Tuesday, August 11, 2009

Hand-Foot Syndrome

Hand-Foot Syndrome

What is hand-foot syndrome?

Hand-foot syndrome is a condition caused by some types of chemotherapy where the palms of the hands and soles of the feet burn or tingle and then become red and sore. Sometimes the hands and feet become so painful that it may be difficult to hold objects in your hands, wear shoes, and even walk without discomfort. It is very important that all of these symptoms are reported to your doctor or nurse immediately. Early reporting of hand-foot syndrome is the best way to decrease the severity and prevent further complications.

How do people describe hand-foot syndrome?

Most of the time, the earliest symptoms of hand-foot syndrome are tingling and numbness with slight redness. Tingling and redness in the hands and/or feet can occur at any time while on chemotherapy. It can be expected with some drugs, too. Do not stop taking medication unless you receive other instructions from your doctor. Tell your healthcare provider know that you are experiencing these symptoms. If the redness continues, the hands and/or feet become red and swollen, or you have any discomfort contact your healthcare provider immediately.

Other more severe symptoms described are dryness, cracking, flaking, and small blisters or sores on the palms of the hands and/or soles of the feet. Hand-foot syndrome can be uncomfortable and interfere with your ability to do normal daily activities.

What causes hand-foot syndrome?

The exact cause of hand/foot syndrome is unknown. One theory is that the chemotherapy builds up in the sweat glands in the hands and feet. Heat or friction on the palms and soles increase the amount of the chemotherapy drug in the capillaries, which can leak out into the tissue. This leakage of drug results in the redness, tenderness, peeling, and discomfort in the hands and/or feet. The chemotherapy drugs most commonly reported to cause hand-foot syndrome include:

  • Capecitabine (Xeloda®)
  • Fluorouracil (5-FU) continuous infusion
  • Liposomal doxorubicin (Doxil®)
  • Idarubicin (Idamycin®)
  • Floxuridine (fudr®)
  • Continuous infusion of doxorubicin
  • Sunitinib (Sutent®)
  • Sorafenib (Nexavar®)

What can I do about hand-foot syndrome?

Prevention is very important in trying to reduce the development of hand-foot syndrome. Management involves modifying some of your normal activities to reduce friction and heat exposure to your hands and feet for a period of time following treatment. This period is about one week after receiving the IV medication and as long as possible while you are taking oral (by mouth) medications, such as Capcitabine or continuous infusion of 5-FU.

Here are some tips you might find helpful:


  • Avoid long exposure of hands and feet to hot water. Examples of hot water exposures include washing dishes, long showers, or tub baths.
  • Take short, cool water showers to reduce the drug exposure to the soles of your feet.
  • Do not wear rubber gloves to wash dishes or clean. The rubber will hold heat against your palms.
  • Avoid activities that cause unnecessary force or friction on the feet, such as jogging, aerobics, and long walks or standing for long periods of time.
  • Avoid contact with harsh chemicals used in laundry detergents or household cleaning products.
  • Avoid using garden tools, household tools (such as screwdrivers), and other tasks that require squeezing your hand on a hard surface.
  • Do not use knives to chop food. It may cause excessive pressure and friction on your palms.
  • Cool your hands and feet with ice packs or cool compresses for 15-20 minutes at a time. Do not apply ice directly to the skin.
  • Elevate your hands and feet to avoid swelling when sitting or lying down.
  • Pat skin carefully to dry. Try not to rub your skin with a towel.
  • Apply mild skin care lotion to keep your hands and feet moist. Do not rub or massage lotion into your hands or feet. Rubbing or massaging can create friction.
  • Avoid sunny windows, or sitting in the sun and wear sunscreen on all exposed skin when you go outside.
  • Wear loose, well-ventilated shoes and clothes.
  • Try gel inserts in your shoes.
  • Wear cotton socks.
  • Immerse hands and feet in cool water 3-4 times a day.
  • Avoid wearing rings.
  • Check your skin for signs of infections. Look for any drainage, odor, or increased redness. If you have an infection, you may also have a fever. If you notice any of these signs contact your healthcare provider.


  • Report any change in your daily activities to your healthcare provider.


  • Drink 8 (8oz.) glasses of water or other non-caffeinated drinks every day. Avoid caffeine (i.e. colas, coffee) when possible. Caffeine can cause dehydration.


