Celiac disease is a chronic autoimmune disorder that affects approximately 1% of the global population. It is triggered by the ingestion of gluten—a protein found in wheat, barley, and rye—in genetically predisposed individuals. While celiac disease is primarily known for its gastrointestinal symptoms, it can also manifest in various extraintestinal ways, including effects on the nervous system, skin, and musculoskeletal system. One lesser-known but significant area of impact is the foot.

What Is Celiac Disease?

Celiac disease occurs when the immune system mistakenly attacks the lining of the small intestine in response to gluten consumption. This immune reaction damages the villi—tiny finger-like projections in the small intestine responsible for nutrient absorption. Over time, this damage leads to malabsorption of essential nutrients such as iron, calcium, vitamin D, and B vitamins.

Common Symptoms

• Abdominal pain
• Bloating
• Diarrhea or constipation
• Weight loss
• Fatigue
• Anemia

However, not all individuals with celiac disease experience digestive symptoms. Many present with extraintestinal manifestations, which can complicate diagnosis and delay treatment.

Beyond the Gut: Systemic Effects of Celiac Disease

Celiac disease is increasingly recognized as a systemic condition. The chronic inflammation and nutrient deficiencies associated with it can affect multiple organ systems, including the nervous system, skin, bones, and joints.

Neurological Manifestations

One of the most documented extraintestinal effects is peripheral neuropathy—a condition involving damage to the peripheral nerves, which can cause tingling, numbness, and pain in the extremities, particularly the feet and hands. This condition, sometimes referred to as “gluten neuropathy,” may occur even in the absence of gastrointestinal symptoms.

Musculoskeletal Issues

Celiac disease can lead to decreased bone density (osteopenia or osteoporosis) due to poor calcium and vitamin D absorption. This increases the risk of stress fractures, particularly in weight-bearing bones such as those in the feet..

How Celiac Disease Affects the Foot

Although the foot may seem an unlikely target for a gastrointestinal disorder, several mechanisms explain how celiac disease can impact foot health.

1. Peripheral Neuropathy

Peripheral neuropathy is one of the most common neurological complications of celiac disease. It typically begins in the feet due to the length of the nerves involved. Symptoms include:

• Tingling or “pins and needles”
• Burning sensations
• Numbness
• Sharp or shooting pain
• Sensitivity to touch

These symptoms can impair balance and coordination, increasing the risk of falls and injuries. In some cases, individuals may experience muscle weakness or foot drop, where the front part of the foot drags while walking.

2. Enthesopathy and Joint Pain

Enthesopathy refers to inflammation at the site where tendons or ligaments attach to bone. Studies have shown that nearly half of individuals with celiac disease may have subclinical enthesopathy, which can affect the feet and ankles. This can lead to pain, stiffness, and reduced mobility.

3. Chilblains and Skin Manifestations

Chilblains—painful, itchy red or purple lesions on the toes—have been reported in individuals with celiac disease. Interestingly, these lesions often appear before a formal diagnosis and tend to improve with a gluten-free diet. This suggests a link between immune dysregulation in celiac disease and vascular responses in the skin.

4. Delayed Healing and Soft Tissue Injuries

Nutrient deficiencies, particularly in vitamins and minerals essential for tissue repair, can lead to delayed healing of foot injuries such as sprains, strains, and plantar fasciitis. Several individuals have reported chronic foot pain and slow recovery from ankle injuries prior to being diagnosed with celiac disease.

5. Loss of Fat Padding

Some anecdotal reports suggest that individuals with celiac disease may experience a loss of fat padding in the soles of their feet, leading to a sensation of walking on bruised bones. This could be due to malabsorption-related changes in body composition.

6. Stress Fractures

Due to compromised bone health, individuals with undiagnosed or untreated celiac disease are at increased risk of stress fractures in the feet. These fractures may occur with minimal trauma and are often misdiagnosed until a comprehensive evaluation reveals underlying celiac disease.

The Role of a Gluten-Free Diet

The cornerstone of managing celiac disease is strict adherence to a gluten-free diet. Eliminating gluten allows the intestinal lining to heal, improves nutrient absorption, and reduces systemic inflammation. Many individuals report significant improvement in foot-related symptoms after transitioning to a gluten-free lifestyle.

Benefits for Foot Health

• Reduction in neuropathic pain and tingling
• Improved healing of soft tissue injuries
• Decreased incidence of chilblains
• Enhanced bone density over time
• Restoration of fat padding and joint support

Diagnosis and Management

Diagnosing celiac disease involves a combination of blood tests for specific antibodies (e.g., anti-tTG and EMA) and a confirmatory intestinal biopsy. For individuals presenting with unexplained foot pain, neuropathy, or recurrent injuries, clinicians should consider screening for celiac disease, especially if other systemic symptoms are present.

Management includes:

• Lifelong gluten-free diet
• Nutritional supplementation (iron, calcium, vitamin D, B12)
• Physical therapy for neuropathy and musculoskeletal issues
• Regular monitoring of bone density and neurological function

Psychological and Quality of Life Considerations

Chronic foot pain and mobility issues can significantly impact quality of life. Individuals with celiac disease may experience anxiety, depression, or social withdrawal due to physical limitations. Early diagnosis and comprehensive care can improve both physical and emotional well-being.

Conclusion

Celiac disease is a complex autoimmune condition with far-reaching effects beyond the digestive system. Its impact on foot health—ranging from neuropathy and joint pain to stress fractures and skin lesions—highlights the importance of recognizing extraintestinal symptoms. For individuals experiencing unexplained foot pain or recurrent injuries, considering celiac disease as a potential underlying cause can lead to timely diagnosis and effective treatment. With proper dietary management and supportive care, many of these foot-related complications can be alleviated, restoring mobility and enhancing overall quality of life.