How To Manage Psoriatic Arthritis On Feet
Medically reviewed by Petros Efthimiou, MD
Psoriatic arthritis is a chronic autoimmune condition1 that can involve serious pain and inflammation in the peripheral joints, tendons, and spine. If you think you have the condition, then you might wonder how to spot psoriatic arthritis on feet. Psoriatic arthritis can affect any joint in the feet, from the metatarsal joints to the ankle and beyond, so you might have foot pain in multiple areas with the condition, according to Alice Bendix Gottlieb, M.D., Ph.D., clinical professor at the Icahn School of Medicine at Mount Sinai and medical director at Mount Sinai Beth Israel Dermatology.21
Psoriatic arthritis happens when your immune system mistakenly attacks healthy cells in your body. If you are trying to determine whether your symptoms could be psoriatic arthritis, its helpful to understand how the disease compares with other conditions that cause foot pain. Read on to learn about psoriatic arthritis on feet, including symptoms, treatment, and home remedies.
Psoriatic Arthritis In Feet And How A Podiatrist Can Help
We find that several patients come to us with heel paincaused by plantar fasciitis, an inflammation of the tissue on the bottom of thefoot. However, there is one ailment that often masks itself as plantarfasciitis until we take a closer look at it: psoriatic arthritis.
What is PsoriaticArthritis?
Psoriatic arthritis is a form of joint inflammation thataffects those suffering from psoriasis. Apart from pain, swelling, and inflammation,this chronic condition can also cause dactylis, which is the swelling of toesin their entirety. It isnt unusual for patients to develop dermatologicalevidence of psoriasis before experiencing arthritic issues.
What are the Symptomsof Psoriatic Arthritis?
This condition can affect any of the bones and joints inyour feet and ankles. Symptoms of psoriatic arthritis are usually persistentthroughout the day and often include the following:
- Swelling in feet
- Stiffness in the feet and ankles
- Pain and difficulty with walking, especially inthe morning or following an extended period of rest
- Inflammation and tenderness in toe joints
- Heel pain similar to plantar fasciitis
- Changes in toenails or the surrounding skin.
- Sometimes nails will thicken and become brittle,which is often mistaken for a fungal infection.
How is PsoriaticArthritis Diagnosed?
How is PsoriaticArthritis Treated?
How Can I PreventPsoriatic Arthritis?
Still Not Sure What Causes Your Itchy Feet
- Bug bites: You should remember seasonality when it comes to itchy feet. If you notice an itch, especially an itchy big toe, a pesky mosquito could be the cause. If the itch is accompanied by a small, swelling roundness and occurs after spending time outside, you may just have an annoying bug bite!
- Scabies: Likely one of the worst-case scenarios for itchy feet, its important to ensure scabies isnt the cause. Scabies is a skin condition caused by Sarcoptes scabiei, a microscopic mite that actually burrows into your skin! With scabies, the itch in your feet will be intense and feel worse at night. There may also be bumps that form a path on the skin.
- Diabetes: A common symptom of diabetic neuropathy is a regular burning or tingling sensation in the feet. Dry skin is also common with diabetes, which can cause itchy feet.
- Thyroid problems: If your itch seems inexplicable, you may have an overactive or underactive thyroid gland. This condition can lead to itchiness on the feet and many other areas of the body.
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Psoriatic Arthritis Foot Pain
The initial symptoms of psoriatic arthritis in the feet are pain, swelling, warmth, and stiffness. Patients may notice the need to change shoe height, weight or width several times a day. Walking can become difficult with stiffness and swelling.3
Plantar fasciitis is the inflammation of a thick band of connective tissue that runs from the bottom of the heel bone to the toes. It is characterized by pain that feels like the arch of the foot is tearing, and the pain is often worse in the morning or after a period of inactivity.2,3
Achilles tendonitis is characterized by the inflammation, heat and pain in the tendon running from the heel up to the calf. The pain may improve slightly with initial activity but worsens with exercise.4
Talk With Others Who Understand
MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 105,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.
Are you living with stress and psoriatic arthritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Distal Interphalangeal Predominant Psa
Distal interphalangeal predominant PsA primarily affects the small joints of the fingers and toes that are closest to the finger and toenails. It affects about 10% of people with PsA.
DIP PsA causes stiffness and pain in the toes, especially in the morning. Stiff and painful toes make to harder to walk and stand for long periods. DIP PsA may also cause nail changes, including detachment, discoloration, crumbling, and pitting .
Getting A Psoriatic Arthritis Diagnosis
Foot and ankle abnormalities, including joint inflammation and enthesitis, occur in up to 70 percent of people with PsA. They might be the first symptom of the disease occurring before any significant joint symptoms. Dactylitis, the painful, sausage-like swelling of an entire toe, rather than just a joint, is another common foot-related symptom of PsA.
Some research even suggests that inflammation that starts at the entheses is what triggers joint synovitis in PsA.
