While there was some cross-platform commonality, there were several key differences in relation to the tone and nature of how platforms were utilised and engaged with, and these are identified throughout the results, but the final theme is dedicated to identifying platform specific phenomenon. Table 4 gives an overview of the themes, sub-themes, and a brief description in relation to the phenomenon identified.
Table 4
themes, sub-themes, and a brief description
Theme title | Sub-themes | Description |
1. Attitudes and beliefs about feet: connect and disconnect | Wider social and cultural phenomenon: foot bones aren’t just connected to your heel bone | The ways in which we are socially and culturally connected by concepts related to feet, and conversely, disconnections exemplified by negative language, foot health knowledge gap, and a disconnect between footwear and foot health. |
when feet stand apart: disconnect and disassociation |
2. Beyond attitudes and beliefs: symbolic representations and impact when foot health is lost | Symbolic references | These sub-themes inform understanding of perceptions toward feet, foot health behaviour, the value (or not) of feet, and impact when foot health is at risk. |
The value of feet, and the impact when foot health is lost |
4. The research tool: platforms and how users engage | Platform specific overview | There were areas of divergence and convergence both within and across the 3 platforms related to SoMe architecture, engagement norms, and lifeworld’s of those engaged within it. |
Cross platform comparison |
the power of SoMe to connect and inform |
Theme 1: Attitudes and beliefs toward feet; connect and disconnect
Connect and disconnect with feet, what they facilitate, expressions shared with others linked by experience, and footwear were central to expressed attitudes and beliefs.
Sub-theme 1: Wider social and cultural phenomenon - foot bones aren’t just connected to your heel bone
The results showed that beliefs and attitudes are often not discrete to the foot but linked to wider constructs. Beliefs about the value of feet often related to what they facilitate such as dancing, travel, hobbies, social occasions, and sport. Foot strength, mobility, and flexibility were mostly connected to their function in activities such as pilates. Positive attitudes were expressed for feet that will not ‘let you down’, fast running feet, or special occasions such as getting married. Beliefs were expressed about dirty feet making for a happy soul, or happy runner, and how feet are hardworking, while concurrently longing for pretty feet and an equivalency between hands and feet, how both are important, and both have capacity to transmit dirt. Connecting within social worlds and a sense of self was evident, for example footwear and self-expression, getting comfortable with new trends such as wearing trainers with dresses, and fitting in socially and at work, even if it induced pain or pathology. Attitudes toward footwear indicated shoes were often coveted, with ‘shoedrobes’ to display shoes, having a strong ‘shoe game’, and excitement toward activity shoes that prioritised aesthetics above function and performance. In pathology this connectivity manifested as a trusted network of people to share advice and experience with.
Some expressed beliefs suggested being barefoot is a lifestyle philosophy, a way of life, related to happiness, and freedom. Physical connectivity to the ground was expressed such as yogic grounding, and belief systems related to environmental concerns about shoe manufacturing, materials, and fast fashion. Positive attitudes were less prevalent (Table 5), and mainly related to babies and young children who were described as comfortable with their feet, exploring them and being barefoot. Several posts referred to liking feet in specific contexts such as snow. Attitudes expressed on Instagram were sometimes abstract, such as ‘badass’ or ‘dream’ feet, where positive attitudes about signs of pathology such as beautiful vascular or veiny feet were common. Beliefs connected to commonly held theories about caring for feet were also expressed. These include the role of devices for non-pathological flat feet, overpronation, advocates for barefoot shoes and forefoot running, running technique, and the impact on muscles, joints, or callus formation, and how shoes are coffins or traps that lock feet in. Several expressions connected the season to a change in attitude or behaviour, such as getting feet summer ready.
