Scleroderma and the Foot

Systemic sclerosis (scleroderma) — an autoimmune condition causing fibrosis (hardening) of the skin and internal organs plus vasculopathy (vascular disease) — creates significant foot health challenges that require specialized care. The combination of skin changes, vascular insufficiency, and structural deformity makes foot problems in scleroderma particularly serious and prone to complications.

Skin Changes and Their Foot Implications

The characteristic skin fibrosis of scleroderma affects the feet as it does the hands: skin becomes thickened, hardened, and loses its elasticity. This reduces the skin’s ability to accommodate deformity pressure, makes it more susceptible to pressure-related injury, and impairs wound healing when injuries do occur. The tight skin may restrict toe and ankle motion. Calcinosis cutis — calcium deposits in the skin — is a specific scleroderma manifestation that can occur on the feet, causing hard, painful nodules that may ulcerate and extrude calcium.

Raynaud’s Phenomenon and Digital Ischemia

Raynaud’s phenomenon is nearly universal in scleroderma — episodic digital vasospasm causing the classic triphasic color change (white, blue, red) with cold or stress exposure. In scleroderma, Raynaud’s is more severe than in the idiopathic form and can progress to digital ulceration from insufficient blood flow. Toe ulcers from Raynaud’s and digital artery occlusion are painful, slow to heal, and prone to infection — they require specialized wound care, vascular management, and often coordination with rheumatology for systemic vasodilator therapy (prostacyclins, phosphodiesterase inhibitors).

Foot Ulcer Management in Scleroderma

Scleroderma-related foot ulcers require a different approach than typical diabetic or venous ulcers — the primary mechanism is ischemia (insufficient blood supply) rather than neuropathy. Key principles: protect the ischemic tissue from additional trauma with appropriate padding and offloading, optimize systemic vasodilator therapy with rheumatology, prevent secondary infection, and avoid harsh debridement of ischemic tissue that lacks healing capacity. Digital amputation may be required for gangrenous digits that cannot be salvaged with vascular intervention.

Comprehensive Care at Balance Foot and Ankle

Scleroderma patients benefit from close podiatric involvement alongside their rheumatologist. Regular foot monitoring identifies developing ulcers before they become limb-threatening, appropriate footwear accommodates foot deformities, and nail care prevents the ingrown nails that can precipitate severe infection in this vulnerable population. Contact Balance Foot and Ankle at (810) 206-1402 to establish foot care coordination for scleroderma and related autoimmune conditions.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.