SlideShare una empresa de Scribd logo
1 de 34
Descargar para leer sin conexión
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.
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?
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…
Some common foot conditions...
Corns and calluses (plantar, interdigital , dorsal)
Toe deformities
Clawed, hammer, mallet, overriding, burrowing,
polydactyly, syndactyly
Verruca
Bunion
Fungal skin infection
Fungal nail infection
Cracked heels
Infected ingrowing
toenail
Flat Feet
High arched feet
Homeless Podiatry Feet on the Street
Trench Foot
Advise to air feet, leather
shoes, change socks
Blisters
Less common foot conditions
Malignant melanoma and tuberculosis
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
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
Diabetic foot ulcers
May be painless if feet are
numb
Central London Community
Health Care
Homeless Podiatry Service
• 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)
Why are homeless people
so prone to foot problems?
• 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.
• 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
• 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
CASE STUDIES
CLCH
Homeless Podiatry Service
• 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
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
• 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
• 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
Homeless Podiatry Feet on the Street
• 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
• 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
• 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
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
Contact Details
Alison Gardiner
Specialist Podiatrist for Homeless and
Vulnerable People
Central London Community Healthcare
Alison.gardiner@clch.nhs.uk
Tel: 07789777498
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)

Más contenido relacionado

La actualidad más candente

Approach to joint pain
Approach to joint painApproach to joint pain
Approach to joint painanoop r prasad
 
Ortho - Splinting, Traction, POP
Ortho - Splinting, Traction, POPOrtho - Splinting, Traction, POP
Ortho - Splinting, Traction, POPPeter Wong
 
Plaster of Paris and Plaster Technique
Plaster of Paris and Plaster TechniquePlaster of Paris and Plaster Technique
Plaster of Paris and Plaster TechniqueAshish Tripathi
 
HIV/AIDS RECENT ADVANCES
HIV/AIDS RECENT ADVANCESHIV/AIDS RECENT ADVANCES
HIV/AIDS RECENT ADVANCESSoumya Sahoo
 
4 Osteo Arthritis 2010
4 Osteo Arthritis 20104 Osteo Arthritis 2010
4 Osteo Arthritis 2010NorthTec
 
comminuted segmental fracture of femur shaft
comminuted segmental fracture of femur shaftcomminuted segmental fracture of femur shaft
comminuted segmental fracture of femur shaftBADAL BALOCH
 
Hydronephrosis for students
Hydronephrosis for studentsHydronephrosis for students
Hydronephrosis for studentsMohammad Manzoor
 
(9)external fixation indications and techniques(bonatus)
(9)external fixation indications and techniques(bonatus)(9)external fixation indications and techniques(bonatus)
(9)external fixation indications and techniques(bonatus)Drpraveen Kumar
 
Cast and immobilization techniques in orthopaedics by Dr O.O. Afuye
Cast and immobilization techniques in orthopaedics by Dr O.O. AfuyeCast and immobilization techniques in orthopaedics by Dr O.O. Afuye
Cast and immobilization techniques in orthopaedics by Dr O.O. AfuyeAlade Olubunmi
 
Plantar fascitis final
Plantar fascitis finalPlantar fascitis final
Plantar fascitis finalAnkur Mittal
 
[Int. med] approach to joint pain from SIMS Lahore
[Int. med] approach to joint pain from SIMS Lahore[Int. med] approach to joint pain from SIMS Lahore
[Int. med] approach to joint pain from SIMS LahoreMuhammad Ahmad
 

La actualidad más candente (20)

Approach to joint pain
Approach to joint painApproach to joint pain
Approach to joint pain
 
Ortho - Splinting, Traction, POP
Ortho - Splinting, Traction, POPOrtho - Splinting, Traction, POP
Ortho - Splinting, Traction, POP
 
Plaster of Paris and Plaster Technique
Plaster of Paris and Plaster TechniquePlaster of Paris and Plaster Technique
Plaster of Paris and Plaster Technique
 
