In my experience the patients most likely to neglect themselves are those with chronic mental illness and learning disabilities. The part of the body they are most likely to neglect is their feet.
Over the years, I have seen neglected toe nails that have grown as thick and as long as the claws of a predatory animal. I have come across calluses and verrucas so extensive as to make walking a few steps an agony. I have treated athlete’s foot in the feet of not very athletic patients who have great difficulties, as a result of poor eyesight, arthritis or obesity, in reaching and tending to their sore and smelly toes. Ill-fitting shoes contribute to a cycle of restricted mobility, swelling feet and infection.
Neglected feet are not just a nuisance – to the patients themselves, their families and carers (and sometimes to other patients in the waiting room) – they can be a threat to life. I remember one patient with autism and learning disabilities whose combination of poorly-controlled diabetes and fungal foot infections led to cellulitis, amputation and a premature death from septicaemia.
One of my most rewarding investments as a GP has been in basic chiropody equipment. Given the difficulties many of our patients experience in gaining regular access to our local foot health clinic, I can offer at least temporary respite from the misery of corns and in-growing toenails, while trying to ensure they get regular expert attention to their feet.
There has been much hot air in recent years about providing regular ‘health checks’ for everybody, including people with mental illness and learning disabilities, and an accompanying obsession with inquiring into their lifestyles and behaviour. I find it more useful to ask them, ‘how are your feet?’.
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