Social Determinants of Health in Podiatric Patients: Trends and Common Concerns
Summary: Published on the HMP Global Learning Network’s Podiatry Today platform, this article examines the intersection of social determinants of health (SDOH) and podiatric care — addressing a dimension of patient management that disproportionately shapes foot and ankle outcomes but is often absent from clinical training and documentation frameworks. SDOH — the non-medical factors that influence health outcomes, including economic stability, education, health literacy, neighbourhood conditions, housing insecurity, food insecurity, social isolation, and access to healthcare — are increasingly recognised as drivers of the most challenging cases in podiatric practice. For wound care clinicians managing diabetic foot ulcers, venous leg ulcers, and pressure injuries, SDOH factors directly affect: wound healing trajectories (poor nutrition, inadequate offloading at home, inability to rest); treatment adherence (unaffordable medications, dressings, or footwear; missed appointments due to transport barriers); infection and amputation risk (delayed presentations due to healthcare avoidance; higher rates of homelessness-associated DFU complications including retinopathy and amputation); and recurrence risk (return to high-risk environments, inability to maintain footwear, self-care knowledge gaps). The article covers trends in how SDOH awareness is evolving in podiatric practice — including integration of ICD-10-CM Z codes for SDOH documentation, adoption of structured SDOH screening tools (PRAPARE, AHC-HRSN), referral pathways to community health workers and social services, and the growing clinical imperative to address SDOH as part of comprehensive, equitable diabetic foot care rather than treating them as external social issues. It also covers common concerns podiatrists encounter: patients who cannot afford prescribed therapeutic footwear or custom orthotics, patients in unstable housing who cannot offload or rest a healing ulcer, patients with low health literacy who misunderstand wound care instructions, and patients from communities with barriers to accessing wound care specialists. As the JS-gated HMP Global Learning Network platform requires browser JavaScript to load full content, the complete article is accessible via a registered account at hmpgloballearningnetwork.com.
Key Highlights:
- SDOH and DFU outcomes: homelessness is associated with significantly higher rates of DFU-related ED visits, hospitalisation, lower limb amputation, and retinopathy — populations experiencing unstable housing carry compounded foot health risk that clinical care alone cannot address without social intervention
- Documentation opportunity: ICD-10-CM Z codes (Z55–Z65) enable systematic documentation of social risk factors in clinical records, supporting population health management, quality metrics, and care coordination — yet uptake remains low across podiatric and wound care settings
- SDOH screening tools: structured instruments such as PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) and the AHC Health-Related Social Needs screening tool can identify actionable SDOH domains within clinical encounters, enabling warm referrals to community resources
- Wound care-specific SDOH barriers: inability to afford wound care dressings or prescribed footwear; inadequate nutrition (protein, micronutrients) for wound healing; inability to rest or offload at home; low health literacy affecting dressing change technique and wound monitoring; transport barriers to follow-up appointments
- Equity imperative: disparities in DFU outcomes — including higher amputation rates among Black, Hispanic, and low-income patients — are well documented; integrating SDOH screening and referral into podiatric wound care represents a structural equity intervention as well as a quality improvement strategy
- Access note: HMP Global Learning Network requires JavaScript and free account registration; content accessible at hmpgloballearningnetwork.com/site/podiatry — a leading podiatric continuing education and clinical practice resource
Keywords: social determinants of health wound care, SDOH podiatric patients, health equity diabetic foot care, housing instability wound healing, podiatry social needs screening, DFU health disparities amputation
HMP Global Learning Network / Podiatry Today