Thursday, October 21, 2010

Painful Feet in Older Patients Untreated. Why?

Briefly NotedMusculoskeletal-related foot pain is highly prevalent in persons aged 50 years or more. Yet, only about 1 in 5 foot-pain sufferers seek medical care for their debilitating conditions, according to a new study, and reasons for this are not entirely clear.

Researchers in England examined data from 13,986 people ≥50 years of age who took part in a regional survey on osteoarthritis [Menz et al. 2010]. Foot problems were defined as affirmative responses to the questions: “Have you had any problems with your feet over the last year?” or “Have you had pain in the last year in and around the foot?” A primary outcome measure was a record of a musculoskeletal foot-related consultation with a primary care provider within 18 months following the survey.

About 2 of every 5 (41%) of survey respondents reported foot pain during the past year, and only 12% said they had brought this to the attention of their primary care providers prior to the survey. Thereafter, only about 9% sought care in the 18 months following the survey, and this was not influenced by such factors as age, sex, education, general health, or pain in other regions. However, foot-care-seekers were significantly more likely to have debilitating pain associated with their foot problems, to consider treatments as effective in controlling such conditions, and to have been frequent visitors at their primary care providers in the 18 months before the survey.

Practice Pointers: According to this large study, there is a high prevalence of musculoskeletal foot-related problems in older persons and only a minority of those persons (about 20% overall) consult their general practitioners about such conditions. The most frequently diagnosed foot disorders in this study were generalized foot pain or arthralgia, toe pain, ankle pain or swelling, plantar fascitis or heel pain, and calcaneal spur. Troublesome foot pain and associated fear, frequent medical consultation for other problems, and positive perceptions of treatment efficacy appear to be the strongest factors influencing care-seeking.

Those motivating factors seem reasonable; however, they do not explain why only about 1 in 5 persons with foot problems in this study sought care, especially in a country (the UK) where healthcare is covered by national insurance. Rates of care-seeking may be worse in the United States and suggest that healthcare providers might consider routinely questioning older patients about foot health during every office visit.

REFERENCE: Menz HB, Jordan KP, Roddy E, Croft PR. Musculoskeletal foot problems in primary care: what influences older people to consult? Rheumatology. 2010(Oct);49(11):2109-2116 [article here].