Nicola Burt

Advanced Staff Podiatrist

Nicola graduated BSc in podiatry in 2015, MSc Principles of Podiatric Surgery in 2021, and to date, has collated additional qualifications in Corticosteroid injection therapy, Independent and Supplementary Prescribing, Skin Surgery for Podiatrists, Expert Witness Report Writing and Law and Medical Ethics. Nicola has a passion for education and raising the profile of podiatric practice.

Nicola has a long history of work experience ranging in a wide scope under the podiatry umbrella, from the sectors of community podiatry to specialising in podiatric surgery. To date, she has 4 research publications with her 5th in peer review primarily focusing on case reports and literature reviews, and has developed keen interests in Podiatric Surgery and Medical Law.

Nicola focuses on educating and public speaking on subjects of Anatomy and Physiology, Nail Surgery, High Risk and Endocrinology, Pharmacology, Skin Surgery, and Research. With 11 years’ post-graduate experience and extensive contribution to the profession, Nicola has been awarded with Fellowships in both the Royal Society of Medicine and the Royal College of Physicians and Surgeons of Glasgow, and had been elected Vice-Chair of the Medicines and Medical Devices Committee for the Royal College of Podiatry.

Nicola follows a notion that with the right support and passion for progress, anyone can achieve their goals regardless of disability and background, and holds a firm belief in cultivating safe spaces for learning.

Perioperative management of glucocorticoids in those with adrenal insufficiency – a take home message for the profession

In podiatric practice, there is familiarity with maximum safe doses (such as when administering local anaesthesia or supplementary medication), but what about minimum safe doses?

Adrenal insufficiency is a potentially life-threatening endocrine disorder characterised by inadequate cortisol production and impaired physiological responses to stress. Patients with adrenal insufficiency depend on exogenous steroid replacement therapy and require dose adjustments to prevent adrenal crisis in response to stress. The cost of not acquiring an adequate minimum dose could induce severe physiological responses which need urgent and immediate remediation. While perioperative steroid supplementation is widely recognised, guidance in supplementation doses regarding procedures performed under local anaesthesia or following corticosteroid injection therapy remain inconsistent.

This presentation will cover pathophysiology, pharmacological considerations and perioperative management of glucocorticoids in patients with adrenal insufficiency with particular attention to procedures frequently encountered in podiatric practice, including nail surgery, soft tissue procedures, bone surgery and corticosteroid injection therapy.

The presentation will aim to assist clinicians in determining appropriate stress-dosing strategies according to procedural severity and type of adrenal insufficiency, in aim of reducing the risk of adrenal crisis.