Clinical assessment of nail and skin lesions in indoor climbers: A clinic-based cross-sectional study.

Abstract

Background: Indoor climbing has grown substantially in popularity; however, clinically assessed data on climbing-related nail and skin conditions remain limited. Tight, performance-oriented climbing shoes and repetitive training exposure may contribute to mechanical stress affecting the toes and forefoot, but evidence derived from direct clinical examination is scarce.

Aim: To characterize the frequency, typology, and anatomical distribution of nail and skin lesions in a clinic-based sample of indoor climbers, and to assess associations with footwear compression and training exposure.

Methods: A retrospective cross-sectional analysis was conducted from data on 156 indoor climbers attending a single outpatient podiatric clinic. Lesions were classified by type, anatomical location, laterality, and affected digit. Demographic, anthropometric, footwear-related (shoe size discrepancy), and training-related variables were also recorded. Associations between lesion burden and continuous variables were assessed using Spearman's rank correlation and non-parametric tests, with statistical significance set at P < 0.05.

Results: Patients showed a mean of 6.6 lesions per individual (range 0-21), most exhibiting multiple nail and skin lesions. Hyperkeratosis accounted for approximately two-thirds of recorded lesions and was mostly localized to the first toe and periungual regions. Traumatic nail disorders, including Beau's lines, longitudinal ridges, onycholysis, and subungual hematomas, were predominantly hallux-related. Shoe size discrepancy showed a weak but statistically significant positive correlation with total lesion burden (ρ = 0.195, P = 0.015), as did weekly training frequency (ρ = 0.180, P = 0.025). No significant associations were observed for age, sex, body mass index, or session duration.

Conclusion: In the selected population of the study, footwear compression and training frequency showed weak but statistically significant associations with lesion burden, while demographic variables showed no significant correlation. Although causal inference is not possible from this cross-sectional design, findings highlight the potential clinical relevance of modifiable sport-specific factors and warrant longitudinal investigation.