Table 5
foot related positive descriptors and expressions
Foot related positive descriptors and expressions to describe feet |
Beautiful | gorgeous | Strong | Pretty |
Cute | awesome | Lovely | Sparkle |
Badass | Crazy beautiful | Willowy ivory | Happy |
Dream feet | Love | Beautiful vascular feet | amazing |
Adorable | Precious | Sensual | Divine |
Mature | Delicious | Da Vinci toes | |
Sub-theme 2 – when feet stand apart: disconnect and disassociation
There was an expressed disconnect between some users based on different belief systems such as vegans who wear leather shoes, and judgement about unshod babies in prams. Disconnect was sometimes present toward health and service providers, such as commercially led foot measuring services offering inconsistent service or advice, and healthcare professionals who could not explain or help manage symptoms, reinforced by expressions of how only those with a shared experience can truly understand. There was also disparity over whether the benefit was worth the risk when treatments were painful such as steroid injections, and knowledge gaps e.g., the importance of diabetic foot checks, and whether first shoes hindered development or helped support ambulation. There was also confusion about footwear e.g., when flat shoes caused pathology, or avoiding high heels did not prevent it. There was also frustration toward institutional footwear policies that did not prioritise comfort, foot health, or practicality, such as schools and workplaces.
While gender related posts were not common, some posts alluded to tension with societal expectations and boy and girl sections in shoe shops. Other posts indicated intolerance of feet being touched, being barefoot, and tickling feet to annoy someone. This sensory link was exemplified in several Tweets, advocating footwear to modulate sensory stimulus for people with autism. Several posts also suggested an upper and lower body divide, where below the waist is less valued than what sits above, with links to a lack of intellect or competence. Examples include references to a person having brains in their feet, being unable to tie shoelaces, footballers having nothing upstairs and interviewing a person’s feet. One poignant Instagram contribution quoted Mahatma Gandhi; ‘I will not let anyone walk through my mind with their dirty feet’. Using feet to eat to offend others was suggested, feet as unclean and unacceptable on furniture, and school science projects to measure the dirtiest feet. Instagram posts suggested strategies to turn back time through cosmetic treatments, sometimes to hide pathology.
There was a predominance of negative attitudes about feet themselves, suggesting a disconnect from the value of feet (Table 6), even in conversations where foot health is important. For example, describing other swimmers as ‘foot touchers’ as a derisory comment toward other swimmers. Comments about foot fetish were often utilised to humiliate, linked to disgust, or common pathologies such as fungal feet and bunions, and qualified with expression such as ‘lmao’[1] and ‘lol’[2].
Table 6
negative descriptors relating to feet
Foot related negative descriptors and expressions to describe feet |
Disgusting | Manky plates of meat | cheesy | Gross |
Repulsive | Webbed | Big | Creepy |
Hobbit feet | Ugly | Dusty | Dirty |
Smelly/sweaty | Strange | Monkey toes | Elephant feet |
Putrid | Stinky | Nutty Professor feet | Hate feet |
Theme 2: Beyond attitudes and beliefs: symbolic representations and the impact when foot health is lost
While not beliefs and attitudes, these sub-themes inform understanding of perceptions toward feet, and concepts that may influence foot health behaviour through the expression of symbolic references, and the impact when foot health is compromised.
Sub-theme 1: Symbolic references
There were several diverse symbolic associations with feet and footwear. Examples include walking barefoot on old city cobblestones linking a person to history, where every shoe tells a story, and how feet have a world of stories in them. Physical representations such as tan lines, dirt, and callus were expressed as a metaphorical badge of honour, symbolising work ethic. Both feet and footwear were also described as objects of art, and canvases to draw or draw upon. Footwear also symbolised personality through customization, or bright shoes and extroversion. The Instagram ‘#selfeet’ phenomena represented shod or unshod feet photographed creatively to blend or contrast with a surface. Feet ‘hitting the floor’ was expressed as a symbol of being alive. There were also symbolic negative attitudes expressed related to worthiness, for example being fit (or not) to polish somebody’s shoes and kissing the feet of revered statues. Some Instagram posts alluded to babies’ feet symbolically making footprints on our hearts, and on the world, or after the loss of a child. Footwear was retained as a symbolic aide memoire of a person after they have passed or happy occasions such as wedding shoes. Footwear no longer wearable due to pathology or post-pregnancy symbolised something lost. Instagram contributions also related to phenomena such as dancing in reference to ‘dreaming with feet’, with feet metaphorically bringing you to where your heart is.
