Celiac disease primarily affects the digestive system but can have significant consequences for the entire body, including the feet. Individuals with celiac disease frequently experience complications in the feet due to two main mechanisms: nutritional deficiencies and autoimmune-related neurological and musculoskeletal effects.
Peripheral Neuropathy
Peripheral neuropathy is one of the most common foot manifestations in people with celiac disease. This condition results from damage to the peripheral nerves, causing symptoms such as numbness, tingling, burning, pain, and even weakness in the feet. The nerves in the feet are often the first affected due to their length and vulnerability. This damage can lead to:
- Numbness and decreased sensation, making it harder to detect injuries or pressure sores.f
- Tingling or prickly sensations, which are uncomfortable and may disrupt normal walking.
- Burning or shooting pain in the feet, sometimes described as electric or stabbing
- Instability and a loss of balance, increasing the risk of falls.
Treating the underlying celiac disease through a strict gluten-free diet may reduce the risk of further nerve damage and even improve symptoms for some individuals. However, prolonged exposure to gluten before diagnosis can cause lasting damage.
Musculoskeletal Manifestations
Celiac disease also impacts the bones and joints, often causing osteoporosis, osteomalacia (bone softening), and arthritis-like symptoms. Reduced bone density increases the risk of fractures in the feet. Joint pain and stiffness, particularly in the small joints like those in the ankles and feet, are also reported.
Patients often experience:
- Morning stiffness in the feet and ankles.
- Swelling and soreness in joints after physical activity or gluten exposure.
- Polyarthralgia (pain in multiple joints), sometimes including those of the feet.
- Back, lower back, and pelvic pain that may indirectly affect gait and weight distribution, aggravating foot issues.
Additionally, children with celiac disease may show joint abnormality in the feet, such as effusion or synovitis, detectable even without obvious arthritis symptoms. In untreated cases, joint abnormalities and enthesitis (inflammation at the site of attachment of tendon or ligament to bone) are more frequent.
Dermatological Manifestations: Dermatitis Herpetiformis
Some people with celiac disease develop dermatitis herpetiformis, a blistering, itchy rash that often appears on the limbs, including around the ankles and occasionally on the feet. The discomfort and ulceration from this rash can make standing and walking painful and may lead to secondary infections if lesions are scratched or unhealed.
Nutritional Deficiencies and Impact
Malabsorption of key nutrients is a hallmark of celiac disease and can significantly affect foot health:
- Iron deficiency can lead to anemia, causing fatigue and limiting mobility.
- Low calcium and vitamin D levels can cause bone weakness and cramps in the feet.
- B12 deficiency contributes to neuropathy and muscle weakness.
Prolonged deficiency makes bones more brittle, increasing the risk of fractures during routine activities. In children, poor nutrition may result in delayed growth and development, affecting foot structure and gait.
Mobility and Quality of Life
The combination of nerve and skeletal damage, pain, numbness, and balance difficulties can severely limit the mobility of those with undiagnosed or poorly managed celiac disease:
- Difficulty walking and maintaining balance increases fall risk and may require assistive devices or physical therapy.
- Loss of sensation in the feet makes new injuries harder to notice and slower to heal, raising the danger of chronic wounds.
- Instability may persist even after a gluten-free diet is initiated, especially if diagnosis was delayed and nerve or bone damage is severe.
Special footwear, orthotic inserts, and routine foot care are recommended to compensate for these risks and improve function.
Secondary Complications
Longstanding nerve and bone problems in the feet increase the risk of secondary complications:
- Ulcers and pressure sores may develop silently due to numbness.
- Poor circulation, combined with nerve damage, increases risk for infections that may be slow to resolve.
- Deformities in foot structure may occur due to abnormal gait and pressure distribution, such as hammertoes or pes planus (flat feet)
Managing Foot Health in Celiac Disease
Routine visits to a podiatrist are crucial for early detection and management of foot complications in people with celiac disease.
Treatment options include:
- Strict adherence to a gluten-free diet.
- Pain management and physical therapy to maintain function.
- Vitamin and mineral supplementation to address deficiencies.
- Specialized shoes or orthotic inserts for those with instability or deformity
- Patient education on inspecting feet regularly to detect injuries or changes early, since sensation may be blunted.
Celiac disease is far more than a digestive disorder—it creates cascading effects throughout the body, with the feet being uniquely vulnerable due to the complexity of nerve and bone systems in this area. Peripheral neuropathy, musculoskeletal changes, dermatological manifestations, and nutritional deficiencies combine to make foot health a crucial and sometimes challenging aspect of living with celiac disease.
Early diagnosis, strict dietary management, and proactive foot care are essential for preventing long-term complications. Individuals should seek both routine medical and podiatric evaluation to address symptoms and mitigate risks, aiming for mobility, comfort, and quality of life even while managing a chronic autoimmune disorder.