At our September Virtual Education Session, our biggest turnout of the year with over 120 people registered, Professor Debbie Turner from Queensland University of Technology joined us to talk about something that doesn’t get nearly enough attention in scleroderma care: your feet.
The session explored why scleroderma affects the feet, how to look after skin and emollients properly, the role a podiatrist can play, what to look for in footwear, and practical tips for protecting your feet day to day. Debbie also shared the FootHold program, a free foot and ankle exercise resource well worth adding to your toolkit.
Why Does Scleroderma Affect the Feet?
Foot problems in scleroderma are common and highly variable from person to person, and they can be genuinely impactful. Unfortunately, the research simply hasn’t caught up yet.
When QUT PhD student Ethan Blanchard searched the global literature, he found only 14 studies that made any reference to feet in scleroderma, covering around 400 people in total, and only one Australian study among them. One UK and US-based study looked specifically at Raynaud’s phenomenon in the feet, and of 40 participants, 28 (70%) said they experienced it there, affecting temperature regulation, pain, cramping, stiffness, numbness, and colour, with real knock-on effects for walking, driving, socialising, and finding footwear that actually works.
Closer to home, a four-year Victorian study followed 531 people with scleroderma and found that around 80% were admitted to hospital at least once. Within that data, podiatry stood out as the most frequently used allied health service of all, which makes it clear just how much people are already relying on podiatry, even while formal guidance for health professionals remains thin.
Protecting Your Skin Starts with Understanding It
Skin sits at a slightly acidic pH of around 5.5. This “acid mantle” helps keep pathogens out and moisture in. As we age, skin naturally becomes more alkaline, weakening that barrier and increasing dryness and infection risk. Around half of people over 65 have dry skin, rising to 90 per cent of people over 80, and things like hot showers, soaps containing sodium lauryl sulphate, central heating, air conditioning, and certain medications can all make it worse.
Itchy skin, or pruritus, affects around half of people with scleroderma at some point, and it can be a sign that the condition is currently active, so it’s worth mentioning to your care team rather than working around it quietly.
Menopause adds another layer. Lower oestrogen means less natural moisture, a weaker skin barrier, and a higher chance of flares in existing skin conditions. Women can lose around a third of their skin’s collagen in the first five years after menopause, which is a good reason to stay consistent with skin care through this stage of life.
Choosing and Using the Right Emollient
Ceramides, the natural fats that help hold the skin barrier together, decrease with age and are worth looking for on the label. Emollients containing ceramides have been shown to outperform those without. For very dry or hardened skin, urea can help too, though products above 20% urea start to soften skin quite aggressively and are best used with a pharmacist’s guidance.
A helpful way to judge how much to use is the “fingertip unit”, roughly the amount of cream that runs from the crease to the tip of an adult finger. For normal dry skin, that’s around four fingertip units per foot per day, doubling for very dry skin, and you generally don’t need cream between the toes unless there’s a specific issue there.
Heels with thick, hardened skin need that hard skin gently removed before any emollient can do its job. And the emollient you’ll actually use every day is often more valuable than the one that looks best on paper. A lighter cream applied consistently will usually outperform a heavier one left in the cupboard.
Nails are worth including in this routine too. Thickening, fungal infection, and difficulty cutting nails all become more common over time, especially if hand function is affected. Even nails that look neglected usually only take a few minutes to bring back under control, so there’s no need to feel embarrassed about asking for help.
Understanding the “High Risk” Foot
Scleroderma can bring together several changes that combine into what’s known as a high-risk foot: skin fibrosis, loss of the fatty padding that cushions the sole, and joint changes that create pressure points, most often at the tips of the toes. Add reduced circulation from Raynaud’s, and thickened, hardened skin can break down into an ulcer. Because there’s so little soft tissue protecting the bones in the feet, infection can spread quickly once it takes hold, which is why even small foot wounds deserve early attention.
Digital ulcers are less common in the feet than the hands, but when they do occur in the feet, they tend to carry a poorer outlook, with higher rates of infection, bone involvement and, in more serious cases, amputation. The likely reasons come down to longer blood vessels reaching the feet, the mechanical demands of walking, cooler foot temperatures, and shoes creating a less clean environment than exposed hands.
Calcinosis, calcium deposits that form under the skin, can also affect the feet, sometimes sitting under a nail or directly under a weight bearing area, which makes it a significant source of pain. Nail surgery for painful calcinosis should always be carried out by a podiatrist experienced specifically with scleroderma, working closely with your rheumatologist, as healing can take considerably longer than expected.
Managing Pain and Discomfort
Some of the most helpful guidance from the session was around managing burning, cramping, and nerve-related pain, which is a real part of the picture for some people. Capsaicin based creams can ease burning nerve pain, though the sensation can increase briefly before it settles, so it’s worth a conversation with your GP first. Transparent film dressings, available from any pharmacy, can also help by creating a barrier over the skin that gradually desensitises the area.
