The Role of Podiatry in the Early Identification and Prevention of Lower Limb Venous Disease: An Ethnographic Study

Lower limb venous disease can cause significant pain, loss of mobility, and can be
detrimental to quality of life. Venous leg ulcers can occur in the most severe stages, and
these pose substantial negative impact on patients and constitute a high demand on
healthcare resources. The problem of lower limb venous disease is internationally
recognised, but the majority of research and discourse has focussed on treatment of leg
ulceration and prevention of recurrence, rather than prevention of lower limb venous
disease progression to the first ulceration. The care of this condition appears to rest in the
domain of medicine and nursing yet podiatry, a profession with responsibility for the lower
limb and foot, is conspicuous by its absence from the literature.

This thesis explores the early identification and prevention role played by podiatrists. It
investigates the role, its drivers and its limitations through the use of an ethnographic
approach to embed the researcher in the culture of podiatry, and gain an understanding of
practice from the viewpoint of participants. Twenty-three podiatrists and three registered
nurses volunteered from a variety of settings. Data were gathered through observation,
semi-structured interviews, and a focus group interview. Analysis was conducted using the
framework approach.

The findings reveal an identity crisis within the podiatry profession. A foot-focussed and
treatment-based identity clashes with a desire to care for people as a whole, and give good
quality health promotion and public health messages. Lower limb venous disease features
in the latter identity and is often marginalised in practice as a result. This also manifests in
ritual and routine practices that did not include lower limb venous disease. There was
evidence that external control over practice limited professional autonomy of podiatrists
determining their own activities. Inter-professional relationships with nursing, and
perceptions of boundaries that venous disease was a nursing role were also found to be
limiting factors. From this in-depth qualitative study, it was evident that podiatry does not
occupy a substantive role in contributing to the early identification and prevention of lower
limb venous disease.