Sub-theme 2: The value of feet, and the impact when foot health is lost
The impact of diminished foot health on activities of daily living such as going to the bathroom, gardening, walking, sports, and shopping, with implications for social participation or capacity to care for others. One Tweet acknowledged a Catch-22 scenario where a diabetic foot ulcer meant that activity to prevent disease progression could no longer be continued. Being on feet all day, and activities such as sightseeing and running were also impeded by foot pain or pathology. Several posts related to the impact of pregnancy, and how for many foot pain, hobbling, or swelling was the only negative experience, how foot shape changes, and can impact footwear choice. The language tended to be emotive or relate to a sense of futility such as likening living with diabetic foot pathology to being on a boat full of holes (Table 7).
Table 7
language used to describe the impact when foot health is lost
Emotive language to describe impact |
Excruciating | Fear | Feet in boiling water |
Indescribable | Hot | Hell |
Agony | Icy | Nightmare |
Constant | Suffering | Depressed |
Pain | Swelling | Deformity |
Puffy ankles | Soreness | Aching |
numbness | Scarring | Worst pain ever |
Feeling suicidal | Anxiety | Overwhelmed |
Many posts shared the impact impaired foot health can have on mental health. Fear was associated with both having a toenail surgically removed, and the prognosis when foot health in diabetes was ignored for 3 years. For many, aesthetics mattered, such as bunions that made feet look like paddles. Sequalae included impaired sleep, reduced quality of the next day, and sense of self for example when clinically appropriate footwear was indicated. Positive coping strategies were represented such as keeping a positive mindset, setting new goals, fighting spirit, humour, volunteering, and distractions could help to cope with foot pain.
Diminished foot health from pathology or pregnancy also impacted capacity to work, particularly if the role was non-sedentary. This sometimes had further financial implications related to the cost of footwear and treatment products or services. However very few posts related to seeking appropriate clinical treatment. Footwear could also create a health dichotomy when safety boots provided protection but were sometimes a barrier to returning to work after foot pathology. Outside of pathology, posts alluded to barefoot vulnerability; stubbed toes, standing on objects, dropped objects, and being bitten by fish in the sea. Others alluded to the positive impact of clinical or aesthetic treatment. These included multiple expressions about pedicure-related expressions suggesting ‘love’ for ‘new’ feet post-pedicure, and celebrations of ‘new’ feet post-surgery. These posts were infrequent and greatly outnumbered by posts sharing negative impact. Others alluded to the impact of extrinsic factors on foot health, reflecting on changes over time when life used to be thriftier, how having no shoes was a signal of hardship and it was common to only have two pairs of shoes, or having to choose between food or shoes. Similarly, school shoes were sometimes bought too large to increase longevity.
Theme 3: The platforms and how users engage
There was evidence of both difference and similarity in relation to how users engaged within and across the 3 platforms. Sometimes this was influenced by specific platform architecture and design, but there was also evidence of social phenomena that varied across the platforms.
Sub-theme 1: Platform specific overview
There were several characteristics that were unique to each platform in relation to who engaged, how, and for what purpose Table 8).
Table 8
Overview of differentiating characteristics of the 3 SoMe platforms
Feature | Facebook | Twitter | Instagram |
Engagement characteristics | • Pathology • Reaching out/advice • Tagging others | • Selling products | • Supportive, celebratory |
Length | • Unlimited • Often long posts | • Limited to 280 characters | • Unlimited/ sometimes just an image • Variation in length |
Engagers | • Individuals | • Professionals and individuals | • Individuals and professionals |
Other characteristics | • Organised into pages with specific interest areas • More emotive | • Neutral/less emotive | • All posts accompanied an image • Abstract concepts • Comparatively positive |
On Facebook, bi-directional engagement with others sharing an experience and advice was prominent both in and outside of pathology and disconnect from those that did not. Facebook posts tended to be longer, especially when foot health was at-risk. Also, more prevalent on Facebook were judging or ridiculing others with different belief systems or experiences, where negative expressions were common. This may reflect Facebook platform dynamics, where public pages (open access) had a clearly defined interest area, unstructured, qualitative text is the primary communication tool, and there is no character limitation.
