One of my blogs in 2018 noted the start of a research priority setting exercise with a difference. We, as researchers, were asking patients and clinicians what we should be doing for a living. It was a brave step, but one many are taking, and it taught me a lesson – always talk to end users and always challenge academics.

Academics might know more or indeed less than anyone else, but doing it right must be more important than “being right”, and the doing is the discourse that is surely the food that feeds our minds? (rather than believing we already have the answer to hand just because we are academics)

Through working with patients and clinicians we asked, and you said, that these were the top ten most important foot health research topics.

Foot Health Top 10

  1. How does poor foot health impact on people’s lives (including work, leisure and social activities)?
  2. What can people who are categorised as ‘high risk’ do to prevent foot health problems (e.g. people with poor circulation, diabetes or other conditions that could cause serious foot problems)?
  3. How important are specialised tests (such as diagnostic ultrasound imaging/advanced vascular and gait/functional assessment) learned at post-graduate level, in the diagnosis of foot health problems?
  4. What is the impact on health and social care services when known foot health problems are neglected?
  5. Are current clinical pathways (treatment plans) fit for delivering high quality foot health provision?
  6. What is the impact of delayed or infrequent foot assessment on foot health in relation to foot problems?
  7. What are the most effective therapies for treating musculoskeletal foot problems, OTHER THAN foot orthoses?
  8. What evidence is there that foot health research is used in clinical practice and the impact that it has on clinical outcomes?
  9. How do health professionals prevent/reduce the risk of foot ulceration occurring or getting worse, in patients with diabetes?
  10. How can people prevent foot health problems?

As expected, these are challenging for the likes of me, and that’s the reason for doing it. Academics should not need validating; we need challenging and then supporting in how we respond.

Look at number 7, I have spent much of my career trying to work out how foot orthoses work, and it turns out it is OTHER treatments that might need looking into. We LOVE quantitative research, for its measurements, its apparent certainties (cough cough), yet the top two priorities are best understood  not through numbers, but through narrative (how else do we understand the “impact on people’s lives” and behaviours that might prevent foot health problems).  So, is research involving words not numbers the answer to better foot health research?

I for one, as many others have, have morphed my own research to embrace qualitative approaches alongside quantitative, recognising these are not competing philosophies, rather they enable us to achieve different things. Why would any professional deliberately reduce the tools available to themself? Furthermore, if the natural line of research is followed for long enough from some quantitative origin, it is often the case that the research questions takes us to a place that requires qualitative rather than quantitative approaches. In other words, qualitative takes over. I used to ask how to orthoses affect foot kinematics, for example,  and that research has now been complemented with questions such as “so what if we change kinematics?” and “how is your life changed by orthoses”. You need both ends of the spectrum.

A Professor of Nursing once told me he often met researchers who moved from quantitative research to qualitative, but never people moving in the other direction. Food for thought.

The impact of our priority setting work will take some time to roll out. However, we have already impacted thinking at Diabetes UK. Interestingly, their 2021 call for proposals (on foot health topics) points to further embracing of a wider set of research values, specifically the connection between social factors and foot health experiences. Through clinical experience, as our practice matures, we recognise the interaction between health and social care factors easily, albeit perhaps only implicitly. For example, when we listen to the explanation a patient provides for their current problem and the constraints on what they might do to help themself. But in research paradigms we too often retreat quickly into our silos – because it is safe there – too often away from where patients live. I am guilty as charged but willing to rehabilitate!  

So, whilst we set out to establish priorities that would challenge academics in terms of the research questions they should focus on, it turns out the impact of the top ten goes much further than that – it asks what sort of research are you doing? should you be doing? and using which research philosophies?