Horseshoes for the Homeless

I have never had a horse in my life with shoes or without. I am aware of the game of horseshoes but this is something I have never played despite growing up on a farm. We never had horses and I never even got a pony for my birthday.

So the topic of shoes for horses is not something I can relate to at all. However, the topic of shoes for people and the feet that go into them are a frequent issue for the clients I find myself serving these days in the Urgent Care Clinic where I work.

Most folks coming into the clinic do no not have specific foot issues but two populations accessing care do. The first and larger group is the diabetics. Uncontrolled diabetes tends to affect not only circulation but in relation to one’s feet, sensation. Many diabetics often have numb feet having diminished or no feeling in their feet. This leads to bangs and bumps, to toes especially, that create small wounds they are unaware of and if not attended to can lead to big problems including infection which along with compromised circulation can eventually lead to amputation. Some of the best nursing advice out there is to look at your feet every day especially between the toes and the soles. If you can’t see down there get a friend to look for you or use a small hand held mirror. If you have a friend to take a look you can also then guilt trip them into a bit of a foot rub maybe.

The other group that often has foot problems is the homeless and of course some of them are also diabetic. Living on the street or shelters if lucky often does not lend itself to good management of your blood sugars. This winter we have seen quite a few cases of frost bitten toes. Sometimes, if not too severe, this sort of resolves on its own but it can be bad enough that necrosis sets in and parts or sometimes-whole toes have to come off.

So perhaps one of the most useful interventions I can provide for homeless folks these days are dry socks. I am sure you have seen these hospital issue socks perhaps you have even worn a pair for a while. The current ones we have are grey or green with these raised horizontal racing stripes top and bottom I suppose to create some traction and prevent slips. If we have them I always prefer giving out the green ones, it really is a pretty shade of green.

One of my recent homeless foot issues involved a fellow with some rather significant frost bite that he had been neglecting and so in addition to some rather intense foot fungal odor I think there was bit of rotting flesh involved. The smell made my old nurse eyes water to say the least. I drew the short straw and got to try and get him to clean up his feet a bit before hitting the streets again. He was having none of it saying he had been at another hospital the night before and they had tried to clean up his feet and the pain was unbearable.

One technique is to use shaving cream on them, which can be less astringent than most soap. He was having none of that either. His plan was to get his check the next day and a cheap hotel room where he could clean them up on his own. He wasn’t a shelter guy so the plan was to spend one more night outside. This was mid-week last week with temps in the single digits. The shoes and socks he had were of course wet despite the plastic bags he had lining them. He was definitely not going to part with the shoes which he said were very fine just wet. He did however take a pair of dry socks I gave him, green ones of course. This was the only part of our interaction that seemed to elicit genuine appreciation on his part.

These folks, during inclement weather, can spend the night in the waiting room once we have addressed as best we can whatever brought them in though most prefer to head out no matter what the weather. If they come in late in the day with some issue they feel can’t wait until the next morning they often then miss the cut-off time, usually early evening, to get into a shelter for the night.

So the topic of horseshoes made me think of one more crazy-ass aspect of life in America in 2015 and that is that our horses often have better foot wear than our homeless. I might start carrying a dry pair of socks or two and on snowy, wet, cold days offer them to folks I encounter on the corner with their signs. A more useful gift than spare change perhaps. Maybe I can appropriate a few of the green pairs and hand them out some wintery nights on my walk home from work.

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