Clinical Rheumatology | 2021
Hiker’s feet
Abstract
A 32-year-old lady presented with complaints of roughening of the fingers and a rash over her face and neck for 6 months. She had difficulty in getting up from squatting position and raising arms overhead. For the last 2 months, she noticed dry cough and roughening of the skin of the dorsal aspect of her toes and lateral aspect of her feet. She complained of worsening of her weakness for the last 1 month. On examination, she had a periorbital heliotrope rash and a rash over her upper chest and back. There was hyperkeratosis of the radial aspects of her fingers (Fig. 1a). She had dryness and hyperkeratosis of the dorsal aspect of the toes and lateral margin of the feet (Fig. 1b and c). Chest examination revealed bibasilar crepitations. Laboratory evaluation revealed elevated creatine phosphokinase and lactate dehydrogenase. CT scan of the thorax showed non-specific interstitial pneumonitis pattern of interstitial lung disease (ILD). Her ANA was negative. Myositis panel showed anti-Jo-1 positivity. She was diagnosed with anti-synthetase syndrome (ASyS). The term “Hiker’s feet” has been proposed for the cutaneous foot manifestations of dermatomyositis [1]. Most of the patients had ASyS with anti-Jo-1 antibodies, and almost all had concomitant mechanic’s hands. Hiker’s feet is typically described as hyperkeratosis and cracking of the toes and plantar aspect of the feet. However, soles were spared in our patient, and hyperkeratosis was noted in the toes and lateral aspect of the feet. Hiker’s feet is probably an under-recognized sign which can aid in the diagnosis of ASyS. Its presence should also warrant an active screening for ILD. The development of mechanic’s hand has been proposed to be a harbinger for disease relapse [2, 3]. Our patient’s myopathy worsened a few weeks after the development of foot lesions; hence, this could be a prodromic sign of worsening myopathy.