The Missing Skill… As podiatrists, we are trained to assess risk, diagnose pathology, and deliver evidence-based treatment. Yet many of the challenges we face in daily practice are not purely clinical in nature, but behavioural.
We know what should happen — offloading should be worn, foot checks should be completed, and follow-ups should be attended. And yet, despite clear advice and best intentions, outcomes do not always align with our plans.
Over time, this disconnect led me to question not what we do in podiatry, but how we support patients to engage with it.
“The most evidence-based plan still depends on what a person can do, wants to do, and feels able to sustain.”
The Missing Skill or The clinical gap we don’t always name
In both NHS and private settings, treatment success often depends on patient behaviour outside the clinic. Adherence, motivation, understanding, and confidence all influence outcomes — particularly in long-term conditions such as diabetes.
Behaviour change is rarely taught explicitly in podiatry training. We learn pathology in depth, but often develop engagement skills informally, through experience.
During my undergraduate dissertation exploring diabetic foot ulcers and quality of life, it became clear that the impact extends far beyond the wound itself — shaping fear, independence, identity, and daily decision-making.
Shifting the focus: from instruction to understanding
Behaviour change is not about enforcing compliance. It is about understanding where a person is, what matters to them, and what barriers they face — physical, emotional, social, or practical.
Simple shifts in language, goal-setting, and consultation structure can significantly improve engagement. Frameworks drawn from health psychology offer practical ways to support this, without extending appointment times or compromising clinical standards.
In my own practice, applying these principles has changed how I approach conversations around risk, prevention, and long-term self-care. It has also changed how patients respond.
What this looks like in everyday practice
Sometimes the most meaningful progress isn’t perfect adherence — it’s a small, sustainable step forward:
- Offloading worn for a few hours a day — consistently.
- Moving from fear to understanding after a clear, calm explanation of risk.
- Feeling listened to, not judged — and choosing to return.
- A student learning to communicate plans in a way that lands.
Key takeaways
What happens between appointments often matters as much as the treatment itself.
Communication and support strategies can be learned, practised, and refined.
Time, fear, confidence, and daily pressures shape follow-through.
Consistent “good enough” often outperforms occasional perfection.
From clinical insight to written resource
These experiences, alongside my academic work, led me to write From Feet to Mind: An Evidence-Based Guide to Behaviour Change in Podiatry. The book brings together theory, clinical application, and reflective practice, supporting students and clinicians to feel more confident in the behavioural side of care.
Rather than offering rigid scripts, it encourages a way of thinking — one that places behaviour, context, and person-centred care alongside clinical expertise.
Explore more professional resources
Practical guides, templates, and evidence-based insights designed for everyday clinic use.
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