The upshot: Early treatment is vital for alleviating symptoms, preventing irreversible structural damage, and maximizing quality of life. Even a six-month delay in PsA diagnosis can result in irreversible joint, noted the authors of a recent review article in the American Journal of Clinical Dermatology.
If you suspect you could have psoriatic arthritis, its important to see a rheumatologist for testing. If you have psoriasis, you may already be seeing a dermatologist. If thats the case, tell them about your ankle pain, joint pain, and other PsA symptoms and they will likely refer you to a rheumatologist.
In order to diagnose psoriatic arthritis, the doctor will likely run different tests to look for signs of psoriatic arthritis and also rule out other conditions. This includes:
Read more here about how psoriatic arthritis is diagnosed.
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Symptoms Of Psoriatic Arthritis In The Feet
Psoriatic arthritis is an inflammation of the joints that is sometimes found in people diagnosed with the skin disorder known as psoriasis. Often, the skin and joints of the feet and ankles are affected. The symptoms of psoriatic arthritis can include having red patches of skin with silvery scales called plaques, swollen fingers and toes, joint pain, and changes in the structure or color of the nails. If you experience any symptoms of psoriatic arthritis in the feet and ankles, it is very important to consult with a podiatrist as this chronic condition can be misdiagnosed. A podiatrist may use X-rays or ultrasounds to determine any joint damage or dislocation, as well as blood tests to check for markers of inflammation and antibodies. Once you are properly diagnosed, treatment can begin.
Arthritis can be a difficult condition to live with. If you are seeking treatment, contact one of our podiatrists from Advanced Foot & Ankle Medical Center . Our doctors can provide the care you need to keep you pain-free and on your feet.
Arthritic Foot Care
Arthritis is a joint disorder that involves the inflammation of different joints in your body, such as those in your feet. Arthritis is often caused by a degenerative joint disease and causes mild to severe pain in all affected areas. In addition to this, swelling and stiffness in the affected joints can also be a common symptom of arthritis.
Alleviating Arthritic Pain
Skin And Nail Changes
daizuoxin / Getty Images
Inflammatory arthritis, especially PsA, can cause skin and nail changes. For example, rashes associated with PsA and psoriasis can occur anywhere on the body, including on the feet. PsA is also associated with a condition called palmoplantar pustulosis, which can cause tiny, pus-filled blisters on the soles of the feet.
Up to 80% of people with PsA will have nail involvement. Toenail symptoms are also common in people with RA.
Nail changes associated with arthritis include pitting , discoloration, brittle nails, and onycholysis .
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Treatment For Psoriatic Arthritis
Treatment for psoriatic arthritis aims to:
- relieve symptoms
- slow the condition’s progression
- improve quality of life
This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis.
The main medicines used to treat psoriatic arthritis are:
- non-steroidal anti-inflammatory drugs
- biological therapies
Surgery And The Psoriatic Foot
Orthopaedic surgery to correct deformed joints is only justified in the presence of long-standing deformity where pain is preventing adequate mobility and all alternative medical treatments have failed. The advancement of newer techniques in recent years has seen better results in small joint replacement, but such procedures still need careful consideration and discussion with advice from an appropriate surgeon.
Give Your Feet A Little Love
OK, so now that you know what you might be dealing with, weve got some good news: There are plenty of things you can do to treat your feet right. Here are a few ideas:
Above all, just remember: If PsA does decide to go after your feet, there is light at the end of the tunnel. If theres one thing I want people to know, its that you dont need to suffer, or live with painful feet, says Dr. Tumen. By seeking early treatment, you can slow or stop the advancement of your arthritis, and it can even go into remission. Its a myth to think youre just going to be doomed or have painful feet for life.
Establish The Right Healthcare Team
It may seem like a hassle to coordinate several specialists, but working with the appropriate healthcare experts can help you minimize psoriatic arthritis symptoms quickly and efficiently.
Its key to work with a rheumatologist, as they will serve as a healthcare provider who can help ensure youre taking proper medications to try to control the inflammation effects, Prestipino says.
Who else to include on your care team may vary based on the severity of your condition. You may want to meet with a physical therapist to address mobility challenges and an occupational therapist to help make daily activities easier.
For more severe cases of psoriatic arthritis, an orthopedist may be a beneficial addition to your care team to discuss the role of surgical options for management of your arthritis.
Finally, since psoriatic arthritis can go hand in hand with psoriasis, which affects the skin, meeting with a dermatologist may also be helpful.
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Coping With Arthritic Feet
- Steroid medications to be injected into the affected joints
- Custom-made shoes, shoe inserts, or arch supports to support your ankles and feet
- Physical therapy that includes foot exercises and stretches
Your doctor might recommend surgery if other treatments dont work to manage foot and ankle arthritis. Surgical options might include:
- Arthrodesis: Also called fusion surgery, this involves fusing bones together with rods, pins, screws, or plates. When bones heal, the bones will stay joined.
