Wound care, preventing amputations the latest challenge facing London's homeless population

A young man hobbles across the parking lot of the homeless hub on Queens Avenue.

He's bent over and favouring one leg, barely managing a forward locomotion that can best be described as an awkward hop.

After a long and slow advance, he manages to reach the front door of the HOME bus, a rolling clinic that provides outreach healthcare for the estimated 2,000 Londoners who regularly sleep outside. It's name is an acronym for Health Outreach Mobile Engagement.

The man, who prefers to only be known as Jay, is finally able to struggle up the stairs where he sits down to be examined and interviewed by the team of paramedics and nurses. 

The health concern that brings Jay to the bus is trench foot, a skin condition that thrives when feet are left wet over a period of time. Untreated, it can lead to painful sores, serious infections and, in extreme cases, even amputations. As its name suggests, it's a condition from another time, one that first appeared among soldiers fighting in the First World War. Now, with a nationwide homeless crisis that's left so many sleeping outside, it's making an unfortunate comeback. 

"I have a multitude of lesions," Jay told CBC News moments after the HOME care team cleaned, dressed and treated painful wounds that cover his feet. "It's scary. You see characters out there with amputations, with their toes gone and their walk is different. It's something that's very real." 

Trench foot and other lower-limb skin conditions are generally treatable and preventable for people who are housed, but they're growing among London's homeless population. It's a problem leading to serious health problems and ER hospital visits. 

Brandi Tapp is a nurse practitioner with London Intercommunity Health and a member of the HOME team which operates the mobile care unit in a converted bus.  Although specific stats aren't kept about the conditions they deal with, she estimates about half of the 3,000 people the mobile care team sees in a year have some kind of skin condition. 

"The frequency of conditions like this has really increased," she said. "We had to come up with our own best practices for an effective way to treat this because it was causing risks to life and limb."

Risks because among people who are housed, most skin conditions can be diagnosed and treated quickly. 

Wounds that are kept clean and dry, treated with the proper medications and covered with sterile and regularly changed dressings typically get better. But for people like Jay who often sleep in the cold and wet with little access to clean clothes, bedding or potable hot water, it becomes a challenge to maintain optimal conditions for a wound to heal. 

Wounds that don't get better can quickly get worse, to the point where they can develop into serious infections that in extreme cases, can lead to infections that require amputation, Tapp said. 

"It's devastating to see people with these conditions," said Tapp. "It's beyond belief. In a well-resourced country one would hope this wouldn't be as commonly occurring as it is."

Trench foot is just one of a long list of skin conditions that Tapp and others on the mobile care team see regularly.