• 1.

    Stark LR: Barriers to Health Care for Homeless People,” in Homelessness: A Prevention-Oriented Approach, edited by RI Jahiel, p 151, Johns Hopkins University Press, Baltimore, 1992.

    • Search Google Scholar
    • Export Citation
  • 2.

    Martell JV, Seitz RS, Harada JK, et al: Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project. Ann Intern Med 116: 299, 1992.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    D'Amore J, Hung O, Chiang W, et al: The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med 8: 1051, 2001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Salit SA, Kuhn EM, Hartz AJ, et al: Hospitalization costs associated with homelessness in New York City. N Engl J Med 338: 1734, 1998.

  • 5.

    Delorme T, Rose S, Senita J, et al: Epidemiology and susceptibilities of methicillin-resistant Staphylococcus aureus in Northeastern Ohio. Am J Clin Pathol 132: 668, 2009.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 6.

    Raoult D, Foucault C, Brouqui P: Infections in the homeless. Lancet Infect Dis 1: 77, 2001.

  • 7.

    Hwang SW: Homelessness and health. CMAJ 164: 229, 2001.

  • 8.

    Wlodarczyk D, Prentice R: Health issues of homeless persons. West J Med 148: 717, 1988.

  • 9.

    Wrenn K: Foot problems in homeless persons. Ann Intern Med 113: 567, 1990.

  • 10.

    Robbins JM, Roth LS, Villanueva MC: “Stand down for the homeless”: podiatric screening of a homeless population in Cleveland. JAPMA 86: 275, 1996.

    • Search Google Scholar
    • Export Citation
  • 11.

    Baggett T, O'Connell J, Singer D, et al: The unmet health care needs of homeless adults: a national study. Am J Public Health 100: 1326, 2010.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 12.

    Lu JT, Creager MA: The relationship of cigarette smoking to peripheral arterial disease. Rev Cardiovasc Med 5: 189, 2004.

  • 13.

    Al-Jarallah KF, Shehab DK, Buchanan WW: Rheumatic complications of alcohol abuse. Semin Arthritis Rheum 22: 162, 1992.

  • 14.

    Freeman R: Autonomic peripheral neuropathy. Neurol Clin 25: 277, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15.

    Vinik AI, Park TS, Stansberry KB, et al: Diabetic neuropathies. Diabetologia 43: 957, 2000.

  • 16.

    Dunn J, Link C, Felson D, et al: Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 159: 491, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Radiaga S, Menard A, Dupont H, et al: Prevalence of skin infections in sheltered homeless. Eur J Dermatol 15: 382, 2005.

  • 18.

    Greenberg L: Analysis of Foot Care Data from the 1990 National Health Interview Survey, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine, Rockville, MD, November 1992.

    • Search Google Scholar
    • Export Citation
  • 19.

    Chen B, Mitchell A, Tran D: Podiatric health needs of homeless populations as a public health concern. JAPMA 102: 54, 2012.

  • 20.

    Jones CL: Foot care for the homeless. JAPMA 80: 41, 1990.

  • 21.

    Kleinman LC, Freeman H, Perlman J, et al: Homing in on the homeless: assessing the physical health of homeless adults in Los Angeles County using an original method to obtain physical examination data in a survey. Health Serv Res 31: 533, 1996.

    • Search Google Scholar
    • Export Citation
  • 22.

    Arnaud A, Fagot-Campagna A, Reach G, et al: Prevalence and characteristics of diabetes among homeless people attending shelters in Paris, France, 2006. Eur J Public Health 20: 601, 2010.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 23.

    Muirhead L, Roberson AJ, Secrest J: Utilization of foot care services among homeless adults: implications for advanced practice nurses. J Am Acad Nurse Pract 23: 209, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 24.

    Brehove T, Joslyn M, Morrison S, et al: Adapting Your Practice: Treatment and Recommendations for Homeless Patients with Diabetes Mellitus, Health Care for the Homeless Clinician's Network, Nashville, June 2007.

    • Search Google Scholar
    • Export Citation

“Step Up for Foot Care”

Addressing Podiatric Care Needs in a Sample Homeless Population

Bright Chen California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA. Drs. Chen and Mitchell are now in private practice.

Search for other papers by Bright Chen in
Current site
Google Scholar
PubMed
Close
 DPM
,
Analiza Mitchell California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA. Drs. Chen and Mitchell are now in private practice.

Search for other papers by Analiza Mitchell in
Current site
Google Scholar
PubMed
Close
 DPM
, and
David Tran Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

Search for other papers by David Tran in
Current site
Google Scholar
PubMed
Close
 DPM, MS
Restricted access

Background

Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San Francisco, California.

Methods

A 37-question survey regarding general demographic characteristics, foot hygiene practices, associated risk factors, and self-reported lower-extremity pathologic conditions was completed by 299 homeless individuals who met the inclusion criteria. The service project included education on proper foot care and the distribution of footwear.

Results

The participants demonstrated mostly good efforts regarding foot hygiene but had high-risk factors, including smoking, alcohol use, and extended hours on their feet. More than half of the homeless individuals surveyed experienced foot pain. Approximately one in five had edema and neuropathic symptoms. The most commonly reported foot problems were dermatologic, but these conditions could pose serious sequelae in the setting of risk factors. The community service project was well received by the homeless community.

Conclusions

This study demonstrates lack of resources and high-risk factors for lower-extremity complications in the homeless individuals studied. It is important in the realm of public health to keep lower-extremity health in mind because it plays an important role in preventing the spread of infection and lowering the social economic burden.

Corresponding author: David Tran, DPM, MS, Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, 3100 Telegraph Ave, Ste 1000, Oakland, CA 94609. (E-mail: DTran@samuelmerritt.edu)