Creative Enquiry: The Big Issue of Feet

One cold day in January, as I dodged the puddles on the pavement, I bumped into a homeless man on the street who was selling the Big Issue. He told me that it was a particularly special edition for him because he was featured on the inside cover and had been interviewed for an article. I recognised this man as I have bought the magazine from him before and often see him standing or walking in this same spot selling the Big Issue. However during this encounter with him I noticed something for the first time: his shoes were old, battered and soaking wet.

I have focussed on shoes in my piece of art as in many ways these are symbolic of homelessness.  Old shoes are worn out, cast aside and forgotten, worthless to many people, but for the homeless even if worn, they still keep functioning, matching the resilience of their wearers. Their shoes are essential as for most homeless people walking is their only mode of transport and they must spend hours on their feet, often carrying heavy bags. Their shoes are exposed to all weather conditions and many homeless people may never take them off for fear of theft or the need to move on quickly.  

It is no wonder that homeless people have a wide variety of podiatric problems, most commonly callouses, corns, ingrown toenails, tinea pedis, keratolysis of the feet and toenail onychomycosis (To et al., 2016). Alcohol and drug abuse, which are prevalent within the homeless community, further contribute to feet problems, as it can lead to peripheral neuropathy; increase the risk of diabetes and osteoporosis; and generally weaken the immune system (Planas-Ballvé et al., 2017).

Despite foot problems representing up to 20% of reported health complaints in the homeless population, these are often overlooked or in adequately treated (To et al., 2016). Many homeless people may avoid seeking help due to self-neglect and a lack of self worth along with practical difficulties accessing health care itself. It is hard to register for care without a fixed address or adequate documentation, such as identification. Also, the chaotic and transient nature of life on the streets makes managing appointments arranged in advance particularly challenging. Meeting the health needs of homeless people requires a different approach; maybe health care should to go to them. And, given the frequency of podiatric problems, in order to help homeless people to get back on their feet, feet are exactly where we need to start!

References:

1. To, M., Brothers, T. and Van Zoost, C. (2016). Foot Conditions among Homeless Persons: A Systematic Review. PLOS ONE, 11(12), p.e0167463.

2. Planas-Ballvé, A., Grau-López, L., Morillas, R. and Planas, R. (2017). Neurological manifestations of excessive alcohol consumption. Gastroenterología y Hepatología (English Edition), 40(10), pp.709-717.