Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Macerated feet

Discussion in 'General Issues and Discussion Forum' started by jollyjoh, Aug 14, 2007.

  1. jollyjoh

    jollyjoh Member

    Members do not see these Ads. Sign Up.
    Macerated feet........

    I have recently started doing some work in a homeless shelter, and am thoroughly enjoying the challenge of some very interesting cases, in fact it's the highlight of my week......
    However, some things get me a bit stumped, and I would appreciate any advice please.
    I have now had two patients present with extremely macerated feet. The first had skin which was literally falling off his feet, and he was quick to tell me that he urinates in a bucket and then soaks his feet in it while it's still warn, because it kills off fungal infection.........
    The second has white, macerated skin, with black dye from his trainers, and a broken blister which extends over 2/3/4 mpjs with a flap of loose skin.

    My question is, how do I treat them?

    They are living on the streets, with a single pair of shoes, in extremely wet conditions.
    Any dressings are going to be put back into their soggy shoes, and soon become wet.

    All suggestions welcomed please.
  2. Wothca jollyjoh

    I have done quite a lot of work in homeless shelters and day centers over the years. As you say it is a fascinating window into a whole other world of podiatric problems and i would recommend it to anyone who is bored of middle class, middle aged, middle english middling mid life crisis types who think that mid length nails or a hmille in the middle of their feet is a major crisis. It comes with a whole lot of new challenges, many of which are more social than clinical. Your greatest assets here might be homeless charities and the local churches. Think the podiatrist edition of the apprentice, you've got to go looking for it. Be cheeky, you never know what you might get.

    My advice is as follows.

    1. Find out what their circumstances are. Many homeless people have shelters to sleep in or day centers for the day time. If they do try to use that time to dry the feet, ie get them to take their soggy shoes off as much as possible. Get air to those feet. Stick the shoes in the microwave. (kidding)

    2. Speak to the shelter or go to primark yourself for some socks. If you can get them some spare pairs of dry socks and get them to change them from time to time that will help a lot. Many shelters offer laundry services, if not speak to your local Salvation army HQ. That sort of thing is right up their street. If they are sleeping somewhere dry get them to take there shoes off and put double fresh socks on at night.

    3. Liase with local shelters / churches for shoes. How many pairs of decent shoes with life left in them get thrown away every week? An appeal on sunday after the service and if you're lucky you'll have a box in various sizes by next time! Ask for socks while you're at it. People often want to help but don't know how and donating old shoes is a nice clean easy way for them to feel good about themselves. Having a spare pair of shoes is a real bonus for their soggy feet, again see if you can organise facilities for them to dry out the pair they are not wearing.

    4. Tell Mr piddlefoot that whilst yes he's right that wee kills fungus it also softens skin. A strong solution of tea however kills fungus AND TOUGHENS the skin. It's half a lie but it might get him to stop and although i've never tried the tea thing people tell me it works. Remember, don't tell people they were wrong, tell them they were right, but you have an even better way!

    Hope some of this is of some use to you. Keep up the good work. What part of the world are you in by the way? Can i help?

  3. Peter

    Peter Well-Known Member

    Might I suggest you contact Orthotist/Shoe manufacturing companies for possible supply of shoes that have been made/ordered and never fitted?

    We recently sent a cageload of shoes to a homeless shelter in Newcastle. We acquired them from merging with a dept that used Pods to prescribe/measure and order stock footwear. Many were inaptly prescribed, or were never fitted for various reasons I couldn't possibly comment upon.
  4. Cameron

    Cameron Well-Known Member


    Run into similar situation in Perth, Western Australia. The chap in question slept rough on the beach and submerged his shod feet in the sea overnight. A step above urinating on them but presumably done for the same reasons.

    He did attend a day centre (eratically) and was a poorly controlled diabetic. His shoes were falling apart and I gave him new orthopadic trainers which were reportedly stolen (or likely sold by himself) at his next vist.

    I notified the Shelter and they informed his GP of our concern. He was unpredicable and behaviour varied with medication and it was difficult to know whether he really understood the seriousness of his situation. However the staff at the centre did what they could to encourage routine hygiene.

    Had I access to formaldihyde impregmated insoles (DX Insoles) I might have prescribed these (with a 3mm plastazote over lays) but the opportunity did not present.

  5. John Spina

    John Spina Active Member

    Re: Macerated feet........

    What these folks need is a cheap and easy way to solve this problem.A solution is have them soak their foot in warm water and a cap of clorox bleach.That will dry their feet,also encourage them to change their socks daily.
  6. jollyjoh

    jollyjoh Member

    Firstly an apology for disappearing after posting this thread, I've been on leave, with no computer access........(honest!)

    Thanks so much for all your helpful suggestions.

    I've been in touch with the salvation army, where they have a brilliant team who do 'foot washing' as part of their service, along with providing socks and other items of clothing.
    Peter, your suggestion of shoe companies is a great idea, will get on to them and see what I can grovel for!
    Robert, great advice, thanks. I'm based in Dorset, the clinic is in Bournemouth, so any spare socks or other useful 'stuff' will be willingly accepted from anybody who can help in that way.
    As far as tea being a better option for soaking feet, I have an avid hatred of tea, and the smell makes me heave, so the thought of suggesting that my gentleman soaks his soggy feet in tea is as repulsive to me as his previous solution, and every time I smell tea now I imagine soggy feet being steeped in it.......hmmmmmmmmmm.

    We do provide a free pair of wool mix walking socks after every treatment, but I wonder if a newer synthetic material may be a better option in getting rid of the excess moisture next to the skin?

    Keep the suggestions coming, all support gratefully received, and once again many thanks.
  7. RussAgg

    RussAgg Active Member

    You could try KMnO4 solution foot soaks - it will dye the skin brown but I've tried these before in a similar situation with good results.

Share This Page