Skip to main content

Injecting Advice

Foot Injecting

Written by Nigel Brunsdon on . Posted in .

One of the exercises I do when I’m delivering safer injecting training looks at the most common injecting sites and the associated risks. People are usually quite good at putting the different sites in some kind of order of risk, but when it comes to the feet they often underestimate the dangers.

Why would someone inject in the foot?!

OK, first lets understand what some of the drivers are for people to use this site for injecting. There is of course the most obvious one, not being able to find a suitable vein elsewhere. This can for many people be a way of avoiding a move to sites that are perceived as higher risk like the groin, which of course does show that someone is taking steps to keep themselves safer.

But there are other reasons people choose the feet, one that I keep coming across is that this is a hidden area so the track marks won’t show on arms where family members/friends/treatment workers may see them. One thing is pretty sure though, people don’t inject in the foot because it feels good.

Problems with the foot

The first one that really comes to mind is that the blood pressure in the feet is incredibly low. You can’t get any further away from the heart (ie the ‘pump’) and you are fighting against gravity. This will effect the way the drug feels for a person (no real ‘rush’ with this one) but it will also mean you have an increased chance of things like abscess and problems with veins, healing is slower in the foot so missed hits turn into abscesses with a predicable regularity.

And those missed hits are common. Although there are some very tempting veins on the feet that at first glance seem big and juicy (Am I the only one who thinks of veins as juicy?) they are in reality quite thin veins with a tendency to burst if put under pressure. Not only that but they have a habit of rolling around when you try to put a needle in them, leading to more misses.

Another reason for the increased chances of infection in feet is the way that (for most people) they are kept enclosed in sweaty shoes and socks all day, this keeps wound hot and wet which makes it a great breeding ground for bacteria.

Advice for people who injecting in their feet

An obvious piece of advice would, of course, be to stop injecting in the feet, although for many people struggling with vein access this may not at first seem possible. Take time to help people find veins elsewhere, show them how to use a tourniquet correctly (see my article on tourniquet use for tips).

This is also the ideal opportunity for people to exit injecting behaviours, support people to transition back to smoking, or encourage them to access treatment services (if people want treatment then do the assessment now, not give them an appointment for two weeks time).

Of course some people will want to continue injecting in this high risk area, if that’s the case:

  • Encourage them to take good thin needles (in the UK I’d always suggest a 30 gauge nevershare syringe)
  • Give advice on ways to minimise ‘rolling’ of the vein (this can be done by gently applying pressure beside the vein to reduce the area it can roll to)
  • Give advice on injecting VERY slowly so they don’t put the vein under stress
  • If possible have a stock of clean dry socks that can be given to homeless injectors

The most important thing as always with people injecting in higher risk areas is to give them good advice and other options.

Writer: Nigel Brunsdon

Nigel Brunsdon is the owner of Injecting Advice. He’s been working in harm reduction since the 1990’s, previously a frontline needle programme worker he now splits his time between photography and developing online resources for drugs workers and users.

Nigel Brunsdon

You might also like

World Health Organisation Calls For The Decriminalisation Of Drug Use

Written on . Posted in .
This month, the World Health Organisation (WHO) – the UN agency that coordinates international health responses – launched a new set of guidelines for HIV prevention, diagnosis, treatment and care for key populations. The new document is the culmi…

Anthrax Infected Heroin

Written on . Posted in .
At the time of writing this there have been 7 deaths and 14 people are in hospital with infections related to anthrax in Scotland. The current official advice from Health Protection Scotland’s Dr Colin Ramsey has been “… I would urge all users t…

Ten reasons to distribute ‘take home naloxone’

Written on . Posted in .
Naloxone is the opiate antagonist that can prevent overdose. In the US it’s use is increasing and within the UK there are national programmes in Scotland, Wales, and Northern Ireland to distribute it, but not in England, in England it’s left up to…