1. Wellness Promotion Project Lois Bouren, RN Deidre Dennison, RN Partnered with Interfaith Partnership for the Homeless Worked in the Health & Wellness clinic at the Sheridan Hollow Drop-In Center Provided care to members of the community that included health teaching, screenings, and support

2. Foot Care as a Public Health Concern for the Homeless Foot care amongst the homeless is of particular concern as a result of many factors, including frequent walking, poor quality/fitting shoes, dirty/wet socks, public showers. Foot care amongst the homeless is of particular concern as a result of many factors, including frequent walking, poor quality/fitting shoes, dirty/wet socks, public showers. We felt we could provide good information at a level that the patrons could understand, as well as then provide screenings and referrals for foot care We felt we could provide good information at a level that the patrons could understand, as well as then provide screenings and referrals for foot care

3. Literature Limited studies Limited studies Studies that were reviewed showed an increased risk for foot issues such as corns, bunions, fungal infections, and lower extremity pathology among the homeless due to a lack of proper hygiene facilities and inability to lie down at night Studies that were reviewed showed an increased risk for foot issues such as corns, bunions, fungal infections, and lower extremity pathology among the homeless due to a lack of proper hygiene facilities and inability to lie down at night Also, compounding factors such as PVD, diabetic neuropathy, and alcoholism add to problem Also, compounding factors such as PVD, diabetic neuropathy, and alcoholism add to problem

4. Implementation Based on the amount of foot issues we saw in the clinic, we decided to make a bulletin board and give a presentation about PVD and foot issues Based on the amount of foot issues we saw in the clinic, we decided to make a bulletin board and give a presentation about PVD and foot issues Bulletin board was applied approximately one week prior to presentation in an effort to begin the dialogue Bulletin board was applied approximately one week prior to presentation in an effort to begin the dialogue After presentation we took specific questions, offered foot care kits & new socks, as well as screenings in the clinic After presentation we took specific questions, offered foot care kits & new socks, as well as screenings in the clinic

5. Foot Care: Protect your Feet Deidre Dennison RN Lois Bouren RN SUNYIT

6. Peripheral Vascular Disease Circulation problem that effects blood vessels in the arms and legs Circulation problem that effects blood vessels in the arms and legs Narrowed blood vessels, usually caused by plaque build-up, Narrowed blood vessels, usually caused by plaque build-up, like a hose plugged up like a hose plugged up with dirt with dirt

7. Causes of PVD Body reacts to certain things that restrict blood flow to vessels of the arms and legs Body reacts to certain things that restrict blood flow to vessels of the arms and legs Think clogged pipes!! Think clogged pipes!!

8. How does this happen??

9. Clogged Pipes!

10. Internal/External Causes External (outside the body): Emotional stress Smoking Cold temperatures Injuries/Infection Internal (inside the body): Smoking High blood pressure High cholesterol Diabetes Heart Disease

11. Lifestyle Choices Choices that increase risk include: Choices that increase risk include:Smoking Poor Nutrition/Overweight Inactivity

12. Symptoms No symptoms for some people No symptoms for some people Pain/cramping Pain/cramping Skin color changes Skin color changes Loss of hair on legs/feet Loss of hair on legs/feet Achiness Achiness Fatigue Fatigue Burning; pins and needles Burning; pins and needles Sores that heal slowly or not at all Sores that heal slowly or not at all

13. Color Changes…

14. Leg pain with activity

15. Sores that don’t heal

16. Prevention Quit smoking Quit smoking Healthy diet Healthy diet Moderate exercise Moderate exercise Blood pressure control Blood pressure control Regular visits with MD Regular visits with MD

17. Athlete’s Foot Fungal infection on the skin of the feet Fungal infection on the skin of the feet Likes to grow in between toes Likes to grow in between toes Spreads easily Spreads easily on shower floors, on shower floors, locker rooms. locker rooms.

18. Symptoms & Treatment/Prevention of Athlete’s Foot Burning, itching areas on feet, between toes Burning, itching areas on feet, between toes Skin peels and cracks Skin peels and cracks Possible blisters, open areas Possible blisters, open areas

19. Painful Painful Toes usually warm and discolored Toes usually warm and discolored Infection where the nail in beds the skin Infection where the nail in beds the skin Occurs when shoes are tight and nails are long Occurs when shoes are tight and nails are long Toe nail trimming is Toe nail trimming is important! important! Ingrown Toenails

20. Heel Blisters Gone Bad!

21. Cracked Heels Can be painful Can be painful Skin cracks Skin cracks Bleeds Bleeds Skin is very hard Skin is very hard Dry Dry Sometimes become Sometimes become infected infected

22. Corns and Calluses Corn is a hard patch of thick dead skin. Corn is a hard patch of thick dead skin. Corns usually on toes or sides of foot Corns usually on toes or sides of foot Callus forms any place there is repeated friction Callus forms any place there is repeated friction Caused by rubbing and pressure Caused by rubbing and pressure Painful! Painful!

23. Inspect feet daily Keep feet clean & dry Try to choose bigger shoes if possible Good shoe care Clean, dry socks Early treatment Avoid going barefoot

24. Project Self-Evaluation: What Worked Pictures worked wonders during the presentation – kept clients engaged! Pictures worked wonders during the presentation – kept clients engaged! Keeping language simple and using analogies (such as clogged pipes/hose to illustrate stenosis) Keeping language simple and using analogies (such as clogged pipes/hose to illustrate stenosis) Acknowledging there will be hand outs at the end of the presentation Acknowledging there will be hand outs at the end of the presentation Great turn-out and feedback from clients & staff Great turn-out and feedback from clients & staff

25. Project Self-Evaluation: What Could We Do Differently Earlier implementation of bulletin board Earlier implementation of bulletin board Cholesterol checks using a portable ‘meter’, although the strips the Center had were difficult to use and required a large drop of blood Cholesterol checks using a portable ‘meter’, although the strips the Center had were difficult to use and required a large drop of blood Make more ‘referrals’ to the presentation directly to individuals throughout that week Make more ‘referrals’ to the presentation directly to individuals throughout that week Hang signs regarding the topic and encouraging clients to attend Hang signs regarding the topic and encouraging clients to attend

26. References Chen, B., Mitchell, A., & Tran, D. 2012. Podiatric Health Needs of Homeless populations as a Public Health Concern Journal of the American Podiatric Society. Jan/Feb. 2012 Vol.102 No. 1. Muirhead, L., Roberson, A., & Secrest, J. (2011). Utilization of foot care services among homeless adults: Implications for advanced practice nurses. Journal Of The American Academy Of Nurse Practitioners, 23(4), 209-215. Schoon, P. M., Champlin, B. E., & Hunt, R. J. (2012). Developing a Sustainable Foot Care Clinic in a Homeless Shelter Within an Academic-Community Partnership. Journal Of Nursing Education, 51(12), 714-718.