Feet On The Street. Providing NHS Podiatry Services to Rough Sleepers in Central London Healthy Feet for All!

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Andrew Cannon
5 years ago
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Alison Gardiner BSc MChS HCPC Reg Specialist Podiatrist

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 Bunion Verruca

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

Good diabetic control Diabetic foot health education Yearly diabetic neurovascular

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

with razor blade Infection & hospitalisation Corn removed, advice,

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?

50 year old Asian male NIDDM, peripheral

padding, swabs, specialist advice, post op

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 deceasedpneumonia

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 Tel:

34 Useful links Society of Chiropodists and Podiatrists (Common foot problems) Diabetes UK CLCH Podiatry Service (Mainstream)

Diabetes - Foot Care

Diabetes - Foot Care Introduction People with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot. Recognizing and treating