Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated withrheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studieshave recommended service and footwear design improvements, it is not known if services have improved or if thisfootwear meets the personal needs of people with RA. As an earlier study found that this footwear has moreimpact on women than males, this study explores women’s experiences of the process of being provided with itand wearing it. No previous work has compared women’s experiences of this footwear in different countries,therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten womenwith RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) wasadopted during data collection and analysis. Conversational style interviews were used to collect the data.Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approachto the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different toothers; footwear influencing social participation; and the women’s wishes for improved footwear services. Despitetheir nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and angerand that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives.This results in severe restriction of important activities, particularly those involving social participation. However,where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, theacceptance of this footwear was much more evident and there was less wastage as a result of the footwear beingprescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with theonly choice being to reject it once it had been provided. All the women were vocal about what would improvetheir experiences and this centred on the consultation with both the referring practitioner and the practitioner thatprovides the footwear.Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of whatit is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of theirconsultations with practitioners has revealed the tension between the practitioners’ requirements and the women’s‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of usingtherapeutic footwear as an intervention