  • Over-the-counter drugs, such as Tylenol® or ibuprofen®, may be helpful to relieve discomfort associated with hand-food syndrome. Check with your doctor before taking any pain medication.
  • Corticosteroids may be ordered from your doctor to help reduce swelling and redness.
  • Taking Vitamin B6 (pyridoxine) may be beneficial in preventing and treating hand-foot syndrome and should be discussed with your doctor.
  • Emollients such as Aveeno®, Lubriderm®, Udder Cream®, Bag Balm®, and Aquaphor® provide excellent moisturizing to our hands and feet.
  • Avoid topical anesthetics or diphenhydramine-containing creams. These can make the toxicity of the skin worse.

How is hand-foot syndrome managed?

Severe cases of hand-foot syndrome are first treated by reducing or temporarily stopping the chemotherapy drug that is causing it. Other approaches that your healthcare provider may suggest include:

  • Over-the-counter Tylenol® or ibuprofen® may help to relieve the discomfort associated with hand-foot syndrome. Check with your healthcare provider before taking any pain medication.
  • Corticosteriods may be ordered by your healthcare provider to help reduce swelling and redness.
  • Vitamin B6 (Pyridoxine) may be beneficial in preventing and treating hand-foot syndrome. Discuss this option with your healthcare provider before taking it.

What can family members and friends do to help me with my hand-foot syndrome?

Ask family members and friends to:

  • Prepare meals for you.
  • Help with daily household chores such as gardening or dishwashing.
  • Test water temperatures before bathing or washing dishes. Inexpensive thermometers are sold in stores that can check water temperatures. This may be an option for you and your family.
  • Help gently apply lotions to hands and feet.
  • Help with your daily activities, such as bathing, and driving.

How can I talk to my family members and friends about my hand-foot syndrome?

Here are some ideas that may help you talk to family members and friends:

  • Ask family members and friends how the hand-foot syndrome is affecting them.
  • Talk to family and friends how the hand-foot syndrome is affecting your emotions and mood.
  • Talk to family and friends how the hand-foot syndrome is interfering with your life and ability to function.
  • Ask family members for suggestions to help you function as close to normal as possible.

What should I report to my healthcare provider?

If you experience any of the following symptoms, report them to your healthcare provider:

  • Redness, swelling, tingling, or pain in the hands and/or feet. Discuss any symptoms with your healthcare provider immediately. Do not stop your medication until you have talked to your healthcare provider.
  • Any temperature rise above 100.9 F (38.3 C), or a temperature higher than 100.4 F (38.0 C) that lasts for more than an hour, or as set by your doctor's office.
  • An increase of 4 stools over normal bowel pattern in a 24 hour period or diarrhea during the night.
  • Tenderness, redness, or sores in the mouth.
  • Vomiting.
  • Unable to keep down any fluids for 24 hours.

What things should I discuss with my healthcare provider?

If you are experiencing hand and foot syndrome, you should discuss the following with your healthcare provider at your next appointment:

  • Will my chemotherapy put me at risk for developing hand-foot syndrome?
  • Are there things you can give me if my hands and/or feet become painful?
  • Will I be able to continue to work?
  • If I do all of the things suggested could hand-foot syndrome be prevented?
  • What symptoms do you want me to call you for?

Where can I get more information?

For more information, contact the people or organizations at the numbers or websites listed below:


  • Backes, W. ( 2001). Prodrugs. Clinical Journal Of Oncology Nursing, 5(1), 35-37.
  • Oestreicher, P. (2007). Manage Skin Toxicities Associated with Targeted Therapies. ONS connect, 22(11),20-21.
  • R4 Healthcare LLC. (2008). Caring4 Cancer: Your complete source for knowledge & support. Retrieved from http://cancer.caring4health.com/default.aspx
  • The Cleveland Clinic Foundation (2005). Chemocare.com. Retrieved from http://chemocare.com
  • Wood, L., S. (2006). Managing the side effects of Sorafenib and Sunitinib. Journal Of Community Oncology, (3)9, 558-562.

Supportive evidence-based practice

  • Coyle, C., & Wenhold, V. (2001). Painful blistered hands and feet. Clinical Journal Of Oncology Nursing, 5(5), 230-232.
  • Gressett, S. Stanford, B., & Hardwicke, F. (2006). Management of hand-foot syndrome induced by Capecitabine. Journal Of Oncology Pharmacy Practice, 12(3), 131-141.
  • Pike, K. (2001). Hand-Foot Syndrome. The Oncology Nursing Forum, 28 (10), 1519-1520.
  • Wilkes, G., & Doyle, D. (2005). Palmar-Planter Erythrodysesthesia. Clinical Journal Of Oncology Nursing, 9(1), 103-106.

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