The following comments were made by Mrs Enid Quest a patient with rheumatoid arthritis in the United Kingdom in a foreword to The Foot and Ankle in Rheumatoid Arthritis. A Comprehensive Guide by Helliwell, Woodburn,Redmond, Turner and Davys. Published by Churchill Livingstone, in 2007.

……a chance remark at the end of a Rheumatology conference in 2004, when I asked the Rheumatology clinicians to pay more than lip service to the problems that patients experience with their feet, has given me the opportunity to write the foreword to this book.

……attention to the problems of the foot and ankle has been the Cinderella of the Rheumatoid world. as any clinician will tell you it is easier to look at the hands in an examination rather than the feet and consequently there appears to be a lack of attention paid to this problem

……there are over 8 million arthritis patients in the U.K., and the overall prevalence of females is far greater than men…….Rheumatoid Arthritis is a time consuming disease, everyday activities of work and leisure take longer to perform, particularly when you feet are swollen, painful and deformed. This often results in decreased capacity for paid and unpaid wok. The cost of the disease is immense with mqany working days lost per year.

… a patient I am  always amazed at the variety of disabilities that Rheumatoid Arthritis can exhibit.

….many foot problems are under reported and only 25% of patients have access to NHS (National Health Service) care, and there is an even greater discrepancy  amongst patients with Rheumatoid Arthritis.

…..a comprehensive foot care programme should lead to treatment for …..demanding problems……such as vasculitis. ulceration, neuropathy and necessary surgical intervention.

… Rheumatoid clinic has recently introduced the provision of a podiatrist to attend monthly clinics…..

If  this is a reasoned comment on the problems in the U.K., what is the situation in South Africa?

To the best of my knowledge, there is only one clinic in the State Health system which provides any foot care for patients attending a Rheumatology clinic – Chris Hani Baragwanath Hospital in Soweto. In the private sector, podiatrists provide foot care on a limited basis if they have a connection with a Rheumatologist. However with fewer than 50 Rheumatologists in the country finding specialised care is amajor problem. Furthermore what about the increasing number of children who are being diagnosed with Juvenile Idiopathic Arthritis?

The challenge is staring us in the face!