“when you’re homeless, you rely on your feet a lot.” street-based podiatry program treats feet of Melbourne’s rough sleepers

“People say your brain controls your body. But your toes control a lot more than you think. When you’re homeless, you’re always on your toes. And for someone like me, I’m on my feet a lot, walking a lot.” 

Lachie*, client of cohealth’s homelessness podiatry program since 2014 

 Lachie* is in his early 50s and has been experiencing homelessness on and off for all that time, including bouts of rough sleeping and cycling through rooming houses. Lachie has an acquired brain injury which affects his behaviour, and has led to his exclusion from some support services.  

“I had been complaining about my feet being sore. I had corns and they were uncomfortable to walk on – I’d be walking down the street and step on the wrong angle, and I’d yell out in pain,” said Lachie.   

“Also, my feet were stinking because my nails were so long. I didn’t know that was the reason they smelled at the time – germs get trapped under the nails.”  

“Someone put me onto cohealth and I met Bec (cohealth outreach podiatrist, Rebecca Mannix).  She helped me by getting my toes done. And getting me some reliable shoes. Bec understands the way you walk,” he said. 

“Rebecca has a lot of knowledge about walking on the street. She understands where I’ve been,” said Lachie.  

When people are sleeping rough they rely on their feet a lot. Yet rough sleepers, and people in other forms of marginal accommodation, have the least opportunity to clean and care for their feet, or access specialists to treat foot problems. 

cohealth’s street-based podiatry program is responding to that problem, and prevent minor foot problems becoming big health issue problems. 

A paper published in the Journal of Foot and Ankle Research in February 2022 examined cohealth’s street-based podiatry program, shedding light on the ravaging impacts of homelessness on people’s feet, and the vital role of publicly funded, community podiatry services. 

The research paper, ‘Responding to foot health needs of people experiencing homelessness: the role of a publicly funded community-based podiatry service’ suggests that footcare can be the ‘gateway’ to getting someone connected to other services, such as housing support, drug and alcohol treatment and mental health care. 

Co-authored by La Trobe University and cohealth, the research paper examined the client data of cohealth’s free Melbourne podiatry service for people experiencing homelessness.  

The analysis reveals the most common issues experienced were skin and nail pathologies (68 per cent), biomechanical issues (51 per cent) and acute foot wounds (44 per cent). Fifty-two per cent of people treated by the cohealth podiatry team had inadequate footwear and nearly 1-in-5 (18 per cent) required acute wound care.  

cohealth’s specialist podiatrists reach out to Melbourne’s homeless on CBD streets and in rooming houses, as well as treating people at cohealth’s Central City clinic, embedding themselves in cohealth’s broader homelessness services.  They treat nearly 300 people each year, nearly half of whom are people who sleep rough, and 1-in-3 who are living in unstable housing such as crisis accommodation and rooming houses.  

Poor quality footwear, exposure to the elements, and substandard living conditions can lead to a litany of foot problems among homeless clients, says cohealth outreach podiatrist, Rebecca Mannix.  

“When you’re sleeping rough or cycling through rooming houses it’s hard to keep feet clean and dry. People often don’t have access to basic podiatric items such as clippers, and problems snowball quickly,” Rebecca said.  

“Having flexible, adaptable services that are designed with clients is really important so that they get the healthcare they need quickly and not wait until problems become emergencies,” said Rebecca.  

cohealth says that free community-based podiatry services that use an outreach model are vital to improving the overall health of people who are without a secure home.  

“Without our podiatry service and outreach model, a great many of our clients would suffer with painful feet, whilst their feet are their only way of getting around,” she said.   

Podiatry was the first cohealth service which Lachie used, but he has since been been looped into a range of other cohealth services to respond to his other health and social support needs, including allied health and social work.  

Lachie has been supported to apply for NDIS, and was recently approved. cohealth has helped him find secure accommodation and is now helping him transition to the NDIS.    

Lachie says his overall health has improved, not just the health of his feet. 

“I’ve been in and out of rooming houses for a long time. I finally got into a place where I’m happy through the NDIS. Now that I have a place to stay, it’s a lot easier to keep my feet right, and keep them rested.”  

Rebecca says, “Lachie has had had bad experiences with many services and has been banned for a few due to some of his reactions and behaviours stemming from his brain injury, but we’ve been able to work with him and he comes to see us when he needs something,” says Rebecca.  

 Rebecca says a key feature of the community health model is this capacity to respond to people’s range of needs beyond the service they may have come in for by building trust with clients. 

“Although I’m here to look after his feet, the cohealth team work together to make sure his holistic health needs are met – social, mental and physical,” she says.  

“Everyone has the right to live free of pain, and to have access to high-quality health care.”