A step into the unknown: Footnotes on feet and diabetes in Aotearoa/New Zealand

Abstract

Aims This interpretive study explored the influences of living in Aotearoa /New Zealand in regard to participants’ attitudes and beliefs towards feet and examined the effect that attitudes had when living with diabetes-related foot problems. Methods During 2014 purposive sampling was used to recruit five non-Māori and five Māori participants with neuropathy-related foot problems from a diabetes multidisciplinary foot clinic. Two interviews were conducted one to two months apart. Semi-structured questions guided the first interview whilst the second interview took prompts from participant-generated photos. Narratives were explored to uncover from participants’ experiences, their beliefs and attitudes towards feet and how these might have influenced foot care behaviours in the presence of diabetes. A Māori whānau reference group provided advice and support for all stages of the research. Results Themes from the participants’ stories were woven together in a framework of Te Timatatanga, Past, Present and Future. Their stories told of a childhood largely spent barefoot. Footwear became a more regular feature at secondary school as part of school uniform requirements. Childhood sports were played barefoot. Feet were commonly ignored with a ‘she’ll be right’ attitude towards foot injuries. Medical attention was only sought for major injuries. This experience was in contrast to stories of the significance of feet for Māori. Diabetes’s assault on foot sensation left participants unaware of foot injuries. The lack of attention given to feet and the absence of feeling meant minor problems became limb threatening with unexpected speed. For many this was their first sign that diabetes had taken its toll. Story themes spoke of the trials of living with neuropathy and the resilience required meeting this challenge. Participants were hopeful for their future and that of their families. The multiple perspectives of feet were re-presented as a model called ‘Pa tu tahi’ (literally the first sense of the body). Conclusion This is one of the first studies to explore the significance that people in Aotearoa/New Zealand place on their feet. Considering patient stories about early attitudes towards feet and footwear may be helpful in planning foot care management plans and education programmes.