HIV/AIDS RECENT ADVANCES
HIV/AIDS RECENT ADVANCESHIV/AIDS RECENT ADVANCES
HIV/AIDS RECENT ADVANCES
 
4 Osteo Arthritis 2010
4 Osteo Arthritis 20104 Osteo Arthritis 2010
4 Osteo Arthritis 2010
 
Athlete's foot
Athlete's footAthlete's foot
Athlete's foot
 
Osteomyelitis of bone
Osteomyelitis of boneOsteomyelitis of bone
Osteomyelitis of bone
 
Diabetic foot
Diabetic footDiabetic foot
Diabetic foot
 
Bursitis
BursitisBursitis
Bursitis
 
Club foot
Club footClub foot
Club foot
 
comminuted segmental fracture of femur shaft
comminuted segmental fracture of femur shaftcomminuted segmental fracture of femur shaft
comminuted segmental fracture of femur shaft
 
Approach to limping child 2
 Approach to limping child 2 Approach to limping child 2
Approach to limping child 2
 
Hydronephrosis for students
Hydronephrosis for studentsHydronephrosis for students
Hydronephrosis for students
 
2. Dislocation of Shoulder
2. Dislocation of Shoulder2. Dislocation of Shoulder
2. Dislocation of Shoulder
 
(9)external fixation indications and techniques(bonatus)
(9)external fixation indications and techniques(bonatus)(9)external fixation indications and techniques(bonatus)
(9)external fixation indications and techniques(bonatus)
 
Sexually transmitted diseases
Sexually transmitted diseasesSexually transmitted diseases
Sexually transmitted diseases
 
Cast and immobilization techniques in orthopaedics by Dr O.O. Afuye
Cast and immobilization techniques in orthopaedics by Dr O.O. AfuyeCast and immobilization techniques in orthopaedics by Dr O.O. Afuye
Cast and immobilization techniques in orthopaedics by Dr O.O. Afuye
 
Plantar fascitis final
Plantar fascitis finalPlantar fascitis final
Plantar fascitis final
 
Gout and pseudogout
Gout and pseudogoutGout and pseudogout
Gout and pseudogout
 
[Int. med] approach to joint pain from SIMS Lahore
[Int. med] approach to joint pain from SIMS Lahore[Int. med] approach to joint pain from SIMS Lahore
[Int. med] approach to joint pain from SIMS Lahore
 

Destacado

Anne doherty and carol gayle - diabetes and mental health
Anne doherty and carol gayle - diabetes and mental healthAnne doherty and carol gayle - diabetes and mental health
Anne doherty and carol gayle - diabetes and mental healthNHS Improving Quality
 
LPT - Adherence To Medication And Appointments (Sept07)
LPT - Adherence To Medication And Appointments (Sept07)LPT - Adherence To Medication And Appointments (Sept07)
LPT - Adherence To Medication And Appointments (Sept07)Alex J Mitchell
 
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...Treatment Duration Aderence Compliance and Concordance and Management Of Oste...
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...National Osteoporosis Society
 
Patient Adherence: For the Integrative Healthcare Professional
Patient Adherence: For the Integrative Healthcare ProfessionalPatient Adherence: For the Integrative Healthcare Professional
Patient Adherence: For the Integrative Healthcare ProfessionalIntegrative Therapeutics
 
Ix for Rx Adherence
Ix for Rx AdherenceIx for Rx Adherence
Ix for Rx AdherenceCindy Throop
 
3.3. The Reality of Non-Compliance
3.3. The Reality of Non-Compliance3.3. The Reality of Non-Compliance
3.3. The Reality of Non-ComplianceTeleosis Institute
 
MPCA Integrating Behavioral Health Project
MPCA Integrating Behavioral Health ProjectMPCA Integrating Behavioral Health Project
MPCA Integrating Behavioral Health ProjectMPCA
 
DEMENTIA everything u need to know
DEMENTIA everything u need to knowDEMENTIA everything u need to know
DEMENTIA everything u need to knowAHMED TANJIMUL ISLAM
 
Primary Health Care
Primary Health CarePrimary Health Care
Primary Health CareDoc Lorie B
 
Dementia powerpoint
Dementia powerpointDementia powerpoint
Dementia powerpointBgross01
 
Understanding Mental Health and Mental Illness
Understanding Mental Health and Mental IllnessUnderstanding Mental Health and Mental Illness
Understanding Mental Health and Mental IllnessTeenMentalHealth.org
 
