Responding to foot health needs of people experiencing homelessness: the role of a publicly funded community‐based podiatry service

Abstract

Background People experiencing homelessness are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Foot and ankle problems are a concern; as well as causing discomfort and pain, they may escalate from a minor problem to a very serious one without timely and appropriate treatment. Little is known about the foot and ankle problems of people experiencing homelessness. This paper describes a podiatric service specifically for people experiencing homelessness, which includes a fixed site as well as outreach services. The service operates as part of the Homelessness Team program at Cohealth, a large community health service in Melbourne. Methods The study used routinely collected data. Every person who was seen by the podiatrist in the Cohealth Homelessness Team in 2019, whether on site or on outreach, was included in the study (n = 295). Of these, 156 were attending for the first time and 139 were returning clients. People who used the service were predominantly rough sleeping (45.2%), with 32.2% in unstable or insecure housing and 22.6% recently housed. Results Skin and nail pathologies (68.1%), inadequate footwear (51.9%) and biomechanical issues (44.1%) were the most common presentations. People sleeping rough were particularly likely to present with biomechanical issues (50.8%), acute wound care needs (17.4%) or traumatic injury (10.6%). Most people presented with more than one issue (mean = 2.4), and new clients (mean = 2.53) and those rough sleeping (mean = 2.69) had more issues than others. Outreach was the most effective way to reach clients in the most difficult circumstances (48.9% of those in unstable housing, 34.8% of rough sleepers). Most of the clients (81.4%) had connections with other services offered by Cohealth, such as social work or physiotherapy. Conclusions This study demonstrated that reaching and intervening on foot and ankle problems of people experiencing homelessness who may not seek care on their own could be achieved through a publicly funded health service, using simplified pathways to care including outreach. In addition to the long- and short- term benefits of the immediate podiatric treatment, building trust and connections through footcare may provide an entry point into accepting other health and welfare services.

Community-Based Wound Care Programs for Unhoused Individuals

“…The Homelessness Team Program at Cohealth in Melbourne, Australia, used active outreach to effectively treat foot wounds in the unhoused population through its no-cost podiatry service [ 23 ]. Since walking is often the main means of mobility for unhoused individuals, small podiatric issues can often compound into more severe wounds if left untreated.…”

“…Since walking is often the main means of mobility for unhoused individuals, small podiatric issues can often compound into more severe wounds if left untreated. The Cohealth podiatry service sets up drop-in clinics at sites where unhoused people gather, so that they can receive primary healthcare for foot wounds and infections before they develop into more severe problems that require more invasive and expensive procedures [ 23 ]. This not only burdens the client but also increases costs to the health system [ 24 ].…”

“…Features such as drop-in service availability [ 18 , 23 , 32 ], HIV or other disease screening [ 18 , 20 , 32 , 33 ], syringe exchange [ 18 , 20 , 21 , 27 , 30 , 32 – 34 ], provision of temporary housing or assistance in securing housing [ 18 , 26 , 30 , 32 , 35 ], case management [ 26 , 30 , 35 ], preventative education [ 18 , 20 ], and the incorporation of an interdisciplinary staff [ 23 , 25 , 26 , 30 , 32 , 35 ] contributed to the effectiveness of community-based programs. For example, the Homelessness Team Program at Cohealth in Melbourne, Australia, offered a fixed site and multiple outreach services.…”

“…For example, the Homelessness Team Program at Cohealth in Melbourne, Australia, offered a fixed site and multiple outreach services. In addition to podiatric health services offered at fixed locations to clients, teams provided drop-in medical services in locations where unhoused individuals tend to gather [ 23 ]. Drop-in services have proven to be effective for these individuals because they can be reluctant to seek healthcare on their own [ 16 , 23 , 36 , 37 ].…”

Intersectionality, vulnerability and foot health inequity

“…Firstly, rising living costs have adversely affected the socioeconomic status of rural and inner‐city communities, which have become further polarised from higher‐income households. This has reduced disposable income in these communities, which has led to limited access to [foot] healthcare services, ultimately leading to higher instances of podiatric complaints [2, 3].…”