For most typical visual artists, use of the hands and arms may be considered essential in contriving a new work of art. But that’s not so for Alana Ciena Tillman, a painter born with a rare disease that has left her unable to contract or move some of her joints.

Fox 5 Atlanta reported that Tillman, of Sonoma County, Calif., completes paintings with her mouth and feet rather than her arms. Her condition, anthrogryposis multiplex congenital (AMC), occurs in about 1 in 3,000 live births, according to the National Institutes of Health.

Styles of Tillman’s artwork span from impressionism to pop art, Fox 5 Atlanta reported. Food and nature are among her influences.

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The artist is part of Mouth and Foot Painting Artists of America, which helps support mouth and foot painting artists affected by accidents or birth defects.

Tillman credited her family for introducing her to the craft.

“Creativity was always encouraged in our household,” Tillman, who is in her 30s, told the news station. “I have been painting since I was 5 years old and haven’t stopped since.”