Does lupus cause foot problems?
The foot is a complex structure and foot
problems are very common in the general
population especially amongst older people.
Lupus, however, can cause specific joint and
muscle pains in the feet; joints may ache even
though there are no obvious signs of
inflammation or swelling. Even a stiff hip or back
can affect the way we walk, perhaps by causing
us to favour one leg, and so cause trouble
elsewhere. Abnormal walking patterns can lead
to misshapen feet with toe deformities such as
bunions and hammertoes. Toe deformities can
then increase the risk of friction and pressure
inside the shoes causing calluses and corns.
Foot complaints tend to be under-reported
amongst lupus patients, perhaps because other
problems are more obvious and more important.
Can skin problems affect the
Corns and callus occur frequently in older
patients, those with problems walking, or those
who wear badly fitting shoes. Lupus and the
drugs used to treat lupus can aggravate the
problem of this hard skin. Specific skin problems
associated with lupus can occur on the feet but
these are rare.
Verrucas can sometimes be a nuisance to people
who are taking immunosuppressants. But,
contrary to popular belief, verrucas are not often
very painful and although they are caused by a
virus and can be spread they are not highly
contagious. They tend to occur only where the skin
is damaged. However, they can linger when the
immune system is compromised and may need
specialised treatment if they are troublesome.
Does lupus affect toe nails?
25% of people with lupus have some sort of nail
problem. In some patients nail growth can be
slow, leading to weak, thin nails sometimes with
pitting in the nail plate and the nail may become
loose. In others, inflammation around the nail or
Raynaud's phenomenon can lead to thickened or
ridged nails. Black or brown marks in the nail are
sometimes seen due to tiny bleeding points in the
nail bed. Nail problems are generally cosmetic
although involuted (curved) or ingrown toenails
are common. These can be very sensitive and it
is important to get professional help to prevent
ingrown toenails from becoming infected.
So what are the risks to the foot
Serious foot problems are rare but any condition
that can reduce the amount of blood reaching the
toes can lead to ulceration and infection. This can
be prevented with effective care.
About 20-30% of lupus patients develop
Raynaud's phenomenon (spasms in the blood
vessels causing cold or white fingers or toes).
Chilblains (small, red, itchy swellings) are also
common, often in association with Raynaud's.
They can become painful and are an abnormal
reaction to cold, usually on toes and fingers. They
can dry out leaving cracks in the skin, which
expose it to infection. It is important to keep the
feet warm but not to warm them up too quickly if
they are cold.
Vasculitis occasionally causes very painful toes
and feet and can lead to infections. It may cause
small red lines in the cuticle or nail fold, or little red
bumps on the legs; sometimes painful red
nodules can form on the legs. Occasionally these
red bumps can ulcerate.
Steroids can make the skin thinner and more
prone to damage and infection. So it is especially
important to look after the feet, which are prone
to pressure, rubbing and damage from shoes.
How can I help myself?
Generally lupus does not cause major foot
problems but no feet will stand up to too much
abuse or neglect. Nails must be cut carefully - it
is often easier and safer to file them rather than
cut them, particularly if they are thick or uneven.
The feet should be washed and examined daily
for any damage or problems. Any dry skin should
be kept moist with a good moisturising cream to
prevent cracks from occurring.
It is vital to wear well-fitting, supportive footwear.
Ideally, shoes should have a soft cushioned sole,
a pliable yielding upper and fasten firmly round
the instep, preferably with laces. There should be
no high-pressure areas on the feet which rub the
skin. Feet must be kept warm. Two thin pairs of
socks are warmer than one thick pair and in cold
weather thermal insoles should be put in shoes
and bed socks worn at night.
Lupus patients should attend a chiropodist (now
often called a podiatrist) on at least one occasion
for foot care advice. Sometimes the chiropodist
will recommend regular checkups even if there are
no current problems. Availability of NHS
chiropodists does vary in different areas but lupus
patients should be able to have NHS chiropody or
podiatry regardless of age. Some rheumatology
departments employ specialist podiatrists. If
looking for a private practitioner check they are
HPC Registered (Health Professional Council