Good and Bad Power Point Examples Ed Tech
Good and Bad Power Point Examples Ed TechGood and Bad Power Point Examples Ed Tech
Good and Bad Power Point Examples Ed TechLynnylu
 

Destacado (20)

Anne doherty and carol gayle - diabetes and mental health
Anne doherty and carol gayle - diabetes and mental healthAnne doherty and carol gayle - diabetes and mental health
Anne doherty and carol gayle - diabetes and mental health
 
LPT - Adherence To Medication And Appointments (Sept07)
LPT - Adherence To Medication And Appointments (Sept07)LPT - Adherence To Medication And Appointments (Sept07)
LPT - Adherence To Medication And Appointments (Sept07)
 
CDS CT Services_FINAL
CDS CT Services_FINALCDS CT Services_FINAL
CDS CT Services_FINAL
 
Hygiene
HygieneHygiene
Hygiene
 
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...Treatment Duration Aderence Compliance and Concordance and Management Of Oste...
Treatment Duration Aderence Compliance and Concordance and Management Of Oste...
 
Patient Adherence: For the Integrative Healthcare Professional
Patient Adherence: For the Integrative Healthcare ProfessionalPatient Adherence: For the Integrative Healthcare Professional
Patient Adherence: For the Integrative Healthcare Professional
 
Ix for Rx Adherence
Ix for Rx AdherenceIx for Rx Adherence
Ix for Rx Adherence
 
3.1. Introduction (Kreisberg)
3.1. Introduction (Kreisberg)3.1. Introduction (Kreisberg)
3.1. Introduction (Kreisberg)
 
3.3. The Reality of Non-Compliance
3.3. The Reality of Non-Compliance3.3. The Reality of Non-Compliance
3.3. The Reality of Non-Compliance
 
MPCA Integrating Behavioral Health Project
MPCA Integrating Behavioral Health ProjectMPCA Integrating Behavioral Health Project
MPCA Integrating Behavioral Health Project
 
Teepa Snow Dementia Building Skill Handout
Teepa Snow Dementia Building Skill HandoutTeepa Snow Dementia Building Skill Handout
Teepa Snow Dementia Building Skill Handout
 
Adherance
AdheranceAdherance
Adherance
 
Teepa Snow, Dementia Expert, on understanding Alzheimers patient behaviors
Teepa Snow, Dementia Expert, on understanding Alzheimers patient behaviorsTeepa Snow, Dementia Expert, on understanding Alzheimers patient behaviors
Teepa Snow, Dementia Expert, on understanding Alzheimers patient behaviors
 
DEMENTIA everything u need to know
DEMENTIA everything u need to knowDEMENTIA everything u need to know
DEMENTIA everything u need to know
 
hygiene
hygienehygiene
hygiene
 
School Mental Health
School Mental HealthSchool Mental Health
School Mental Health
 
Primary Health Care
Primary Health CarePrimary Health Care
Primary Health Care
 
Dementia powerpoint
Dementia powerpointDementia powerpoint
Dementia powerpoint
 
Understanding Mental Health and Mental Illness
Understanding Mental Health and Mental IllnessUnderstanding Mental Health and Mental Illness
Understanding Mental Health and Mental Illness
 
Good and Bad Power Point Examples Ed Tech
Good and Bad Power Point Examples Ed TechGood and Bad Power Point Examples Ed Tech
Good and Bad Power Point Examples Ed Tech
 

Similar a Homeless Podiatry Feet on the Street

The diabetic foot in primary care andre sookdar
The diabetic foot in primary care   andre sookdarThe diabetic foot in primary care   andre sookdar
The diabetic foot in primary care andre sookdarAndre Sookdar
 
A diabetic patient with wound on foot
A diabetic patient with wound on footA diabetic patient with wound on foot
A diabetic patient with wound on footAbdullah Mohammad
 
Milady nail disease and disorder Lecture
Milady nail disease and disorder LectureMilady nail disease and disorder Lecture
Milady nail disease and disorder LectureCosmetology
 
disease of external ear.pptx
disease of external ear.pptxdisease of external ear.pptx
disease of external ear.pptxAhmad Ahmad
 
