If the Shoe Fits:
Enabling Patient-Centred Podiatry

Following the success of the original ITSF project, further funding was secured in 2015 for a follow-on project, ‘If the Shoe Fits: Enabling Patient-Centred Podiatry’. A collaboration between the University of Sheffield, UK and the Podiatry Team at Sheffield Teaching Hospitals, the project involved semi-structured interviews, shoe diaries, shoe photography and a focus group with podiatry patients, podiatrists and shoe-fitters around the subjects of footwear and identity. We explored:

  • patients’ motivations and values behind shoe choices and their reasons for acting on (or rejecting) the expert advice of podiatrists as to appropriate footwear

  • the practical barriers that might prevent changes in footwear and how these might be addressed in consultations

  • what might be done to facilitate dialogue between podiatrists and patients to encourage footwear changes that take into consideration patient preferences and values as well as their health needs

Using the findings, we produced a set of recommendations and designed a toolkit for podiatrists to help them initiate conversations with their patients and better understand potential barriers to footwear change.

  • The research was conducted between February and July 2015 and involved in-depth, semi-structured interviews with 13 podiatry patients and 6 professionals, including podiatrists and shoe fitters. Five of the patients also completed a shoe diary for approximately one month after the interview, and took part in a follow-up interview, where photographs were taken of some of their shoes. Finally, we conducted a focus group with professionals and patients to share, discuss and refine the draft toolkit.

  • The project highlighted some of the barriers that podiatrists may encounter when trying to support patients to make ‘healthier’ footwear choices. For example, desirable footwear from a medical perspective may be perceived as unfashionable and unwearable over the long term by patients. Shoes form a key part of individuals’ self-image and identity, so making ‘healthier’ footwear choices can be difficult for patients when recommended shoes appear to sit at odds with their sense of self and the identity they wish to portray. The toolkit we designed outlined four different types of ‘fit’ for podiatrists to explore in consultation with patients, in order to open up conversations around the barriers to footwear change and start to address these:

    - Physical fit: How well do the shoes ‘fit’ in a conventional sense and does the patient feel physically comfortable in them? Do they help to minimise pain or increase mobility?

    - Mental fit: What do these shoes say about the patient’s identity? Does the patient feel the shoes ‘fit’ who they are as a person?

    - Social fit: Do these shoes take into consideration the social norms and expectations around footwear and the impact these might have on patient preferences and values? Do family and friends understand the importance of the shoe changes?

    - Fit for purpose: What does the patient need these shoes for? Do these shoes ‘fit’ the patient’s lifestyle / hobbies / social and leisure activities / occupational needs?

  • The toolkit was rolled out in Podiatry training via Sheffield Teaching Hospitals and headline findings were shared with the Society of Shoefitters to help inform a presentation to Parliament in October 2015. A question and answer session was hosted in August 2015 with the Sheffield Diabetes group to present findings to patients with diabetes, and findings have been shared internationally including at the College of Podiatry Annual Conference, and American Sociological Association and European Sociological Association conferences. The project was shortlisted for a Medipex Innovation Award and awarded a Council for Allied Health Professions Research (CAHPR) Public Health Research Award in 2015.

    Click here to view the research publications.

Patient Centred Podiatry Toolkit (click to view)

The research team

  • Prof. Victoria Robinson

    Principal Investigator,
    University of Sheffield

    Bio

  • Prof. Wesley Vernon OBE

    Co-investigator, Podiatry Team, Sheffield Teaching Hospitals

    Bio

  • Dr. Lisa Farndon

    Co-investigator, Podiatry Team, Sheffield Teaching Hospitals

    Bio

  • Dr. Emily Nicholls

    Research Associate,
    University of Sheffield

    Bio