Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

Background: The aim of the present study was to explore the variation in theprovision of care for people with rheumatic and musculoskeletal diseases (RMDs),and foot and ankle problems between European healthcare systems.Methods: An electronic questionnaire was developed and piloted in seven countriesprior to being distributed to the presidents of all 22 national health professionals inrheumatology associations within the European League Against Rheumatism(EULAR). Summary data were obtained using SPSS V22. Ethical approval was soughtfrom the Medical Research Ethics Committee of University of Malaga (CEUMA-91-2015-H).Results: Sixteen questionnaires (73% response rate) were completed (Austria,Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, theNetherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All16 respondents indicated that foot and ankle healthcare services were providedin their country, but only three countries had services specializing in RMD-relatedfoot and ankle problems (the Netherlands, the UK and Malta). The professionsproviding care varied, depending on the pathology and the country. Foot andankle pain was mostly treated by rheumatologists and physiotherapists; foot andankle deformities by orthopaedic surgeons and orthotist/prosthetists; and footand ankle ulcers by nurses. Services were predominantly delivered through thepublic sector, and in secondary care (hospital) settings.Conclusions: Only three countries reported having specialist foot and ankle servicesaddressing the needs of people with RMDs. Variation was seen in the professionswhich provided care between countries, and also between the foot and ankle pathol-ogies cared for. There is a lack of clinical pathways and guidelines for the manage-ment of patients with RMD-related foot and ankle problems.