Cramping at night is often linked to reduced circulating blood volume when calf muscles are inactive, so gently working the calf muscle pump before bed may help. Gentle stretching or rolling the sole of the foot over a soft ball may also offer relief, though Debbie was clear that ice isn’t recommended for the plantar fascia in scleroderma the way it might be for other conditions. If pain is disrupting sleep, it’s worth raising with your GP or rheumatologist, since poor sleep has a real flow-on effect on pain and overall wellbeing.
The Role of a Podiatrist
Podiatrists do far more than most people realise. Beyond routine foot care, they provide wound management, vascular and neurological risk assessment, diagnostic imaging referrals, and falls risk screening. Foot pain, bunions, reduced ankle flexibility, and reduced sensation are all recognised, independent risk factors for falls, which makes this kind of assessment genuinely worthwhile.
Podiatrists can also guide you toward simple foot and ankle exercises that support strength and balance over time. The free FootHold program is a good place to start if you’re looking for structured exercises you can do at home.
Choosing the Right Footwear
Footwear makes a real difference to comfort and skin protection. A few features worth looking for include a rounded toe box, which reduces pressure on the tops of the toes, a padded and bellowed tongue for extra room through the midfoot, a stiff heel counter for support around the ankle and arch, and the right amount of toe spring if movement through the midfoot or forefoot is restricted.
Getting properly measured matters as much as the shoe itself. Many people end up wearing the wrong size as their feet change shape over the years, often sizing up for width while the rest of the shoe ends up in the wrong place. If your feet swell during the day, it helps to get fitted later in the day when they’re largest, wearing the socks you’d normally wear with that shoe. It’s always fine to keep the receipt, try shoes indoors first, and take them back if they’re not right.
A few everyday habits round this out well. Wearing two thin pairs of socks rather than one thick pair traps a warming layer of air, and shoes left in a cold cupboard stay cold, so warming them before putting them on can help. Materials like EVA foam, commonly used in orthotics, offer good thermal insulation too. And Raynaud’s isn’t only a cold-weather concern. Sudden temperature shifts, like walking from warm outdoors into heavily air-conditioned spaces, can trigger symptoms just as easily as winter cold, so it’s worth planning ahead wherever you are.
Advocating for Yourself in Healthcare
People living with scleroderma often understand their symptoms better than anyone. Sharing what works for you, asking for a podiatrist with genuine experience in rheumatology, and pushing for imaging when pain doesn’t have an obvious explanation are all part of getting the right care. This matters just as much outside your usual specialist service. If you develop a foot wound, a waterproof cast protector lets you shower without soaking the dressing, and warming your cleaning solution before use, rather than using it cold, supports healing.
Frequently Asked Questions
1. Why do people with scleroderma get foot problems?
A combination of Raynaud’s phenomenon, skin changes, loss of the fat padding under the foot, joint changes, and reduced circulation can all affect the feet, sometimes leading to pain, ulcers or calcinosis.
2. What’s the best way to care for scleroderma skin on the feet?
Emollients containing ceramides, applied using the fingertip unit as a guide, support the skin’s natural barrier. Avoiding products with sodium lauryl sulphate also helps prevent unnecessary dryness.
3. Are foot ulcers different from hand ulcers in scleroderma?
Foot ulcers are reported less often than hand ulcers, but they tend to carry a higher risk of infection and slower healing, likely due to the mechanical demands of walking and the shoe environment.
4. What footwear features help with scleroderma feet?
A rounded toe box, padded and bellowed tongue, stiff heel counter, and the right amount of toe spring can all support comfort and reduce pressure-related skin damage. Getting properly measured matters just as much as the shoe itself.
5. When should I see a podiatrist?
If you notice an open wound, new or worsening pain, colour or temperature changes, numbness, tingling or difficulty finding comfortable footwear, a podiatrist experienced with rheumatology is a great place to start
TL;DR
Feet don’t get the same research attention as hands in scleroderma, but the impact on daily life can be just as significant. At our September Virtual Education Session, Professor Debbie Turner from QUT shared how scleroderma affects circulation, skin, nails, and joints in the feet, and offered practical guidance on skin care, footwear, pain management, and the role podiatry can play. The key message: look after your skin daily, get regular checks, choose footwear that fits your needs, and act early on any changes.
Conclusion
Your feet carry you through every part of daily life, and they deserve just as much care as any other part of your scleroderma journey. Protecting the skin, choosing the right footwear, getting regular checks, and acting early on changes can all make a genuine difference to comfort and mobility.
For those living with Scleroderma, staying updated and informed can make a world of difference. Connecting with others can also be hugely beneficial. Find out more about support in your area by clicking here.
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