Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Scleroderma and the Foot: A High-Risk Vascular Challenge

Systemic sclerosis (scleroderma) — the autoimmune disease characterized by fibrosis and vascular dysfunction — creates some of the most challenging foot health problems in all of podiatric practice. The combination of severe Raynaud’s phenomenon, digital ischemia, skin fibrosis, and impaired wound healing creates a patient population at significant risk for digital ulceration and loss. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we provide specialized foot care for scleroderma patients in close collaboration with rheumatology, vascular surgery, and wound care teams.

Raynaud’s Phenomenon in Scleroderma

Raynaud’s phenomenon — episodic digital vasospasm from cold or emotional stress causing triphasic color change (white, blue, red) — occurs in essentially all patients with scleroderma and is significantly more severe than primary Raynaud’s in otherwise healthy individuals. In scleroderma, the Raynaud’s is not purely functional vasospasm but occurs against a background of structural vascular damage and obliteration — progressive fibrosis of the digital arteries creates a fixed vascular compromise that worsens with each vasospastic episode. Michigan’s cold winters create a particularly hostile environment for scleroderma patients, requiring aggressive cold protection: insulated boots, chemical toe warmers for outdoor exposure, avoidance of cold temperature even indoors, and vasodilator medications (calcium channel blockers, PDE5 inhibitors) to maintain adequate digital perfusion.

Digital Ulcers: The Most Serious Foot Complication

Digital ulcers — ischemic ulcers on the toes and foot from inadequate blood supply — occur in 35-50% of scleroderma patients and are one of the leading causes of morbidity in the disease. Ulcers typically appear at the fingertips and toe tips from ischemia, and at bony prominences (knuckles, lateral foot) from pressure combined with impaired healing. Scleroderma digital ulcers are notoriously difficult to heal: the fibrotic skin has poor vascularity and impaired healing response, the underlying vascular disease limits blood flow to the healing wound, and infections risk progressing rapidly to osteomyelitis in the ischemic tissue. Intravenous iloprost (prostacyclin) — used during acute digital ischemic episodes — can improve blood flow and facilitate ulcer healing. Bosentan (endothelin receptor antagonist) reduces new ulcer formation in scleroderma.

Podiatric Management Priorities

Preventive foot care for scleroderma: daily skin inspection and lubrication to prevent skin cracking that creates infection portals. Professional nail care — scleroderma skin is too fragile and vasculature too compromised for self-care that could create wounds. Footwear with wide, deep toe boxes and soft upper materials that don’t create pressure on compromised skin. Padding of any bony prominence at risk of ulceration. Any wound or skin break — regardless of how minor it appears — requires immediate professional evaluation in scleroderma patients. Contact Balance Foot & Ankle at (810) 206-1402 for scleroderma foot care and wound management with the specialized approach this complex disease demands.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Scleroderma Foot Problems

Scleroderma can cause severe foot complications including skin tightening, Raynaud phenomenon in the toes, digital ulcers, and calcinosis. At Balance Foot & Ankle, Dr. Tom Biernacki provides specialized wound care, protective footwear guidance, and coordinated care for autoimmune-related foot conditions.

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Clinical References

1. Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis, 1972-2002. Ann Rheum Dis. 2007;66(7):940-944.
2. Nihtyanova SI, Brough GM, Black CM, et al. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis. 2008;67(1):120-123.
3. Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. Nat Rev Rheumatol. 2012;8(8):469-479.

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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.