Milady nail disease & disorder
Milady nail disease & disorderMilady nail disease & disorder
Milady nail disease & disorderCosmetology
 
Foot Presentation May12
Foot Presentation May12Foot Presentation May12
Foot Presentation May12suefeetfirst
 
Feet First presentation - May 2012
Feet First presentation - May 2012Feet First presentation - May 2012
Feet First presentation - May 2012suefeetfirst
 
LMTC Module dog disases.pptx
LMTC Module dog disases.pptxLMTC Module dog disases.pptx
LMTC Module dog disases.pptxAnilKumarNair23
 
Training the trainers - management of the diabetic foot
Training the trainers - management of the diabetic footTraining the trainers - management of the diabetic foot
Training the trainers - management of the diabetic footDavid Lewis
 
nail and medicine.ppt
nail and medicine.pptnail and medicine.ppt
nail and medicine.pptFisayo5
 
congenitalsyphilis-140810152305-phpapp02 (2).pptx
congenitalsyphilis-140810152305-phpapp02 (2).pptxcongenitalsyphilis-140810152305-phpapp02 (2).pptx
congenitalsyphilis-140810152305-phpapp02 (2).pptxSachinSabu19
 
Congenital anomalies of the hand
Congenital anomalies of the handCongenital anomalies of the hand
Congenital anomalies of the handAnand Karia
 
congenitalsyphilis-140810152305-phpapp02 (2).pdf
congenitalsyphilis-140810152305-phpapp02 (2).pdfcongenitalsyphilis-140810152305-phpapp02 (2).pdf
congenitalsyphilis-140810152305-phpapp02 (2).pdfSachinSabu19
 
congenitalsyphilis-140810152305-phpapp02.pdf
congenitalsyphilis-140810152305-phpapp02.pdfcongenitalsyphilis-140810152305-phpapp02.pdf
congenitalsyphilis-140810152305-phpapp02.pdfSachinSabu19
 

Similar a Homeless Podiatry Feet on the Street (20)

The diabetic foot in primary care andre sookdar
The diabetic foot in primary care   andre sookdarThe diabetic foot in primary care   andre sookdar
The diabetic foot in primary care andre sookdar
 
Footcare
FootcareFootcare
Footcare
 
A diabetic patient with wound on foot
A diabetic patient with wound on footA diabetic patient with wound on foot
A diabetic patient with wound on foot
 
Milady nail disease and disorder Lecture
Milady nail disease and disorder LectureMilady nail disease and disorder Lecture
Milady nail disease and disorder Lecture
 
disease of external ear.pptx
disease of external ear.pptxdisease of external ear.pptx
disease of external ear.pptx
 
Diabetic foot ulcer
Diabetic foot ulcerDiabetic foot ulcer
Diabetic foot ulcer
 
Milady nail disease & disorder
Milady nail disease & disorderMilady nail disease & disorder
Milady nail disease & disorder
 
Foot Presentation May12
Foot Presentation May12Foot Presentation May12
Foot Presentation May12
 
Feet First presentation - May 2012
Feet First presentation - May 2012Feet First presentation - May 2012
Feet First presentation - May 2012
 
LMTC Module dog disases.pptx
LMTC Module dog disases.pptxLMTC Module dog disases.pptx
LMTC Module dog disases.pptx
 
dog breeds lmtc.pptx
dog breeds lmtc.pptxdog breeds lmtc.pptx
dog breeds lmtc.pptx
 
Training the trainers - management of the diabetic foot
Training the trainers - management of the diabetic footTraining the trainers - management of the diabetic foot
Training the trainers - management of the diabetic foot
 
nail and medicine.ppt
nail and medicine.pptnail and medicine.ppt
nail and medicine.ppt
 
Lecture 30 parekh charcot
Lecture 30 parekh charcotLecture 30 parekh charcot
Lecture 30 parekh charcot
 
congenitalsyphilis-140810152305-phpapp02 (2).pptx
congenitalsyphilis-140810152305-phpapp02 (2).pptxcongenitalsyphilis-140810152305-phpapp02 (2).pptx
congenitalsyphilis-140810152305-phpapp02 (2).pptx
 
