By Dr. Kayla Wright, DPM
Some breast cancer treatments can affect the nerves, skin and toenails of the feet. These changes may make walking less comfortable, affect balance or make it easier to miss a blister, pressure spot or small wound.
The most important thing is to notice changes early and know which symptoms should be discussed with your oncology team or a podiatrist.
Common treatment-related foot concerns include:
- Numbness, tingling or burning
- Balance changes
- Toenail discoloration or separation
- Red, tender or peeling skin
- Foot or ankle swelling
- Blisters, wounds or pressure areas
October is Breast Cancer Awareness Month, and foot health is part of maintaining mobility, comfort and quality of life during treatment and recovery.
Noticing foot changes during breast cancer treatment?
Foot pain, numbness, toenail changes, swelling or skin problems deserve attention, especially during active treatment.
Chemotherapy-induced peripheral neuropathy
Some chemotherapy medications used for breast cancer, including paclitaxel and docetaxel, can affect peripheral nerves. This is called chemotherapy-induced peripheral neuropathy (CIPN).
Symptoms may include:
- Numbness or tingling
- Burning or electric-type pain
- Increased sensitivity
- Difficulty sensing temperature
- Changes in balance
- Reduced awareness of where the feet are while walking
Reduced sensation matters because a blister, cut or pressure injury may go unnoticed.
Protect numb or tingly feet
- Check your feet daily for cuts, blisters, redness or drainage
- Look between the toes and around the nails
- Wear supportive, properly fitting shoes
- Avoid walking barefoot if sensation is reduced
- Protect your feet from extreme temperatures
- Keep walking areas clear if balance is affected
Report new or worsening numbness, weakness or balance problems to your oncology team.
Toenail changes during breast cancer treatment
Cancer treatment can sometimes cause:
- Nail discoloration
- Ridges or brittleness
- Tenderness
- Dark spots or lines
- Partial separation of the nail from the nail bed
- Irritation around the nail
These changes can resemble toenail fungus, but a discolored or thickened nail is not automatically fungal.
Have the nail evaluated if it becomes painful, drains, develops surrounding redness or begins separating significantly.
What is hand-foot syndrome?
Some cancer medications can cause hand-foot syndrome, also called palmar-plantar erythrodysesthesia.
On the feet, symptoms may include:
- Redness
- Burning or tenderness
- Swelling
- Peeling or cracking
- Increased sensitivity
- Blistering
Contact your oncology team if these symptoms develop or worsen. A podiatrist may also help identify footwear or pressure points that are making symptoms more uncomfortable.
Not every foot problem is caused by chemotherapy
Patients receiving cancer treatment can still develop common conditions such as:
- Plantar fasciitis
- Tendon problems
- Arthritis
- Stress injuries
- Ingrown toenails
- Corns and calluses
- Sprains or fractures
- Skin or nail infections
New foot pain should therefore be evaluated rather than automatically attributed to neuropathy.
When is swelling concerning?
Foot and ankle swelling has many possible causes.
Contact your medical team about new or unexplained swelling, especially when one leg or foot is substantially more swollen than the other.
Seek urgent medical care if swelling occurs with:
- Calf pain or tenderness
- Redness or warmth
- Sudden shortness of breath
- Chest pain
Cancer can increase the risk of blood clots, so new one-sided leg swelling should not simply be assumed to be routine fluid retention.
How to protect your feet during treatment
A few habits can reduce the chance of small problems becoming larger ones:
- Check your feet regularly
- Keep the skin clean and dry
- Moisturize dry skin, but avoid lotion between the toes
- Wear clean socks and properly fitting shoes
- Avoid shoes that rub or create pressure
- Do not cut corns or calluses yourself
- Avoid walking barefoot when sensation is reduced
- Report wounds that are not healing normally
If treatment has significantly affected your immune system or blood counts, check with your oncology team before procedures that could break the skin.
What about pedicures?
Use extra caution during active chemotherapy or significant immune suppression.
Avoid:
- Cutting the cuticles
- Aggressive callus removal
- Instruments that injure the skin
If you have an ingrown toenail, painful callus or another medical foot problem, podiatric evaluation is preferable to aggressive home or salon treatment.
Choosing shoes during treatment
Good footwear becomes especially important when neuropathy, swelling or balance problems are present.
Look for:
- Enough room for the toes
- A secure heel
- A stable sole
- Appropriate cushioning
- No seams or edges rubbing sensitive skin
- Enough space for mild swelling
If balance is affected, stability may be more important than simply choosing the softest shoe.
When should you see a podiatrist?
Consider evaluation for:
- Persistent foot or ankle pain
- Numbness, tingling or burning
- Balance or walking problems
- Painful or damaged toenails
- Ingrown toenails or painful calluses
- Blisters, wounds or skin breakdown
- New footwear or pressure problems
- Symptoms that make walking or exercise difficult
Tell your podiatrist about your cancer treatment and current medications. Coordination with your oncology team may be appropriate before certain procedures.
When should you contact your oncology team?
Contact your oncology team for:
- New or worsening neuropathy
- Weakness or increasing balance problems
- Significant redness, peeling or blistering
- Rapidly worsening nail changes
- New or unexplained swelling
- Fever, drainage or other signs of infection
Do not stop, delay or change cancer treatment because of a foot symptom unless your oncology clinician advises you to do so.
Foot health is part of cancer survivorship
Foot pain, neuropathy and instability can affect walking, exercise, work and independence during treatment and recovery.
These problems may seem small compared with cancer itself, but addressing them early can help preserve comfort and mobility.
Protect your feet during breast cancer treatment.
If treatment is affecting your feet, toenails, sensation or walking, schedule a foot and ankle evaluation with Dr. Kayla Wright.
Metro Foot & Ankle 3231 S Country Club Way, Suite 108 Tempe, AZ 85282 480-831-0700
Frequently asked questions
Can breast cancer treatment cause numbness in the feet?
Yes. Some chemotherapy medications can cause peripheral neuropathy, leading to numbness, tingling, burning or altered sensation.
Can chemotherapy change the toenails?
Yes. Treatment-related changes can include discoloration, brittleness, tenderness, ridges or separation from the nail bed. These changes are not always caused by fungus.
What is hand-foot syndrome?
Hand-foot syndrome is a treatment-related reaction that can cause redness, burning, tenderness, peeling, swelling or blistering of the palms and soles.
Should I get a pedicure during chemotherapy?
Use caution, particularly during active chemotherapy or immune suppression. Cuts, cuticle trimming and aggressive callus removal can increase infection risk.
Should I see a podiatrist for chemotherapy neuropathy?
A podiatrist can evaluate sensation, pressure areas, footwear, toenails, wounds and other foot problems that may complicate neuropathy. New or worsening neuropathy should also be reported to your oncology team.
When is foot or leg swelling urgent?
Seek urgent care when swelling is accompanied by calf pain, redness, warmth, chest pain or sudden shortness of breath.