- Joint replacement surgery: Also called arthroplasty, this surgery is used only in severe cases. The surgeon will take out damaged bones and cartilage and replace them with metal and plastic.
Home remedies you can try to help you cope with arthritic feet include:
- Creams containing capsaicin or menthol: These creams may stop the nerves from sending out pain signals.
- Hot or cold packs in the affected areas
- Gentle exercises, including yoga and tai chi
- Foot massage
Making changes to your lifestyle can also help you to feel better and keep arthritis in your feet from getting worse. Lifestyle changes might include choosing low-impact exercises like swimming rather than high-impact ones , maintaining a healthy weight to keep stress off joints, and reducing or avoiding activities that trigger symptoms in the feet and ankles.
Carpal And Tarsal Tunnel Syndromes
Carpal and tarsal tunnel syndromes involve nerves in the hands or feet that run between the carpal or tarsal bones. Most of us have heard of the carpal form. Its a repetition injury mainly associated with people who spend long hours typing on a keyboard or doing other repetitious tasks. With RD, however, these syndromes are caused by inflammation and swelling.
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Engage In Regular Physical Activity
Physical activity should not be ignored. Light exercise is crucial in order to maintain good health and prevent the body from becoming stiff.
Simple indoor exercises such as stretching, walking and yoga are enough for patients of arthritis.
Regular massage of the affected area helps to improve the blood flow and makes the immune system stronger and better during the winter season.
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How Do You Treat Psoriatic Arthritis Symptoms In The Hands And Feet
Treatment of PsA symptoms in the hands and feet is the same as treatment for PsA in general. Medications called immunosuppressants treat the cause of inflammation in the hands and feet: an overactive immune system that is attacking the skin, joints, and tendons.
The goal is to find a medication regimen that clears your skin and improves joint pain and swelling, everywhere youre affected. It can take some time to find the medication or medications that work for you, but there is a regimen out there that can do both!
During a PsA flare , anti-inflammatory medications like steroids or non-steroidal anti-inflammatory drugs can quiet down symptoms in a short amount of time. A quick course of anti-inflammatories may be particularly helpful for dactylitis and enthesitis.
While its rare, steroid injections near tendons and joints may be performed, too. Steroid shots are typically a last resort since there are potential side effects.
Left untreated, PsA can cause complications, including permanent joint damage. This can cause deformities in the hands and feet and difficulty performing daily activities. So starting treatment early is important. It might feel overwhelming, but talk to your provider about treatment options. You can work together to find a regimen that you feel comfortable with.
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How To Manage Psa In The Feet
People cannot take direct action to prevent PsA from developing, but they can take some steps to limit flare-ups and the impact of this condition on their lives.
For example, people may find it helpful to work with a doctor or podiatrist to help them find the right sort of footwear for their condition. Using shoe inserts may provide symptom relief and make it easier to walk.
Strengthening exercises and stretches may also prevent more severe symptoms. Doing exercises that involve slow, gentle, strength building movements, such as yoga and tai chi, can be safer for the joints than higher impact exercises such as running.
Trying physical therapy can also help build strength, work through stiffness, and maintain mobility in the feet.
When a person is experiencing pain, treatment can help them feel more comfortable, slow down the progression of the condition, and prevent joint injury.
The sections below look at some treatments and home remedies in more detail.
Increased Risk Of Uvetis And Other Eye Problems
Having psoriatic arthritis ups your risk of uveitis a condition that causes inflammation of the uvea, or the middle layer of the eye, located under the white of the eye.
According to the National Psoriasis Foundation, about 7 percent of people with psoriatic arthritis will develop uveitis. If its not treated, uveitis can lead to vision loss.
The reasons for this higher risk are uncertain, but its likely the inflammation that causes joints to flare also can affect some of the tissues in the eye.
People with the gene for the human leukocyte antigen B27 may have a higher risk for psoriatic arthritis and uveitis, according to an article published in January 2016 in the Review of Optometry.
Stress Is The Top Psoriatic Arthritis Trigger
The number-one thing patients tell me is that when stress levels go up, they have a flare and more pain, says Alexis Ogdie-Beatty, MD, a rheumatologist at the Perelman Center for Advanced Medicine and an associate professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia.
Why? Stress sets off the immune systems inflammatory response, according to the Arthritis Foundation. Inflammation, in turn, can fuel joint damage in people with psoriatic arthritis and other arthritic conditions.
The longer youre exposed to stress, the worse your psoriatic arthritis symptoms may get.
Another reason stress can create a cycle of pain, then more stress, is that when youre stressed, you tend to sleep less, says Dr. Ogdie-Beatty.
And when you get less sleep, your pain is likely to seem worse.
Stress can also prompt you to engage in unhealthy behaviors like smoking, drinking alcohol, and overeating, which may worsen symptoms.
How to avoid this trigger Stress busters such as yoga and meditation can help ease pain, according to the Arthritis Foundation.