This document discusses foot health issues among those experiencing homelessness and provides strategies for addressing them. It notes that homelessness can contribute to many foot problems due to lack of hygiene, poor footwear, and limited access to healthcare. Common issues include corns, fungal infections, trench foot, and diabetic foot complications which can lead to amputation if not addressed. The author describes their homeless podiatry service which provides on-site treatment, education, and referrals to address foot problems before they become serious for this vulnerable group.

1. Feet On The Street
Providing NHS Podiatry
Services to Rough
Sleepers in Central
London
Healthy Feet for All!
Alison Gardiner BSc MChS HCPC Reg
Specialist Podiatrist for Homeless and Vulnerable People
Central London Community Healthcare.

2. Group Task
• It’s difficult to look after your feet on the street!
What challenges would you encounter ?
• What foot problems might you be more likely
to develop?

3. Foot Facts
• The foot contains 26
bones, 100
ligaments, 33 joints
& 20 muscles
• The average person
walks 4 miles every
day
• Feet produce an
eggcup full of sweat
every day…

4. Some common foot conditions...
Corns and calluses (plantar, interdigital , dorsal)

5. Toe deformities
Clawed, hammer, mallet, overriding, burrowing,
polydactyly, syndactyly

6. Verruca
Bunion

7. Fungal skin infection
Fungal nail infection

8. Cracked heels
Infected ingrowing
toenail

9. Flat Feet
High arched feet

11. Trench Foot
Advise to air feet, leather
shoes, change socks

12. Blisters

13. Less common foot conditions
Malignant melanoma and tuberculosis

14. Diabetes and Feet
• 3.6 million diagnosed cases in the UK but many
more undiagnosed
• Black and ethnic minority groups higher rates
• Social exclusion/ deprivation/ mental health
problems/learning difficulties higher rates
• Most common cause of amputation of the lower
limb in the UK
• 150 amputations every week in UK

15. Diabetes can cause
• Peripheral neuropathy (numb
feet)
• Peripheral vascular disease
(poor circulation)
• Ulceration, infection, gangrene
and amputation
This can be prevented by
• Good diabetic control
• Diabetic foot health education
• Yearly diabetic neurovascular foot assessment by
nurse, gp, podiatrist
• Quick access to podiatry/healthcare for any
problems

16. Diabetic foot ulcers
May be painless if feet are
numb

17. Central London Community
Health Care
Homeless Podiatry Service

18. • Alongside nurse led CLCH Homeless Health Team
provision
• Easy access. Drop in
• 5 sessions a week in homeless day centres
• Good links with specialist pods in mainstream
• Westminster and Hammersmith & Fulham
• Hostel visits for housebound
• Foot health promotion/screening in day
centres/hostels
• Training for hostel/day centre staff
• Promote access of vulnerable people to mainstream
service. Training for pods in mental health, working
with interpreters etc. Undergraduate placements
and teaching University of East London
• NEW! Vulnerable SOP (Standard Operating
Procedure)

19. Why are homeless people
so prone to foot problems?

20. • Alcohol. Peripheral neuropathy, increased risk of
diabetes and osteoporosis, poor immunity, assault,
accidents. Wernicke Korsakoff Syndrome
• Drugs. Infection of injection sites, thrombosis, HIV,
chaotic lifestyle
• Sleeping on buses/benches. Peripheral dependent
oedema
• Asylum seekers. Conditions rarely seen in UK. Polio,
TB, leprosy, rickets, polydactyly, untreated talipes
(club foot), industrial/agricultural accidents, torture
• Carrying heavy bags
• Increased risk of diabetes & diabetic complications.

