Journal List > J Korean Foot Ankle Soc > v.21(4) > 1043432

Min, Kim, and Kim: A Study on the Foot and Ankle Disease of Shelter-based Homeless People

Abstract

Purpose:

Foot and ankle disease (FAD) is a frequent cause of morbidity among the homeless population. Various conditions, exacerbated by malnutrition, poor lifestyle habits, psychiatric disorders, physical injuries, poor hygiene, and limited access to healthcare, have been described in this population. The purpose of this study was to investigate the cognition and management status of FAD in shelter-based homeless people.

Materials and Methods:

Fifty-two male and twenty-five female volunteer homeless individuals were recruited from two homeless shelters. Each person completed a questionnaire assessing any presence of pain, pain management, as well as foot and ankle care status. A foot and ankle surgeon examined the physical status of the individual’s foot and ankle, including tenderness and instability. A radiologic evaluation was done for 18 male and 11 female homeless people who agreed to participate in this test for the existence osteophyte or joint space narrowing representing osteoarthritis and some reference angles for hallux valgus, flatfoot and cavus foot.

Results:

Homeless people had higher prevalence of body mass index, diabetes, and smoking than the general population. The most prevalent infectious disease was fungal infection (male 78%, female 68%), with a low compliance of management for FAD.

Conclusion:

Although most of shelter-based homeless people showed an acceptable foot and ankle management status, the potential risk for FAD development and exacerbation of mild FAD was high.

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Figure 1.
The results of the baseline survey. HTN: hypertension, DM: diabetes.
jkfas-21-156f1.tif
Figure 2.
The results of the question investigation.
jkfas-21-156f2.tif
Table 1.
Visual Examination
Variable Male (n=52) Female (n=25)
Erythema 1 (1.9) 3 (12.0)
Swelling
Ankle 4 (7.7) 8 (32.0)
Hindfoot - -
Midfoot - -
Forefoot 1 (1.9) -
Deformity
Hallux valgus 3 (5.8) 8 (32.0)
Lesser toe deformity 5 (9.6) 7 (28.0)
Flatfoot 1 (1.9) 2 (8.0)
Cavus foot 2 (3.8) 2 (8.0)
Ankle varus 1 (1.9) 2 (8.0)
Others 2 (3.8) -
Skin findings
Corn or callus 31 (59.6) 12 (48.0)
Fungal infection 41 (78.8) 17 (68.0)
(tenia pedis or onychomycos sis)
Eczema 4 (7.7) 3 (12.0)

Verruca vulgaris 1 (1.9) -

Table 2.
Physical Examination
Variable Male (n=52) Female (n=25)
Tenderness
Ankle 7 (13.5) 7 (28.0)
Hindfoot - 1 (4.0)
Midfoot 2 (3.8) 5 (20.0)
Forefoot 3 (5.8) 2 (8.0)
Stress test
Anterior drawer test 13 (25.0) 9 (36.0)

Stress varus test 11 (21.2) 8 (32.0)

Table 3.
Radiologic Evaluation
Variable Male (n=18) Female (n=11)
Arhtiritis
Ankle joint 10 (55.6) 3 (27.3)
Subtalar joint 1 (5.6) 1 (9.1)
Talonavicular joint 3 (16.7) 1 (9.1)
Calcaneocuboid joint 3 (16.7) 2 (18.2)
Lisfranc joint 1 (5.6) 1 (9.1)
First MTP joint 1 (5.6) -
Other joint 4 (22.2) 2 (18.2)
Fracture 1 (5.6) -
Deformity
HVA ≥15。 or IMA1∼2 ≥9。 2 (11.1) 3 (27.3)
Talocalcaneal angle ≤25。 and calcaneal pitch angle ≤15。 1 (5.6) 1 (9.1)
Talo-first metatarsal angle ≥5。 of calcaneal pitch angle ≥30。 2 (11.1) -

MTP: metatarsophalangeal angle, HVA: hallux valgus angle, IMA1∼2: first intermetatarsal angle.

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