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

Student thesis: Doctoral Thesis


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.
Date of Award2023
Original languageEnglish
SupervisorKaren Ousey (Main Supervisor), Caroline Barker (Co-Supervisor) & Sarah Reel (Co-Supervisor)

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