Title: Primary care encounters for foot and ankle problems in children: an epidemiological analysis
Funder: Department of Health and Social Care

Abstract: Background Foot and ankle problems in children are a common reason for accessing healthcare services. Foot-related complications can have profound impact on participation in play, increase foot-specific disability, and underpin poorer health outcomes. Access to foot-care services are therefore an important foundation for longer-term health. Despite this, little is understood about the characteristics of foot and ankle problems in children. Aim and objectives The aim of this work is to describe the epidemiology, presentation and service access for foot and ankle problems in children across England. The objectives of this work are to: 1. Describe the annual consultation prevalence and incidence of foot and ankle problems in children across the UK. 2. Describe the range of foot symptoms and diagnoses occurring in children. 3. Identify the primary care referral patterns. 4. Examine patterns of presentation and consultation for foot and ankle problems by disease status, age, sex, ethnicity, regional, and socio-economic deprivation. 5. To describe secondary care intervention for children with foot and/or ankle problems. Methods The work will adopt a population-based, retrospective cross-sectional design and undertake a descriptive epidemiological analysis of GP encounters for foot and ankle problems in children. This work will draw data from the Clinical Practice Research Datalink and foot and ankle consultations for children aged between 3 and 10 years of age will be extracted for a 4-year data period. To describe the range of foot symptoms and diagnoses, the data and corresponding read codes will be reviewed and reported as a symptom read code, or a diagnosis read code. As presented, diagnosis codes will be stratified and further investigated to understand symptom codes and the patterns of read codes will be described by age group, sex, gender and ethnicity. The analysis of the data will be stratified by several covariates of interest: pre-existing health condition(s) (e.g. neurodisabilities), age, sex, ethnicity, socioeconomic deprivation, regional patterns, and type of foot and or ankle problem. This will be a 12-month project. Anticipated impact and dissemination Footcare services for children are inconsistent and poorly defined. This work will establish an England-wide profile of foot and ankle problems in children and allow us to determine predictive characteristics of foot and ankle problems. These findings will inform strategies to inform referring practitioners (i.e. GPs), promote appropriate health services, and contribute towards reducing the burden and longer-term impact of foot problems. We will work with our clinical collaborators and PPIE partners to ensure a dissemination strategy with appropriate translation of key messages to target audiences. Our dissemination strategy will help increase awareness of foot problems and help the public understand how (and when) to seek help. We will deliver mixed-media outputs to parents and children organisations. We also anticipate some downstream effects of this work on policy for improving the design and delivery of footcare services. The findings generated from this study will inform the development of a national programme of work looking at the organisation of children s footcare services.

Lay abstract: Aim The aim of this project is to describe foot and ankle problems in children. Background to the research Foot and ankle problems in children are a common reason for visits to the General Practitioner (GP). Parents have told us that foot and ankle problems can be difficult to manage and that these problems can impact on children s mood, self-confidence, and willingness to play with their friends. Parents have told us that referral to the appropriate health professional(s) can be difficult, and often delayed. Ensuring that foot and ankle problems are managed through appropriate footcare services is essential to keep children active. Despite this, we don t know much about the types of foot and ankle problems that children experience and, across the UK, there is variation in the services that children are referred to. Design and Methods This work will explore patterns of foot and ankle problems that children and young people present to their GP. This work will look at data from a UK-wide electronic medical record database called the Clinical Practice Research Datalink. This database holds data for people across the UK and we will explore data for children aged between 3 and 10 years of age. This data will allow us to understand more the types of foot problems that children report to their GP. It will also allow us to examine how pre-existing medical conditions, age, sex, ethnicity and socio-economic deprivation impact of the type(s) of problems that children experience, and which health professionals are involved in treating children. This project will last for 12 months. Patient and public involvement and engagement (PPIE) The development of this work has been informed by our experiences of working with children and young people in clinical practice, as well as exploring these issues with parents. This has helped us to build a story about the challenges and experiences that children [and their parents] have faced. We have already involved parents in the development of this project, and they (including their children) will be given a voice throughout the research project and involved through the work with engagement events. Dissemination The dissemination of the findings from this study will increase our understanding of the types of foot and ankle problems that children encounter. Building upon our existing networks, we will seek to deliver presentations to parents and children (such as through School engagement events, and youth clubs), as well as promoting work through social medial channels (such as professional health organisation). The plans for dissemination will involve parents and children, who will also have an important role in shaping the work that comes after this.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: MUSCULOSKELETAL