Many Tweets were orchestrated by professionals, often conversational and marketing products, or services, not always transparently. Although confined to 280 characters, complex beliefs could still be expressed, for example a Tweet relaying an interchange with a young child querying the point of shoes, flipping from protection to a belief that shoes were traps for feet. There were comparatively less tweets in the searched criteria and very little social support constructs involving emotive exchanges. The potential for SoMe to influence purchasing habits was identified, with tweets relating to trends and where to find them, and advice on how to emulate a look, often targeted at women.
Instagram posts were notably more positive by comparison, even when foot health was diminished, for example positive descriptions of feet with visible signs of pathology, or expressions of post-amputation achievements. More abstract phenomena was almost exclusive to Instagram, such as describing feet as ‘dream’ feet, and ‘#selfeets’ relating to posts about feet blending or contrasting artistically with a surface.
Sub-theme 2: Cross platform comparison
Unlike Twitter’s 280-character limit, Facebook and Instagram allow unlimited text. However, the freeform potential was not always utilised. Longer Facebook posts were mostly the reserve of pages linked to pathology and children’s feet and footwear. Instagram posts and tweets tended to be succinct. Reflecting the platform dynamic, initial Instagram posts were always accompanied by a graphic or photograph, whereas unstructured text was the dominant communication tool on Facebook and Twitter.
While personal experience of foot related pathology was present on both Facebook and Instagram, the nature of that expression was notably different. There was a positivity-negativity spectrum ranging from Instagram positivity for example expressing beauty in features such as prominent veins or bunions, physical signs of gardening celebrated as representations of a strong work ethic or achievements post-amputation, often depicted in images of the female foot with painted toenails. Alternatively, beliefs, attitudes and comments expressed in Tweets were often neutral and less committed to personal reflection. One notable Twitter exception was affiliation to beliefs that barefoot as a positive healthy lifestyle choice were strong. Facebook posts however were often negative not just in relation to shared experience but also expressions such as ridicule or judging, though rarely in pathology specific areas. An exception of this was in the Feet & Feet Facebook page which identifies as a place where people can share foot health problems. However, some engagers chose to express ridicule with no reference to a foot health problem or empathy with other engagers.
The dynamics of the platform sometimes influenced how the platform was utilised. As an example, fetish was referenced on all 3 platforms, however while on Facebook it was utilised as a mechanism to humiliate, offend, or joke, on Twitter and Instagram it was predominantly utilised as a hashtag where the topic was not about fetish, and the hashtag served to increase engagement. Instagram posts and Twitter-based tweets accompanied with the hashtag #lovefeet were all related to fetish. Where Instagram posts were largely about celebration of a phenomenon, Facebook tended to be more divisive, negative, or judgmental and Twitter comparatively neutral. Posts sharing or requesting foot pictures were prevalent on Instagram and Twitter, sometimes for payment. The omission of this finding on Facebook could be explained by the organisation of the platform where selling pages were omitted from the search.
Sub-theme 3: the power of SoMe to connect and inform
Several Facebook page posts indicated the power of SoMe to connect people with shared experiences. While some self-management strategies appeared to be underpinned by efficacious clinical advice, others were clearly attributed to advice from companies selling products. An example includes alleviating neuropathy with a homemade tea tree oil foot spray, or equipment to self-treat an ingrowing toenail. On Twitter and Instagram health education was promoted, such as exercise or checking feet daily. Twitter was also about connecting service and product providers to the marketplace. Empowerment and foot health was occasionally advocated outside of a pathological domain, for example exercises to strengthen dancer’s feet. However, one Facebook post shared information from a clinical encounter, that was shared in a subsequent appointment for another engager, positively informing one clinician’s practice. There was an implicit trust in some expressions predominantly from those who had shared a similar experience, relating to foot pathology diagnoses, treatment or product recommendations, or non-clinicians such as the reflexologist who informed an engager that serious foot pathology was the result of a traumatic event in childhood.
1 Lmao is an abbreviation for ‘laughing my ass off’
2 Lol is an abbreviation for ‘laugh out loud’