Guidelines for the management of the foot health
problems associated with rheumatoid arthritis

Williams, AE; Davies, S; Graham, A; Dagg, A; Longrigg, K; Lyons, C; Bowen, C

Abstract

Background. Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting
negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and
management of foot and ankle problems within this patient group. However, it has been identified that in many
areas there is no specialist podiatry service, with many patients being managed by non‐specialist podiatrists.
Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified
the need to develop ‘practitioner facing’ guidelines for the management of specific foot health problems associated
with RA.
Methods. Members of a guideline development group from the NWCEG each reviewed the evidence for specific
aspects of the assessment and management of foot problems. Where evidence was lacking, ‘expert opinion’ was
obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative
approach was employed, with the results being reviewed and revised by all members of the group and external
reviewers before the final guideline document was produced.
Results. The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific
interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in
relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding nonspecialist
podiatrists through the complexity of assessing and managing those patients with problems requiring
input from a specialist podiatrist and other members of the rheumatology multidisciplinary team.
Conclusion. This pragmatic approach ensured that the guidelines were relevant and applicable to current practice
as ‘best practice’, based on the available evidence from the literature and consensus expert opinion. These
guidelines provide both specialist and non‐specialist podiatrists with the essential and ‘gold standard’ aspects of
managing people with RA‐related foot problems.

Citation

problems associated with rheumatoid arthritis. Musculoskeletal Care, 9(2), 86-92. https://doi.org/10.1002/msc.200

• Journal Article Type: Article
• Publication Date: Jan 24, 2011
• Deposit Date: Feb 15, 2011
• Journal: Musculoskeletal Care
• Print ISSN: 1478-2189
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 2
• Pages: 86-92
• DOI: https://doi.org/10.1002/msc.200
• Publisher URL: http://dx.doi.org/10.1002/msc.200
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1557-0681