Challenges faced by nurses in managing patients with foot pathologies at primary healthcare clinics in Johannesburg-South Africa

Background: Foot health (podiatric) services remain inaccessible in many primary healthcare clinics across South Africa. As first-line contact practitioners at primary health care clinics, nurses manage all patients, including those presenting with foot pathologies. Anecdotal evidence suggests that nurses have challenges and are limited in their capability to assess the foot. In most cases, they do not assess the foot as part of the routine patient assessment. The primary aim of this study was to investigate the challenges nurses face in managing patients presenting with foot pathologies at primary healthcare clinics. Methods: The study used a qualitative design to explore nurses' challenges in managing patients presenting with foot complaints. A purposive sampling strategy was used to select participants from primary health care clinics in Johannesburg to participate in a focus group discussion. Data were analysed using Giorgi's qualitative thematic analysis to reveal themes based on similarities and relationships between the collected data. Results: Six PHC nurses participated in the focus group discussion. Participants confirmed challenges in managing patients presenting with foot pathologies. These include poor guidelines, limited training, consultation times, and a lack of defined referral pathways for patients with foot pathologies. Nurses indicated that due to challenges at the PHC level, foot assessment is not a mandatory part of patient assessment. All participants agreed on the need for structured foot health services. Conclusion: Primary healthcare nurses have challenges in managing patients with foot pathologies. There is a need for structured foot health services and training for nurses to coordinate care for this patient group effectively. Further studies should establish the need and demand for podiatric services to distribute the limited podiatry resources equitably, such as placement of podiatrists at community healthcare centres which serve as the first referral point for primary healthcare clinics.