hi, thank-you for providing the brief history. a Thorough neuromuscular assessment is advised. As mentioned he is suffering from scleroderma in the hand and feet. I will advice something which as per my knowledge should work. Try undergoing a physical therapy. By the use of therapeutic ultrasound therapy under water. As this will produce the ripples in the water and an activation of the microvasculation of the skin. there is wide based physics behind it. As by having the activation of the microvascular system, there will be improvement in the blood supply . As the improved blood supply is needed for the soft tissue and cellular functioning to the optimum. It may sound a different therapy but there is nothing harm trying, since there are no side effects. Also perform regular breathing exercises as increase in oxygen in body will help improve the metabolism and immune system. Also, you can keep me updated for the same as I can further assist how to keep a change of mechanism and newer protocols. Regards Jay Indravadan Patel