problems in the lower limb, is there any evidence to show how much impact we have?

CD0101 – Crawford et al (2016): ABI for diagnosis of lower limb Peripheral Arterial Disease. Evidence to support the accuracy of ABI in diagnosis of PAD is sparse. CD010835 – Andras and Ferket (2014): Screening for peripheral arterial disease. No data available for review, therefore unable to detect the effectiveness of PAD screening. BMC Musculoskelet Disord. 2015 Jun 5;16:134. doi: 10.1186/s12891-015-0596-0.Gait characteristics associated with the foot and ankle in inflammatory
arthritis: a systematic review and meta-analysis.Carroll M(1), Parmar P(2), Dalbeth N(3), Boocock M(4), Rome K(5). Most studies report gait adaptations for RA very little reported for other IA’s. Future studies need a standardised analytical approach to gait analysis to provide objective evidence of foot function in IA

Health Research Classification System category Generic health relevance
Extra information provided by this PSP
Original uncertainty examples Podiatrists are so important in the assessment and diagnosis of vascular problems in the lower limb, is there any evidence to show how much impact we have? ~ In the future how are we going to advance our diagnostic skills in line with higher risk patients we are working with - when the NHS (broadly) has very little understanding or concept of who we are and what we can offer? ~ How widespread is the use of diagnostic ultrasound in the Podiatry profession given the applicability of its use in MSK and vascular pathology? ~ In a climate where traditional clinical assessments of the foot and ankle (e.g. foot shape, ankle ROM) are increasingly criticised within research (typically based on cohorts of healthy students), what clinical assessment tools can be recommended to guide management of complex foot problems?
Submitted by Healthcare professional x 23, Patient x 6, Other x 3
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