Foot care when you live outside comes down to a dry pair of socks every day, airing your feet whenever it is safe, checking the tops, soles and between the toes, and never cutting your own corns or calluses. Three problems turn serious: trench foot, cellulitis and an unfelt wound in a diabetic foot.
Feet are the most common medical problem among people living outside and the least often treated. They are also the one where a small intervention early prevents something that ends in an amputation.
Why are foot problems so common in people experiencing homelessness?
A systematic review of foot conditions in people experiencing homelessness found high rates of problems across every category studied — skin and nail conditions, corns and calluses, infection, and nonfreezing cold injury. The reasons are structural rather than personal: shoes that do not fit and cannot be replaced, socks that stay wet, walking most of the day, nowhere to sit down and take boots off, and no way to dry anything.
Add diabetes, which is common and frequently undiagnosed in this population, and you have a foot that cannot feel an injury developing on a body that cannot rest it.
Which foot problems turn serious when you live outside?
- Nonfreezing cold injury. Wet and cold above freezing, sustained for hours to days. The foot goes numb, then white or mottled, then intensely painful on rewarming. Recovery is slow and can leave lasting sensitivity. It is entirely preventable with dry socks.
- Cellulitis. Spreading redness, warmth and swelling, often from a small crack or blister. This one moves fast and it is the common route to hospital admission and to sepsis.
- An unfelt wound in a diabetic foot. No pain, so no reason to look, so it is found late. This is the pathway that ends in amputation, and it is why we ask to look at feet even when nobody has mentioned them.
How do you take care of your feet when living outside?
- Change socks before you change anything else. One dry pair a day prevents more harm than any dressing.
- Air the feet whenever there is a safe chance to. Twenty minutes with boots off matters more than it sounds.
- Look, or ask someone to look. Tops, soles and between the toes. If you cannot see the sole, a phone camera works.
- Do not cut calluses or corns yourself, and do not use over-the-counter corn removers on a diabetic foot.
- Boots one size up, with room for a dry sock. Tight boots cause more of this than worn-out ones.
Ask us to look
There is no threshold for this. A dressing changed and nothing else is a complete visit, and nobody is asked to accept anything further in order to get it. Barriers to foot care in this population are well documented and most of them are about how services are set up rather than about whether people want care.
Street medicine outreach brings this to where people are, and socks and boots are always on the in-kind needs list for exactly the reasons above.
Frequently asked questions
How often should you change your socks when living outside?
Every day. One dry pair a day prevents more harm than any dressing, so change socks before you change anything else. Wet socks that never dry are how trench foot starts, which is why socks and boots are always on our in-kind needs list. Boots one size up leave room for a dry sock, and tight boots cause more of this than worn-out ones.
What does trench foot look like?
Trench foot, or nonfreezing cold injury, comes from feet staying wet and cold above freezing for hours to days. The foot goes numb, then white or mottled, then intensely painful when it rewarms. Recovery is slow and can leave lasting sensitivity. It needs no ice at all, and it is entirely preventable with dry socks.
What are the signs of cellulitis in the foot?
Spreading redness, warmth and swelling, often starting from a small crack or blister. Cellulitis moves fast, and it is the common route to hospital admission and to sepsis for people living outside. Checking the tops, soles and between the toes every day is how it gets caught early. If you cannot see the sole, a phone camera works.
Should you cut your own corns or calluses?
No. Do not cut calluses or corns yourself, and do not use over-the-counter corn removers on a diabetic foot. Ask the street medicine team to look instead. There is no threshold for asking: a dressing changed and nothing else is a complete visit, and nobody is asked to accept anything further in order to get it.
Why do people with diabetes need to check their feet?
Because a diabetic foot can have a wound it cannot feel. No pain means no reason to look, so the wound is found late, and that is the pathway that ends in amputation. Diabetes is common and frequently undiagnosed among people living outside, which is why we ask to look at feet even when nobody has mentioned them.
Sources
- To MJ et al. Foot Conditions among Homeless Persons: A Systematic Review. PloS one, 2016. PubMed 27936071
- Zafren K. Nonfreezing Cold Injury (Trench Foot). International journal of environmental research and public health, 2021. PubMed 34639782
- Mistry K et al. A review of trench foot: a disease of the past in the present. Clinical and experimental dermatology, 2020. PubMed 31309614
- Benadda I et al. A Preliminary Assessment of Barriers and Facilitators to Accessing Foot Care in Homeless Shelters: A Scoping Review. Annals of vascular surgery, 2025. PubMed 39613026