Previous research [11] has demonstrated that foot health habits are strongly linked to other aspects of life and impact other areas of health and wellbeing. One example is the direct and indirect link between an individual’s socioeconomic status and their foot health. For patients deemed low or moderate risk of ulceration, private foot care is available, while public high-risk foot care is usually provided. This has resulted in the former group being forced to choose between financial burdens or neglecting their foot health. The latter group, meanwhile, has experienced increased uncertainty over appointment times when reliant on chronic wound management to prevent lower limb amputation. Furthermore, it is well-documented that those on a low income are more likely to develop type II diabetes and, once diagnosed, are more likely to develop foot related complications such as ulceration and amputation [5, 12,13,14]. Similarly, patients diagnosed with rheumatoid arthritis (RA), a condition with a high prevalence of foot pain and disorders complaints, and those belonging to high social deprivation categories struggle to access foot care and reported the impact of foot pain and disorders on the ability to work and on quality of life [15, 16].

In the UK, general practitioners (GPs) remain the primary point of contact for most NHS patients seeking assistance with foot health pain or disorders. Despite an increased demand for podiatric services [17], research has shown that patients often feel that their foot-related problems are overlooked or neglected by their GPs [18] and that their GPs focus on treating patients based on their condition, rather than their complaint [19]. Furthermore, the perception and limited understanding of the role of the podiatrist in healthcare and among patients, and the cuts in NHS services such as podiatry have further contributed to the limited public access and use of podiatry services [19], affecting most likely the most deprived segments of the UK population who heavily rely on NHS care and often lack the means to seek private healthcare.

In another study [20], foot pain, calluses, corns, nail pathologies, and structural deformities such as Hallux Abducto Valgus (HAV) were reported to be more commonly detected in females due to poor footwear habits, while fungal infections are more common in males. Consistent low socioeconomic position impacts on the ability to access new footwear and replace it when needed. Furthermore, the footwear industry has struggled to cater to the three-dimensional variation of feet in the population, leading the latter to wear functionally inadequate footwear. As an example, on one hand, less stock in shoe shops as half-sizes reduce the number of styles to be stocked; on the other hand, many shoe models are not available in half-sizes. Additionally, people do not buy footwear only to fit or only for comfort and mobility, but also based on style, colour, and occasion. A previous review of 18 international studies including the UK looking at correct shoe fit to foot shape, found that 63–72% of the population choose footwear that is a poor fit length/width/both [21]. The findings were strong in suggesting poorly fitting footwear results in foot pain, skin conditions (corns and callus), bony deformity such as HAV and lesser toe deformity, or ulceration if diabetic or with poor circulation. Other vulnerable groups also display a wider range of foot morphology; for example, those with intellectual disabilities like Down syndrome, older people, and those with diabetes are more likely to wear narrower footwear [21].

Finally, previous research has shown how podiatrists should ensure a culturally sensitive, patient-centred approach to managing high-risk podiatric clients from a refugee background, and ultimately from an ethnically and linguistically diverse population [22]. Some of their strategies include group education programs in languages other than English, client advocacy, working closely with family members and interpreters, negotiating health beliefs and customs and foot health behaviour changes, obtaining funding, and tackling social determinants that were impacting on foot health.