Pillow Foot in Cats: A Vet’s 2025 Guide to Immune‑Mediated Pad Disease 🐱

Hello! I’m Dr. Duncan Houston BVSc, veterinarian and founder of Ask A Vet. Today we explore plasma cell pododermatitis—often called “pillow foot.” This immune-mediated condition causes paw pads to become swollen, purple, and sometimes ulcerated. Though uncommon, it can cause serious discomfort. In this 2025 guide, we’ll cover why it happens, how to diagnose it, and proven treatment approaches, along with home care tips to help your cat walk happily again 😊.

📘 What Is Pillow Foot?

Plasma cell pododermatitis occurs when plasma cells accumulate in footpads, causing immune-mediated inflammation. Pads look spongy or puffy—sometimes like little pillows—hence the term “pillow foot” :contentReference[oaicite:3]{index=3}.

⚠️ Who Is Affected & Why

• Any age or breed, though often seen in adult/male cats :contentReference[oaicite:4]{index=4}.
• Exact cause unknown; immune dysfunction linked to FIV/FeLV in ~50–60% of cases :contentReference[oaicite:5]{index=5}.
• Other factors: food/environmental allergies, viral infections (calicivirus), plasmacytic stomatitis, kidney conditions :contentReference[oaicite:6]{index=6}.

👀 Signs to Watch For

• Paw pad swelling—purple or pink, soft/"bean‑bag" feel :contentReference[oaicite:7]{index=7}.
• Hyperkeratosis, fissures, ulceration, bleeding :contentReference[oaicite:8]{index=8}.
• Lameness, reluctance to jump, paw licking, tenderness :contentReference[oaicite:9]{index=9}.
• Occasional fever, appetite changes, stomatitis, kidney signs :contentReference[oaicite:10]{index=10}.

🛠️ How It's Diagnosed

1. Physical exam: swelling of multiple paws with classic appearance :contentReference[oaicite:11]{index=11}.
2. Cytology (FNA): plasma cell infiltration :contentReference[oaicite:12]{index=12}.
3. Biopsy: confirms diagnosis with tissue analysis :contentReference[oaicite:13]{index=13}.
4. Bloodwork: check CBC, chemistry, FIV/FeLV, kidney, allergy panels :contentReference[oaicite:14]{index=14}.
5. Rule out other diseases: bacterial/viral infections, granulomas, tumors :contentReference[oaicite:15]{index=15}.

💊 Treatment Options

• Doxycycline is first-line—provides immunomodulatory and antibiotic effects. Course typically 3–4 weeks :contentReference[oaicite:16]{index=16}.
• Corticosteroids (prednisone) added for inflammation control :contentReference[oaicite:17]{index=17}.
• Cyclosporine or other immunosuppressants if steroids aren’t enough :contentReference[oaicite:18]{index=18}.
• Topical care: pad soaks, antimicrobial ointments, pain relief.
• Surgery: rare; reserved for non‑responsive ulcerated lesions :contentReference[oaicite:19]{index=19}.

📈 Prognosis & Monitoring

• Many cats respond well—improvement often within weeks :contentReference[oaicite:20]{index=20}.
• Recurrence possible; long-term or intermittent therapy may be needed :contentReference[oaicite:21]{index=21}.
• Untreated ulcerated lesions risk pain, infection, and deeper spread :contentReference[oaicite:22]{index=22}.
• Monitor weight, pad appearance, bloodwork, FIV/FeLV status, and kidney function over time.

🏠 Home & Supportive Care

• Soft bedding and gentle surfaces to ease pressure.
• Clean and inspect paws daily—apply topical meds as needed.
• Ensure regular medication adherence (reminders via Ask A Vet app).
• Provide joint-friendly environments—ramp/vet‑approved matting.
• Track symptoms and flare-ups using mobile tools and photo logs.

📚 Case Examples

“Whiskers,” a 6‑year‑old neutered male, showed swollen, purple metacarpal pads, mild lameness. FIV-positive; cytology confirmed plasma cells. Started doxycycline + prednisolone. Pads softened and ulceration healed within 3 weeks. Medication tapered over 6 months with no recurrence.

“Luna,” 4‑year‑old with painful ulcerated pads, failed doxy-only treatment. Cyclosporine added; healing in 4 weeks. Long-term low-dose cyclosporine followed—comfort maintained over 1 year.

🚨 When to Contact the Vet Immediately

• Cracked, bleeding, or ulcerated pads
• Severe limping or inability to walk
• Fever, lethargy, appetite loss
• Signs of infection—pus, swelling, redness

✨ Final Thoughts

Though uncommon, pillow foot can significantly impact a cat’s comfort and quality of life. Early detection, accurate diagnosis, and targeted treatment (like doxycycline with immunosuppression) lead to excellent outcomes. Home care and monitoring are essential for managing and preventing recurrence. With Ask A Vet’s tele‑support, reminders, and guides, you’re empowered to care for your cat’s paws with confidence and compassion ❤️.

For customized care plans, guided medication scheduling, and direct vet access, visit AskAVet.com or download the Ask A Vet app. We’re with you every step of the way. 🐾🐱