PhD Project - Dermatological Manifestations in the Foot in Adult Prisoners; awareness, needs and self-care interventions
Applications for this PhD project are now open. The deadline for applications is 6 April 2026.
Overview
Current epidemiological data highlights that one of the commonest reasons for seeing a GP are for skin lesions.1 In the foot dermatological manifestations (corns, calluses, fungal infections etc) are common; with a pan-European study indicating a prevalence of 61%.2 Importantly, in the ‘at-risk foot population’ (typically those with long term conditions such as diabetes), amputation is preceded by a foot lesion such as callus or a blister, in 80% of cases.3 The UK prison system houses a vast, underserved community, who disproportionately represent those with long-term health conditions and who have often received limited healthcare provision and present with a higher burden of ill-health.4-6
Adult male prisoners represent a marginalised group, who typically come from socially and economically disadvantaged backgrounds, characterised by lower educational attainment, high unemployment rates, a history of poverty and adverse childhood experiences.4,5,7 Higher rates of drug use, mental illnesses and infectious diseases are noted in a recent umbrella review of the adult prison population.4 In addition, prison living conditions including shared bath facilities and poorer personal hygiene may exacerbate dermatological complaints.
Foot conditions for those in prison remains under-researched and poorly understood. Anecdotal data from prison health workers suggest high levels of foot pathology and some dermatological problems manifesting after prison entry. Issues of stigma presenting some from seeking treatment, limiting opportunity for early intervention. Equally, relatively simple self-care interventions may offer substantive improvements to both physical and mental health.
Foot conditions for those in prison remains under-researched and poorly understood. Anecdotal data from prison health workers suggest high levels of foot pathology and some dermatological problems manifesting after prison entry. Issues of stigma presenting some from seeking treatment, limiting opportunity for early intervention. Equally, relatively simple self-care interventions may offer substantive improvements to both physical and mental health.
Project Contact:
Dr Simon Otter
Email: simon.otter@hsu.ac.uk
Details
- To explore the nature, extent and impact of common dermatological foot disorders in the prison population
- To develop screening tools to aid early identification/referral of foot complaints
- To scrutinise the availability, uptake and use of health promotion advice
Initially a stratified foot screening programme using validated method2 at different points of prison journey. In parallel to determine the impact of foot complaints will be undertaken using validated generic and foot-specific instruments.8-10
Quantitative data will be used to undertake a qualitative exploration of current foot care available and prison residents’ experiences using interview/focus groups
Data will be used to develop both a foot screening tool suitable for use by range professional for initial screening and to develop/refine self-care advice/processes appropriate for prison populations.
The project seeks to determine the nature and extent of dermatological complaints in the foot and foot health needs in the adult prison population. An appropriate foot health screening tool will be developed together with staff training needs and improved self-care advice/processes specific to this population.
At a service level this project seeks to improve foot health for the adult prison population and prevent more serious secondary foot complications (e.g. foot ulceration)/infection) in those with long-term conditions.
Considering the extent of skin complaints seen in the general population, at a national level we seek to determine if those in prison have a specific pattern of skin disorders affecting the foot, which would represent an opportunity for health education intervention In addition to improving physical health, these interventions could enhance positive mental health given the stigma anecdotally noted due to foot disorders.
Funding 
HSU is offering up to three fee waivers for UK home applicants starting in October 2026. All eligible UK home applicants will automatically be considered for fee waiver support, which is awarded competitively based on the excellence of the candidate.
International applicants are unfortunately not eligible for fee waivers.
All applicants are expected to have financial plans in place to cover their studies and should not rely on a fee waiver.
Self-funded students are also welcome to apply for this project. Self-funded students can be UK home students or international students.
Availability
Available to both UK and International students
Potential Supervisors
- Dr Simon Otter
- Dr Ivan Bristow
References
1 Schofield JK, Fleming D, Grindlay D Williams H, Skin conditions are the commonest new reason people present to general practitioners in England and Wales British Journal of Dermatology, 2011 165 (5) 1044–1050, https://doi.org/10.1111/j.1365-2133.2011.10464.x
2 Roseeuw D. Achilles foot screening project: preliminary results of patients screened by dermatologists. J Eur Acad Dermatol Venereol. 1999 Sep;12 Suppl 1:S6-9
3 Diabetic foot problems and management NICE guideline NG19 https://www.nice.org.uk/guidance/ng19/chapter/Context:text=Theriskoffootproblems,ofwhiteEuropean2familybackground.
4 Favril L, Rich JD, Hard J, Fazel S. Mental and physical health morbidity among people in prisons: an umbrella review. Lancet Public Health. 2024 Apr;9(4):e250-e260. doi: 10.1016/S2468-2667(24)00023-9.
5 McLintock K, Sheard L. Prison healthcare in England and Wales is in perpetual crisis. BMJ 2024;384:q562. https://doi.org/10.1136/bmj.q562
6 HM Chief Inspector of Prisons. Annual report 2021–22. In. London: HM Stationery Office; 2022. URL: https://www.gov.uk/government/publication
7 Emilian, Christina et al. Prevalence of severe mental illness among people in prison across 43 countries: a systematic review and meta-analysis The Lancet Public Health, 10(2) e97 – e110
8 EQ-5D: a measure of health status from the EuroQol Group Rabin R, de CF Ann Med 2001 Jul;33(5):337-343
9 DLQI guidelines, registries and reimbursement guidelines. Available at: https://www.cardiff.ac.uk/__data/assets/pdf_file/0008/1744793/DLQI-guidelines-worldwide-Jan-2020.pdf
10 Barnett S, Campbell R, Harvey I. The Bristol Foot Score: developing a patient-based foot-health measure. J Am Podiatr Med Assoc. 2005 May-Jun;95(3):264-72. doi: 10.7547/0950264.
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