Patient-centred outcomes of a rheumatology podiatry service for people with foot-specific symptoms: a randomised feasibility trial

The intervention group will receive access to a free podiatry service. The podiatry service will operate from the La Trobe University Health Sciences Clinic in Melbourne, Australia. Treatment provided will be individualised to participants based on their needs and goals. Participant needs and goals will be triaged during eligibility screening, and participants will access the podiatry service as many times as they require over the 12-week duration of the trial. Based on previous research, it is anticipated that treatment will involve broad categories of: • dermatological care (nail and callus care, education); • musculoskeletal care (managing pain, deformity, and improve function using: (i) medication in conjunction with medical team, (ii) strengthening exercise and stretches, (iv) footwear, (v) foot orthoses, (vi) in-shoe padding, (vii) toe splints, and (viii) education); • neurovascular care (assessment, education, management where appropriate, and referral if needed); • foot ulcer management (pressure offloading, wound care and dressing, and referral where appropriate). Treatment will be provided by a podiatrist with over 10 years of experience in clinical practice, who is endorsed to prescribe scheduled medicines, has undertaken further training in rheumatological conditions, and plays an active role in the Australian Rheumatology Association. For participants who require foot orthoses, Formthotics™ full length prefabricated foot orthoses will be provided. These are manufactured from a dual-density polyethylene closed cell foam that has a firm-density bottom layer (Shore-A durometer 50), and a soft-density top layer (Shore-A durometer 25). Participants will receive the foot orthoses in accordance with the manufacturer’s instructions. Participants who require footwear will be provided with a $250 discount from the cost of new footwear. The footwear will be agreed with the podiatrist and participants will be required to attend pre-arranged footwear suppliers to receive the discount. All other treatment, such as skin or nail care, exercises, or other aids, will be provided in line with standard podiatry practice in Australia. Adherence to the interventions for the intervention group will be evaluated at weeks 6 and 12 by asking participants whether they followed the treatment plan provided by the podiatrists. Participants will be asked “Have you followed the treatment plan you were provided as part of the study?” and respond using a 5-point Likert scale from 0 meaning “Strongly disagree” to 5 “Strongly agree”.