Tommy, 49, a resident at the shelter, was first in line. He leaned against a set of bunk beds in the dimly lit hall and looked down at the ground. The line wove between the rows of beds where many of the men would sleep that night.

"If it weren't for things like this I'd have to go to the emergency room to get treatment. I got hit by a car a bit ago, had to get surgery," he said, pointing at his ankle. "Screws and everything. Cost about $12,000. How am I supposed to pay that back?"

For Tommy and many other Chicagoans who are homeless, impoverished or living in shelters, last week's free foot and ankle clinic at the Franciscan House of Mary and Joseph represents one of their few opportunities for affordable medical care.  

Such examinations can reveal significant medical issues specific to homeless people, like foot infections and chronic swelling, a Rush physician said.

According to the U.S. Census Bureau's American Community Survey, there were nearly 900,000 uninsured people living in Cook County in 2011, almost identical to the number of residents living below the poverty level. Some shelter residents said they depend on emergency-room care and free clinics like these and to treat their physical problems.

Dr. Simon Lee, a foot and ankle orthopedic surgeon from Midwest Orthopedics at Rush and assistant professor at the Rush University Medical Center, has helped run the annual free clinic since 2007. He and a group of first- and second-year medical students from Rush volunteer their evenings once a year to give examinations and hand out free shoes,  courtesy of Our Hearts to Your Soles, a non-profit that organizes similar clinics throughout the U.S.

"A lot of us who aren't exposed to this situation in life are used to being in our comfortable homes, not worrying about shoes, heat or food," he said. "Especially with the Chicago winter coming around, I think this is a good opportunity for people to volunteer their time and help people."

Lee estimates that more than 120 pairs of shoes are handed out every year, many of which are boots donated by the Red Wing Shoe Company.

"It's a good opportunity to see a part of the community you wouldn't otherwise interact with," said Lizzy Gabel, 23, a medical student at Rush and a coordinator for the student-run weekly clinic at the same shelter. "Being around the impoverished certainly gives you an appreciation for having a place to go home to."

Some other medical professionals around the Midwest emphasized the importance of having proper footwear, especially as the seasons change.

"Some people come in wearing dress shoes, which is completely inadequate for a Midwestern winter. We try to hand out boots as much as we can," said Dr. John Feighan, an orthopedic surgeon who runs a similar free clinic in Cleveland. "A lot of these people are just trying to get back on their feet."

As the night progressed and Tommy's turn for an exam came, he was led to a well-worn chair and asked to take off his shoes and socks. A young medical student asked about the scars on his ankle before rubbing his feet with powder.

The student advised him to stay dry in the winter and assisted as they fitted Tommy's feet.

After two pairs were rejected, Tommy found some boots to his liking, wide enough to stay comfortable when he walked.

He layered two pairs of wool socks and slipped on his new beige boots. He walked down a long hallway on his way out, flanked on either side by impromptu screening rooms.

The medical students replaced their gloves, closed the bottle of foot powder and prepared for the next patient.

"It's going to be a long night," Lee said. "We'll be here as long as there are people to see."