Irreversible nerve damage to the lower limbs is a common side effect of chemotherapy, yet up to 50% of patients are missing out on vital care that could significantly ease their symptoms, according to University of South Australia researchers, who have developed clinical guidelines on the subject.
Assessing the use of podiatry services by those at risk of developing Chemotherapy Induced Peripheral Neuropathy (CIPN) – which causes numbness, tingling, pain, and weakness in the feet – the UniSA team found that despite its severe and often permanent impact on foot and lower limb health, fewer than one in five patients accessed podiatry services, even in the five years after treatment.
The study examined 3 292 people with colorectal cancer, 82% of whom received the standard platinum-based chemotherapy drug, Oxaliplatin, a known cause of CIPN.
UniSA PhD candidate and podiatrist Sindhrani Dars said the findings highlight a serious and avoidable gap in cancer survivorship care.
“Colorectal cancer treatment is heavily dependent on neurotoxic chemotherapy, with CIPN a painful and debilitating side effect,” she said.
“Neurotoxic chemotherapy can cause permanent nerve damage in the feet, leading to numbness, burning, a loss of feeling, and a ‘pins and needles’ sensation. Because it reduces balance and muscle strength, it increases the risk of falls, foot injury and reduced quality of life.”
Sometimes, CIPN symptoms can be so severe that people choose to reduce or even cease their chemotherapy treatments, so there was a clear need for additional care strategies, she added.
“As registered allied health professionals, podiatrists are skilled in managing lower limb complications and are well placed to care for people undergoing or recovering from chemotherapy. Yet as this research shows, too many cancer patients are unaware of how podiatrists can help.”
She said that given the high prevalence of CIPN among cancer patients receiving chemotherapy, it was vital that podiatry is not only included in routine oncology care but promoted among patients and clinicians to manage the symptoms of neuropathy-related foot complications.
With no evidence-based prevention strategies to prevent or reverse CIPN, podiatry should play a more prominent role in cancer survivorship care.
“Early podiatric assessment could prevent falls, prevent ulcerations preceding amputations, reduce pain, and improve mobility – all of which have a huge impact on recovery and well-being,” pointed out Dars.
Further, no Australian guidelines exist for CIPN management and the only published clinical pathway for its management does not include podiatry services.
The lack of awareness among cancer patients and treatment teams about the role of podiatry in cancer care was considerable, said the study team.
“The high incidence of CIPN is well established, but with fewer than 20% of chemotherapy patients accessing podiatry services, there’s a concerning gap.
“Podiatry must hold a more prominent role in cancer care, and we must establish better referral pathways in oncology settings to ensure this inclusion.”
With consensus from Australian podiatrists, the research team has developed clinical recommendations on how best to care for and manage symptoms in people with CIPN, which can be found online here.
Study details
Patterns and Factors Associated with Podiatry Service Use Among Colorectal Cancer Patients Following Chemotherapy in South Australia: Focus on Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Sindhrani Dars, Tenaw Tiruye, David Roder, Helen Banwell, Ian Olver, Kerri Beckmann.
Published in Journal of Multidisciplinary Healthcare on 3 October 2025
Abstract
Objective
To investigate patterns and factors associated with podiatry service use following chemotherapy for colorectal cancer (CRC) in South Australia (SA), with a focus on addressing needs related to Chemotherapy Induced Peripheral Neuropathy (CIPN), a common and detrimental complication of neurotoxic chemotherapy.
Methods
This retrospective cohort study included adult CRC cases in SA (2011 to 2013). Patient characteristics, chemotherapy and podiatry service use were determined using linked health and administrative datasets. Crude and adjusted Poisson regression analyses compared annual rates of podiatry service use between chemotherapy recipients and non-recipients, and whether chemotherapy was neurotoxic from four years before to five years after diagnosis. Multivariable Poisson regression identified factors associated with podiatry service use post-diagnosis.
Results
This is the first population-level study to examine the use of Medicare funded podiatry services by people with CRC within South Australia. Of 3,292 patients, 1,535 (47%) received chemotherapy. Despite a high prevalence of CIPN reported in the literature (up to 24% at three years’ post-chemotherapy), the crude rate of podiatry service use among chemotherapy recipients in this study did not exceed 20% across the five years post-diagnosis. Adjusted analyses showed similar podiatry service use among chemotherapy recipients and non-recipients, except for higher rates during the second-year post-diagnosis in chemotherapy recipients (Incidence Rate Ratios (IRR) 1.22, 95% CI: 1.01-1.48). No differences were observed at any timepoint between neurotoxic or non-neurotoxic chemotherapy recipients. Podiatry service use post-diagnosis was positively associated with prior podiatry service use (IRR 4.08, 95% CI: 3.48-4.79), having diabetes (IRR 1.26, 95% CI: 1.01-1.57), receiving chemotherapy (IRR 1.18, 95% CI: 1.01-1.37) and older age (IRR 1.28, 95% CI: 1.07-1.53, 80+ vs <80years).
Conclusion
Despite a known higher prevalence of CIPN of up to 24% at three years’ post-chemotherapy, the podiatry service use by chemotherapy recipients in this study appears low, and independent of neurotoxic risk. This may indicate suboptimal follow up care for CIPN in CRC patients receiving chemotherapy who are at an inferred higher risk of CIPN. Given the known risks of CIPN to lower limb health (eg, proprioception loss, falls, ulcers), improved integration of podiatry services into cancer survivorship care is critical to address unmet needs in CIPN management.
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