Management of foot health in inflammatory arthritis

24 April 2025
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Article kindly written by Lindsay Turner, Clinical Guidelines Programme Manager, British Society for Rheumatology


The majority of people with inflammatory arthritis (IA) will experience foot problems throughout the course of their disease. The first British Society for Rheumatology foot health guideline is now available and provides evidence-based guidance on the management and care of foot health in IA for adults, children and young people. As a whole life-course guideline, it provides recommendations to improve the quality and consistency of care across the MDT for all ages.

See below for some key recommendations relevant to primary care services:

  • In adults, children and young people with foot problems in IA, prompt referral to specialist foot services, e.g. podiatry, should be considered at any stage of the disease course where they impact on activities of daily living, participation and quality of life. Foot problems include but are not limited to pain, joint damage, deformity, risk of ulceration and/or footwear difficulties.
  • All adults or children and young people with IA should be offered personalized nail care advice, including footwear advice, to help prevent and/or treat common toenail pathologies. People should be advised when to access foot healthcare, for example, for ingrowing toenails, wounds and infections, and how to do this.
  • Adults or children and young people with foot problems in IA should be encouraged and supported to meet physical activity guidelines for people with IA. This may include regular assessment and management of foot health needs, including appropriate footwear.

Please read the full guideline for more information and further recommendations.


The BSR foot health guideline

The guideline was developed by members from rheumatology as well as a wider working group made up of experts by experience, podiatrists, physiotherapists, orthotists, general practitioners, orthopaedic surgeons, and specialist rheumatology nurses.

Discussing how the guideline will support the management of foot health within primary care, Professor Edward Roddy, academic rheumatologist at Keele University and chair of the guideline working group said:

“…one of the most important things it will hopefully do is to raise the profile and awareness of foot problems in inflammatory arthritis, how common they are, the burden they pose to patients and the related unmet need. Advice is also provided regarding when to seek help from specialist foot care professionals and who to seek help from.”

The guideline is the first BSR guideline to be published that has been developed in a collaboration with the School of Medicine at Keele University, who are supporting the evidence reviews of several BSR guidelines. In addition to using the best available evidence, the inclusion of experts by experience within the guideline working group is invaluable. Their input ensures the guideline considers all aspects of patient care journeys.

Expert by experience, Alan Rawlings, reflects on his experience in the guideline working group:

“It was awe-inspiring from a patient's perspective, to know the degree of detail that had gone into this…wherever one has the consultation, wherever one has treatment, one knows that with the guidelines in the background, then the best of all possible treatment can be given. By experience these people have put together something that we, as patients, can only benefit from.”

The guideline, endorsed by Royal College of Podiatry, is now available to read in Rheumatology.

An audit tool has also been developed to assist the implementation of the guideline.

Find out more