title: Rheumatoid arthritis patients' experiences of wearing therapeutic footwear - a qualitative investigation.
abstract: BACKGROUND
  Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not.
  
  
  METHODS
  Ten females and three males with RA and experience of wearing specialist footwear were recruited from four National Health Service orthotic services. Semi-structured interviews were carried out in the participants own homes. A hermeneutic phenomenological analysis of the transcripts was carried out to identify themes.
  
  
  RESULTS
  The analysis revealed two main themes from both the female and male groups. These were the participants' feelings about their footwear and their experiences of the practitioner/s involved in providing the footwear. In addition, further themes were revealed from the female participants. These were feelings about their feet, behaviour associated with the footwear, and their feelings about what would have improved their experience.
  
  
  CONCLUSIONS
  Unlike any other intervention specialist therapeutic footwear replaces something that is normally worn and is part of an individual's body image. It has much more of a negative impact on the female patients' emotions and activities than previously acknowledged and this influences their behaviour with it. The patients' consultations with the referring and dispensing practitioners are pivotal moments within the patient/practitioner relationship that have the potential to influence whether patients choose to wear the footwear or not.
authors.affiliation: Directorate of Podiatry, University of Salford, Frederick Road, Salford, UK. a.e.williams1@salford.ac.uk
authors.forename: Anita E
authors.initials: AE
authors.lastname: Williams
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Nester
authors.forename: Michael I
authors.initials: MI
authors.lastname: Ravey
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy*; D001294:Attitude to Health; D004185:Disability Evaluation; D004644:Emotions; D005260:Female; D033023:Foot Joints / Q000503:physiopathology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D009989:Orthotic Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D010147:Pain Measurement; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012727:Sex Characteristics; D012775:Shoes / Q000009:adverse effects / Q000706:statistics & numerical data*