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

doi:10.5662/wjm.121149

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 121149
Published online Sep 20, 2026. doi: 10.5662/wjm.121149

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

Gabriele Carioti, Irene Brighenti, Niccolò Le Donne, Carlo Banfi, Lina Azzahrani, Luca Galassi

Gabriele Carioti, Irene Brighenti, Niccolò Le Donne, Department of Podiatric Care, IRCCS Galeazzi Sant’Ambrogio Hospital, Milan 20157, Lombardy, Italy

Carlo Banfi, Geneva Hemodynamic Research Group, University of Geneva, Geneva 1211, Genève, Switzerland

Lina Azzahrani, School of Health Studies, University of Western Ontario, London N6A 3K7, Ontario, Canada

Luca Galassi, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Milan 20122, Lombardy, Italy

Author contributions: Carioti G and Galassi L contributed to conceptualization; Carioti G, Banfi C, and Galassi L contributed to methodology; Le Donne N contributed to formal analysis; Carioti G and Brighenti I contributed to investigation; Brighenti I and Le Donne N contributed to data curation; Carioti G and Le Donne N contributed to writing-original draft preparation; Banfi C, Azzahrani L, and Galassi L contributed to writing-review and editing; Galassi L contributed to supervision, project administration.

AI contribution statement: While the manuscript did not use any artificial intelligence tools for content creation, standard digital tools commonly available within word-processing applications may have been used to assist with minor grammar and spell-checking issues during the revision process.

Institutional review board statement: The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. This retrospective cross-sectional study analyzed fully anonymized data that had been prospectively collected during routine podiatric clinical practice at a single outpatient clinic. All data were irreversibly anonymized prior to analysis, and no additional procedures or interventions were carried out for research purposes. In accordance with applicable local regulations, studies based exclusively on fully anonymized retrospective data are exempt from formal ethical review and Institutional Review Board approval.

Informed consent statement: Informed consent was waived due to the retrospective nature of the study and the use of fully anonymized clinical data, in accordance with applicable local regulations exempting retrospective analyses of anonymized records from mandatory informed consent requirements.

Conflict-of-interest statement: All authors declare no financial, personal, or professional conflicts of interest related to this study or its findings.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to ethical and privacy restrictions but are available from the corresponding author on reasonable request. All data were fully anonymized prior to analysis.

Corresponding author: Luca Galassi, MD, Lecturer, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it

Received: March 17, 2026
Revised: April 27, 2026
Accepted: May 28, 2026
Published online: September 20, 2026
Processing time: 115 Days and 14.5 Hours

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

Keywords: Indoor climbing; Nail disorders; Hyperkeratosis; Foot injuries; Climbing footwear; Podiatry

Core Tip: Indoor sport climbing requires tight technical footwear that increases mechanical stress on the toes and forefoot, yet clinically assessed evidence on climbing-related nail and skin conditions remains limited. In this clinic-based cross-sectional study of 156 indoor climbers, hyperkeratosis and traumatic nail disorders were the most frequent findings, often involving the hallux and periungual regions. Greater climbing shoe downsizing and higher weekly training frequency showed weak but significant associations with lesion burden. Although observed effect sizes were small and causal inference is not possible from this design, findings highlight the potential role of modifiable sport-related factors and suggest the value of preventive podiatric assessment in climbers.