This past week, I had the privilege of speaking at the Alabama Podiatric Medical Association (ALPMA) Beachside Scientific Seminar 2025. The setting was sunny, the company was outstanding, and the topic was close to my heart.

My talk, titled “Footprints of Lupus,” explored how systemic lupus erythematosus (SLE) leaves subtle but meaningful clues in the lower extremities. Often, these signs are overlooked,  not because they’re invisible, but because our attention tends to go elsewhere: kidneys, skin, lungs, and other major organ systems. But the feet carry more than just the body. They can carry the earliest signs of disease.

When we hear the word lupus, we often think of rashes, kidneys, abnormal labs. But in reality, it’s a multisystem condition with wide-ranging impact including the feet. In my talk, I covered how lupus can affect the lower extremities in several ways:

Vascular findings:
Raynaud’s phenomenon
Livedo reticularis
Digital ulcers from vasculitis
Avascular necrosis

Musculoskeletal involvement:
MTP synovitis
Posterior tibial tendinopathy
Achilles tendon rupture
Avascular necrosis of the foot and ankle

Neurologic symptoms:
Neuropathy
Sensory changes due to small fiber involvement

Cutaneous signs:
Periungual telangiectasias
Malar rash
Subacute cutaneous lupus
Discoid lupus
Chilblains

A patient may present with a foot ulcer, chronic tendon pain, or cold, discolored toes. And while these may be treated as isolated issues, in the context of autoimmunity, they could represent the first visible signs of a systemic disease like lupus.

Podiatrists are uniquely positioned to see these footprints first, possibly even before they show up on ANA panels or kidney biopsies. Podiatrists may be the first to hear a patient say, “My toes feel numb,” or “My feet turn purple in the cold.” Those comments aren’t just foot problems, they might be signs of something much bigger. It was inspiring to connect with a community of podiatrists who are on the front lines of patient care: physicians who often see these subtle changes first. I believe that collaboration across specialties is one of the most powerful tools we have to improve outcomes for patients living with lupus. When we catch lupus early, we have more time to intervene. More time to protect joints. More time to preserve mobility. More time to give patients a fuller life.

In closing, “Every footprint tells a story: some are faint, some are deep, but each one matter. By recognizing the footprints of lupus early, we can help our patients walk lighter, longer, and stronger.”

Thank you again to ALPMA for the warm welcome, and to the podiatrists who engage in this work every day. Together, we walk alongside patients, literally and figuratively.