BH13 Itchy feet: skin and nail conditions in the podiatrists’ clinic

Abstract Podiatrists play an integral role in the chronic management of patients with a wide variety of pathologies affecting the skin and toenails of the lower limb. Effective care of dermatology patients often requires support from a wide variety of allied healthcare professionals. We previously identified, in a survey of 247 Irish podiatrists, that over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, but most podiatrists (81.7%, 196 of 240) did not feel they received satisfactory education in melanoma. We aimed to further understand the role podiatrists play in treating patients with chronic skin and nail conditions. We engaged with Podiatry Ireland to design a targeted survey emailed to registered members. Our ethically approved 13-question survey was distributed over a period of 3 months. Our survey received 104 responses. We asked podiatrists to identify the skin and nail conditions they most commonly identified in their clinic; multiple responses were accepted. The most commonly identified presentations were (i) fungal nails (n = 92), (ii) ingrown toenails (n = 85), (iii) corns and callus (n = 82), (iv) diabetic feet (n = 76) and (v) tinea pedis (n = 70). A high proportion of responses identified inflammatory skin conditions such as eczema (n = 51) and psoriasis (n = 40) as commonly seen in their clinics. Overall, 76.9% (n = 80) reported not receiving sufficient education on skin and nail conditions in their undergraduate training. Most (82.6%, n = 86) reported not being familiar with a Marjolin ulcer, while 54.8% (n = 57) reported confidence in advising emollients in patients with dry skin. Approaches to fungal nails and tinea pedis varied, with 47.1% (n = 49) reporting routinely taking nail clippings and conducting skin scrapings within their clinic. In total, 59.6% (n = 62) of podiatrists report advising general practitioner presentation routinely when they clinically suspect a fungal nail infection. Only 4.8% (n = 5) felt as though they received sufficient education in skin and nail conditions in patients with darker skin tones. Seventeen (16.3%) reported feeling comfortable in discussing eczema or psoriasis of the feet with their patients. Nine (8.7%) correctly provided the exact name for the clinical sign ‘Hutchinson’s sign’ from a photograph of a subungual melanoma. Our study demonstrates that many patients with inflammatory skin conditions attend their podiatrist for assistance with management of their condition. A majority of podiatrists do not feel as though they have received sufficient education in skin and nail conditions of the foot, particularly in patients with skin of colour. We advise increased engagement through education with allied healthcare professionals such as podiatrists to ensure patients with skin and nail conditions of the feet are effectively supported, managed and appropriately referred in the community.