Foot Conditions among Homeless Persons: A Systematic Review

Abstract

IntroductionFoot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons.MethodsA literature search was conducted on MEDLINE (1966–2016), EMBASE (1947–2016), and CINAHL (1982–2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist.ResultsOf 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes.DiscussionFoot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and addressing social factors that lead to increased risk of foot problems. Targeted efforts to screen for and treat foot problems could result in improved health and social outcomes for homeless individuals.

A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets

“…Groups that are overrepresented include people who have physical and mental disabilities, have substance use problems, and are members of racialized groups [ 1 , 2 , 7 , 8 ]. Furthermore, people experiencing homelessness are vulnerable to developing medical conditions, including tuberculosis, hepatitis B and C viruses, HIV, skin and foot problems, and oral health problems [ 9 , 10 , 11 , 12 ]; being physically and sexually assaulted [ 13 , 14 ]; being arrested [ 15 ]; being socially isolated [ 13 , 16 ]; and experiencing stigma and discrimination [ 17 ]. People experiencing homelessness are also at-risk of dying younger than the general population, with life expectancies between 8–22 years shorter than those without histories of homelessness [ 18 , 19 , 20 ].…”

Health supports needed for homeless persons transitioning from hospitals

“…Homelessness has direct negative effects on health, and the health needs of individuals experiencing homelessness are especially complex and challenging to address (Frankish, Hwang, & Quantz, 2005;Hwang, 2001). Compared to the general population, persons experiencing homelessness have a disproportionate burden of acute and chronic illnesses (Zlotnick & Zerger, 2009), including seizures, chronic pulmonary obstructive disease, arthritis, musculoskeletal disorders (Crowe & Hardill, 1993); hypertension, diabetes, liver, renal disease (O`Connell, 2004); tuberculosis, hepatitis C, influenza, HIV/ AIDS (Beijer, Wolf, & Fazel, 2012); oral and dental health problems, such as missing and decayed teeth, oral pain and gum disease (Collins & Freeman, 2007;Daly, Newton, Batchelor, & Jones, 2010;Khandor & Mason, 2007); skin problems (Badiaga et al, 2005;Raoult, 2001); and foot problems (To, Brothers, & Van Zoost, 2016). Individuals who are homeless also suffer higher rates of mortality than populations that are housed (Hibbs et al, 1994;Morrison, 2009).…”

Proper fitting shoes: Reducing pain, increasing activity, and improving foot health among adults experiencing homelessness

“…Minimal changes in foot conditions were noted in this study. Many adults experiencing homelessness may incur foot‐related problems such as fungal infections of the toe nails and foot, foot lesions resulting in ulceration, and painful calluses caused by repetitive trauma (Buldt & Menz, ; Chen et al, ; To et al, ). Participants reported less pain in the ankle joint and general arthritis.…”

“…The most commonly reported pain locations for adults experiencing homelessness were in the legs and feet (Fisher et al, ). Adults experiencing homelessness were more likely to report pain in their feet when walking compared to housed participants (To, Brothers, & Van Zoost, ). With many adults experiencing foot and lower limb pain, it is important to examine possible contributing factors.…”