Congenital anomalies of the hand
Congenital anomalies of the handCongenital anomalies of the hand
Congenital anomalies of the hand
 
Diabetic foot ulcer
Diabetic foot ulcerDiabetic foot ulcer
Diabetic foot ulcer
 
Congenital syphilis
Congenital syphilisCongenital syphilis
Congenital syphilis
 
congenitalsyphilis-140810152305-phpapp02 (2).pdf
congenitalsyphilis-140810152305-phpapp02 (2).pdfcongenitalsyphilis-140810152305-phpapp02 (2).pdf
congenitalsyphilis-140810152305-phpapp02 (2).pdf
 
congenitalsyphilis-140810152305-phpapp02.pdf
congenitalsyphilis-140810152305-phpapp02.pdfcongenitalsyphilis-140810152305-phpapp02.pdf
congenitalsyphilis-140810152305-phpapp02.pdf
 

Más de lnnmhomeless

Human trafficking, immigration and accomodation and support options
Human trafficking, immigration and accomodation and support optionsHuman trafficking, immigration and accomodation and support options
Human trafficking, immigration and accomodation and support optionslnnmhomeless
 
Complex Needs and Homelessness Presentation
Complex Needs and Homelessness PresentationComplex Needs and Homelessness Presentation
Complex Needs and Homelessness Presentationlnnmhomeless
 
Local Authority support for NRPF migrants
Local Authority support for NRPF migrants Local Authority support for NRPF migrants
Local Authority support for NRPF migrants lnnmhomeless
 
Partnership working and sexual health
Partnership working and sexual health Partnership working and sexual health
Partnership working and sexual health lnnmhomeless
 
Mental Health Interventions and Rough Sleepers "Saving Lives"
Mental Health Interventions and Rough Sleepers "Saving Lives"Mental Health Interventions and Rough Sleepers "Saving Lives"
Mental Health Interventions and Rough Sleepers "Saving Lives"lnnmhomeless
 
Sexual and Reproductive Health and Homelessness CDAT
Sexual and Reproductive Health and Homelessness CDATSexual and Reproductive Health and Homelessness CDAT
Sexual and Reproductive Health and Homelessness CDATlnnmhomeless
 
PAUSE Creating Space for Change
PAUSE Creating Space for Change PAUSE Creating Space for Change
PAUSE Creating Space for Change lnnmhomeless
 
Respiratory Health and Homelessness,
Respiratory Health and Homelessness, Respiratory Health and Homelessness,
Respiratory Health and Homelessness, lnnmhomeless
 
Sepsis the Hidden Killer
Sepsis the Hidden KillerSepsis the Hidden Killer
Sepsis the Hidden Killerlnnmhomeless
 
Female entrenched rough sleeper project Dagnija O Connell JHT
Female entrenched rough sleeper project Dagnija O Connell JHTFemale entrenched rough sleeper project Dagnija O Connell JHT
Female entrenched rough sleeper project Dagnija O Connell JHTlnnmhomeless
 
Gerry Dickson Groundswell
Gerry Dickson GroundswellGerry Dickson Groundswell
Gerry Dickson Groundswelllnnmhomeless
 
Midwifery 101 by Corrine Clarkson and Morag Forbes
Midwifery 101 by Corrine Clarkson and Morag Forbes Midwifery 101 by Corrine Clarkson and Morag Forbes
Midwifery 101 by Corrine Clarkson and Morag Forbes lnnmhomeless
 
Parents and Communities Together
Parents and Communities TogetherParents and Communities Together
Parents and Communities Togetherlnnmhomeless
 
Safeguarding adults care act 2014 homeless pathway
Safeguarding adults care act 2014  homeless pathwaySafeguarding adults care act 2014  homeless pathway
Safeguarding adults care act 2014 homeless pathwaylnnmhomeless
 
Care act presentation for LNNM
Care act presentation for LNNMCare act presentation for LNNM
Care act presentation for LNNMlnnmhomeless
 
Find and Treat TB
Find and Treat TB Find and Treat TB
Find and Treat TB lnnmhomeless
 
Pregnancy and Homelessness
Pregnancy and HomelessnessPregnancy and Homelessness
Pregnancy and Homelessnesslnnmhomeless
 
