Center City: Washing the Feet of Philadelphia’s Vulnerable Residents

Kevin Wilson’s feet hurt.

The 50-year-old Philadelphian was diagnosed with diabetes this August, and resulting nerve damage weakened his ability to care for his feet. Plagued with callouses, blisters, and an ingrown toenail, every time he walks, Wilson feels pain.

“Sometimes it hurts so bad I want to chop it off,” Wilson said. “But I acclimated myself to the pain. I just continue. I know I’m alive. It’s a motivator to me.”

Wilson has been sleeping at Sunday Breakfast Rescue Mission, a shelter and meal provider for people experiencing homelessness in Philadelphia, since Sept. 19, after being evicted from his apartment two days prior. He lost his job as a grill chef at 30th Street Station less than a month before that, on Aug. 30, and said his money slowly drained until he became unable to pay rent.

Wilson’s financial situation amplifies the foot pain, he added, as he cannot spend adequate time or money on his health.

Wilson attended a free clinic at the end of September administered by Best Foot Forward Philly Sunday Breakfast. Best Foot Forward Philly is a nonprofit that holds bi-monthly foot clinics for vulnerable Philadelphia residents.

Volunteers consist primarily of Philadelphia nursing and podiatry students—although volunteers are not required to have medical experience, said founder and director Kara Cohen—and begin by administering a vital sign check to all attendees. From there, they wash each patient’s feet in a bucket of warm, sudsy water, and apply ointments like vaseline and athlete’s foot spray, depending on the individual’s needs. Afterward, some patients are permitted to clip their toenails. Patients with diabetes are not.

Despite his inability to participate in “the clip,” the care and pampering at the clinic were “exhilarating,” Wilson said.

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Kara Cohen started Best Foot Forward Philly in 2012 to address disparities in foot health among vulnerable Philadelphia residents and to initiate conversation between people of vastly different financial status.

Foot problems are both prevalent and neglected among individuals experiencing homelessness, according to a 2016 report in the Public Library of Science. People experiencing homelessness may develop foot problems from a variety of sources, including walking long distances, wearing ill-fitting shoes, or lacking access to medical care.

Ailments can result from social and environmental factors like lack of access to transportation, education, housing, and food. Approximately 60% of a person’s life expectancy is driven by these social determinants of health, according to Project HOPE, a global health and humanitarian relief organization.

Cohen developed the idea for the clinic after working as an outreach worker in Boston, where there was a foot clinic. She admired the Boston clinic and thought it would be fun and easy to start something like that in Philadelphia, she said.

“It’s been fun, but it has not been easy,” Cohen added.

From balancing clinic hours with her day jobs as a registered nurse for Project HOME healthcare services at Hub of Hope and conducting street-based outreach, Cohen relies on available volunteers and supplies to keep things moving smoothly.

“Every week, something happens where I think we’re going to have to cancel the clinic,” Cohen said, who recently had to frantically search for misplaced towels. “There’s always something.”

One time, a board member crawled through the ceiling to unlock the closet, she added.

And yet, in some ways, the missing supplies are insignificant. Now in the seventh year of operation, Cohen said the clinic’s strongest attribute is not its treatments, but the heartfelt conversations between patients and volunteers.

While their feet soak, patients and volunteers talk. On a recent Thursday, some quietly discussed critical health issues, trusting strangers with intimate and at times embarrassing information, and others discussed their days, their lives, and the upcoming Eagles’ football game.

“Best Foot Forward Philly is a foot clinic that doesn’t have that much to do with feet,” Cohen said. “It’s about connecting people to health care and making them feel valued as individuals.”

Moments later, a smiling Lamont Miller—a Sunday Breakfast volunteer whose multiple roles include mediator, security guard, and “ultimate people’s guy,” he said—appeared with a stack of fresh, white towels, laying them down as the first guests began to fill the room.

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That day’s guests grappled with a variety of foot problems. Multiple people experienced nerve damage from diabetes or walked long distances on blisters and ingrown toenails.

“A lot of people walk around huge distances during the day,” said Anna Melton, a volunteer at the clinic and registered nurse, currently working at Women’s Space in Germantown. “Whether you’re going to work or panhandling, going to appointments, [or] going about your business, if you can’t afford the transit, then you’re walking.”

Between 2 and 18% of people experiencing homelessness are diabetic, according to a 2015 study in the American Journal of Public Health.

Kevin Wilson struggled with diabetes for years before he was officially diagnosed. Previously incarcerated, a high-carb diet exacerbated symptoms like numbness in his fingers and toes, he said. These went unaddressed in prison, he added.

At any given time, almost 5% of the inmate population has diabetes, according to the American Diabetes Association. Further, formerly incarcerated people are almost ten times more likely to experience homelessness than the general public, according to a 2018 report by the Prison Policy Initiative.

Other patients at the clinic reported soreness, aching, athlete’s and trench foot.

Alfred Nieves, who has now been staying at Sunday Breakfast for 60 days, said he spends the first 15 minutes of his mornings stretching in attempts to quell swelling in his feet. Some nights he wraps his belt around his foot like a sling to elevate it from his bedpost, he added.

“You really don’t feel it, it’s too much pain,” Nieves said. Pausing, he added, “but you feel pain.”

Patients are never turned away from the clinic, but the nurses will call them an ambulance if a wound or infection requires a doctor’s attention, Melton said. This is a rare occurrence, she added.

Out of those they do treat, the clinic has a high return rate, Cohen said.

“One of the things you can’t make up is the reputation you have on the street,” Cohen added. “I’ve met people in my primary care practice… and they’ll remember the foot clinic or they’ll have heard good things about it. And that’s very, very satisfying to know that the people in the street are talking about it in a positive way.”

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At 7:30 p.m., Cohen sealed the door behind the last patient of the night. Following protocol, volunteers continued to serve guests in the waiting room but did not accept new entries. Yet as a familiar voice echoed behind the door, Cohen couldn’t help but bend the rules.

“It’s Russel,” she said.

Wearing a light blue Phillies’ T-shirt and holding a dark brown cane, Russell Staton followed his booming voice into the waiting room.

Staton is “homeless by choice,” sleeping at Sunday Breakfast while he looks for affordable housing, he said. Not having a home forces him to walk more and amplifies his pain, he said. With sore feet, nerve damage, a bad hip, side, and back, he cannot walk a block without sitting down, he added.

Cohen met Staton six years prior when Staton stumbled upon the clinic during a previous stay at Sunday Breakfast. He had lost his job and house in Florida and was looking for help in Philadelphia. He had never received foot care, having previously tended to his feet by himself, but since developing arthritis was unable to continue.

For Staton, the clinic was a blessing, he said.

“I can’t bend to tie my shoes, I can’t clip my toenails, I can’t wash between my toes, it’s kind of rough,” Staton said. “You have to ask somebody to do that for you… it’s kind of, you know, men have our pride.”

Cohen and Staton connected a second time when Staton visited Mary Howard Health Center for The Homeless looking for a primary care doctor. He met with Cohen.

“I said, ‘Didn’t you do my feet?’ and she said, ‘Yea!” Staton recalled. “So, I asked if she would become my primary care doctor.”

Their doctor-patient relationship endured for four or five years until Cohen left Mary Howard for a new work opportunity. Before Thursday, the two hadn’t seen each other in years.

Six years later, the blessings endure.

Flashing a smile and hiking his tone up a few notches, Staton lifted a foot from the bubbles.

“You ready for my toesies?” He asked.

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