21. • Finance. Lack of money for shoes, socks and
clippers, cheap shoes man made materials. Pulling
off nails, sharing clippers.
• Not removing shoes/socks at night. Fear of theft,
self neglect, need move quickly, constantly ‘on the
go’. Trench foot. Fungal infection, blisters
• Self treating due to lack of podiatry access with
blades, knives, acid based corn plasters.
Ulceration. Infection and scarring
• Smoking
• Sharing showers. Verrucae
• Walking long distances. Stress. No choice! Blisters,
biomechanical problems

22. • Mental health issues resulting in self neglect.
Difficulty engaging with workers.
• Difficulty in maintaining good hygiene. Scabies,
infections (fungal, bacterial and viral)
• Exposure to elements. Cold/wet/heat
• Poor nutrition. Poor healing and infection
• Difficulty accessing healthcare and podiatry
• Banned from services due to behavior
• Perceived or actual insensitive treatment by
medical staff / receptionists
• Embarrassment
• Language barriers
• Illiteracy
• No glasses
• No internet access
• Maslow’s Hierarchy of Need

23. CASE STUDIES
CLCH
Homeless Podiatry Service

24. • 39 year old male
• Alcoholic, multiple drug
user
• Fracture left leg at 24,
no physio, led to clawed
toes & plantar corn
• Self treated corn with
razor blade
• Infection &
hospitalisation
• Corn removed, advice,
physio/orthopaedic/pod
iatric surgery referral,
orthopaedic shoes,
insoles?

25. • 50 year old Asian male
• NIDDM, peripheral
neuropathy, heart
disease
• Neuropathic foot ulcer,
Charcot foot . MRSA
infection
• Dressings, deflective
padding, swabs, specialist
advice, post op sandals.
• Now under specialist
diabetic podiatry team
and housed.
• Foot healed

26. • 50 year old black male
• Mycotic thick toenails could not cut
• Intravenous drug user now on methadone
• Now stable on methadone in hostel
• Nails later treated with Terbinafine tablets.
Now able to self care

27. • Alcoholic male 55
• Poor memory
• Shoes and socks not
removed for 8 months
• Trench foot got worse
when in hostel! Refused
to go into hospital for IV
antibiotics
• Recently deceased-
pneumonia

29. • Male 63
• Frequent hostel
evictions. Revolving
door
prison/street/hostel
• Alcoholic, Wernicke-
Korsakoff Syndrome,
epilepsy. PVD, heavy
smoker
• Fracture right ankle
age 15, not set at
time!!!! Walks on side
of foot
• Infected ulcer right
foot. Trench foot

30. • Not able to attend
appointments or
follow advice due to
Korsakoff’s. Never
took off shoes/socks.
Not suitable for
surgery. Ulcer dressing
and redistributive
padding. Antibiotics.
Orthopaedic shoe
referral difficult. Now
in a home

31. • Elderly male
• Diabetic, schizophrenia
• Slept rough in Hyde
Park many years
• MDT work with Joint
Homeless Team and
nurse from Great
Chapel Street
• Shoes/socks never
removed
• Very flexible podiatry
• Leg ulcers with
maggots
• Hospitalised
• Now in a home

32. TAKE HOME MESSAGES!
• THINK FEET. What could be going on in my
clients shoes?
• Be DIABETES AWARE. Is my diabetic client
getting annual neurovascular foot checks? If
you are a nurse consider updating skills to
perform a diabetic foot assessment and give
diabetic foot care advice, ensure access to the
necessary testing equipment.
• Provide SUPPORT FOR SELF CARE AND
PREVENTION– socks, shoes, nail clippers,
bathing

33. Contact Details
Alison Gardiner
Specialist Podiatrist for Homeless and
Vulnerable People
Central London Community Healthcare
Alison.gardiner@clch.nhs.uk
Tel: 07789777498

34. Useful links
• Society of Chiropodists and Podiatrists (Common
foot problems) http://www.scpod.org/foot-
health/common-foot-problems/
• Diabetes UK https://www.diabetes.org.uk/Guide-
to-diabetes/Complications/Feet/Taking-care-of-
your-feet/
• CLCH Podiatry Service (Mainstream)
www.clch.nhs.uk/services/podiatry-(foot-health)