From Symptoms to People; Personality Disorder and Homelessness
From Symptoms to People; Personality Disorder and HomelessnessFrom Symptoms to People; Personality Disorder and Homelessness
From Symptoms to People; Personality Disorder and Homelessnesslnnmhomeless
 
Homeless Prevention Initiative - Joint Homeless Team
Homeless Prevention Initiative - Joint Homeless TeamHomeless Prevention Initiative - Joint Homeless Team
Homeless Prevention Initiative - Joint Homeless Teamlnnmhomeless
 

Más de lnnmhomeless (20)

Wound Care
Wound Care Wound Care
Wound Care
 
Human trafficking, immigration and accomodation and support options
Human trafficking, immigration and accomodation and support optionsHuman trafficking, immigration and accomodation and support options
Human trafficking, immigration and accomodation and support options
 
Complex Needs and Homelessness Presentation
Complex Needs and Homelessness PresentationComplex Needs and Homelessness Presentation
Complex Needs and Homelessness Presentation
 
Local Authority support for NRPF migrants
Local Authority support for NRPF migrants Local Authority support for NRPF migrants
Local Authority support for NRPF migrants
 
Partnership working and sexual health
Partnership working and sexual health Partnership working and sexual health
Partnership working and sexual health
 
Mental Health Interventions and Rough Sleepers "Saving Lives"
Mental Health Interventions and Rough Sleepers "Saving Lives"Mental Health Interventions and Rough Sleepers "Saving Lives"
Mental Health Interventions and Rough Sleepers "Saving Lives"
 
Sexual and Reproductive Health and Homelessness CDAT
Sexual and Reproductive Health and Homelessness CDATSexual and Reproductive Health and Homelessness CDAT
Sexual and Reproductive Health and Homelessness CDAT
 
PAUSE Creating Space for Change
PAUSE Creating Space for Change PAUSE Creating Space for Change
PAUSE Creating Space for Change
 
Respiratory Health and Homelessness,
Respiratory Health and Homelessness, Respiratory Health and Homelessness,
Respiratory Health and Homelessness,
 
Sepsis the Hidden Killer
Sepsis the Hidden KillerSepsis the Hidden Killer
Sepsis the Hidden Killer
 
Female entrenched rough sleeper project Dagnija O Connell JHT
Female entrenched rough sleeper project Dagnija O Connell JHTFemale entrenched rough sleeper project Dagnija O Connell JHT
Female entrenched rough sleeper project Dagnija O Connell JHT
 
Gerry Dickson Groundswell
Gerry Dickson GroundswellGerry Dickson Groundswell
Gerry Dickson Groundswell
 
Midwifery 101 by Corrine Clarkson and Morag Forbes
Midwifery 101 by Corrine Clarkson and Morag Forbes Midwifery 101 by Corrine Clarkson and Morag Forbes
Midwifery 101 by Corrine Clarkson and Morag Forbes
 
Parents and Communities Together
Parents and Communities TogetherParents and Communities Together
Parents and Communities Together
 
Safeguarding adults care act 2014 homeless pathway
Safeguarding adults care act 2014  homeless pathwaySafeguarding adults care act 2014  homeless pathway
Safeguarding adults care act 2014 homeless pathway
 
Care act presentation for LNNM
Care act presentation for LNNMCare act presentation for LNNM
Care act presentation for LNNM
 
Find and Treat TB
Find and Treat TB Find and Treat TB
Find and Treat TB
 
Pregnancy and Homelessness
Pregnancy and HomelessnessPregnancy and Homelessness
Pregnancy and Homelessness
 
From Symptoms to People; Personality Disorder and Homelessness
From Symptoms to People; Personality Disorder and HomelessnessFrom Symptoms to People; Personality Disorder and Homelessness
From Symptoms to People; Personality Disorder and Homelessness
 
Homeless Prevention Initiative - Joint Homeless Team
Homeless Prevention Initiative - Joint Homeless TeamHomeless Prevention Initiative - Joint Homeless Team
Homeless Prevention Initiative - Joint Homeless Team
 

Último

Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 

Último (20)

Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 

Homeless Podiatry Feet on the Street

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