Psoriatic arthritis can cause substantial pain and swelling in the feet and toes. Feet-related symptoms are a common cause of decreased mobility in people with the condition.
Psoriatic arthritis (PsA) is a chronic condition that causes pain, swelling, and inflammation in the joints. It also causes dactylis, which is the swelling of entire toes or fingers.
Treatment can help people feel more comfortable, slow down the progression of the condition, and prevent joint injury.
The feet are among the body parts most commonly affected by PsA.
In this article, we look at how PsA can affect the feet, including its symptoms, risk factors, and diagnosis. We also discuss how to relieve the foot-related symptoms of PsA.
How can PsA affect the feet?
PsA can affect any of the 26 bones in the foot, plus the ankle bones and synovial membranes that surround the joints. It can make the joint inflamed, sore, and tender. PsA can develop in just a few joints or in several.
Symptoms of PsA in the feet include:
- foot swelling
- stiffness in the feet and ankles
- pain and difficulty walking, especially in the morning or after a long period of rest
- dactylis, wherein entire toes swell up
- heel pain, similar to plantar fasciitis, which inflammation in the Achilles tendon causes
- toes bending and shortening to look like claws
- an over-extended big toe
- painful calluses or sores over joints
- flattening of the arch, leading to a tendency to roll the foot inward when standing or walking
- limited range of motion and a tendency for the joints to lock
- the skin of affected joint areas turning a purplish color
The joint pain associated with PsA typically gets worse with inactivity. People often experience stiffness in the morning. This difficulty can last for more than half an hour.
PsA symptoms come and go in periods called flares and remission. People should maintain their treatment throughout both phases. Treatment can prevent the condition from progressing.
In the later stages of the condition, the joints can become so damaged that the toes fuse together.
At present, there is no specific test that can determine whether someone has PsA. The process typically begins when a person visits a doctor about pain in their joints.
To determine the cause of the problem, a doctor will:
- take a complete medical history, especially in people who may have psoriasis
- conduct a thorough medical exam
- look for pitting and other changes in the nails, which are common signs of PsA
- use MRIs or X-rays to look for any PsA-related joint injuries
Diagnosing PsA can be difficult because its symptoms are similar to those of other arthritic conditions, such as gout and rheumatoid arthritis. Doctors may use blood tests or draw fluid for analysis from painful joints to rule out these options.
The joint pain of PsA can be asymmetrical, meaning that it affects the two sides of the body differently. This is a key difference between PsA and other conditions, such as rheumatoid arthritis, which tend to affect both sides of the body in a symmetrical manner.
Persistent morning heel pain that lasts for as long as 6 months and does not respond to treatment can often be a telltale sign of PsA. This could be a sign of fasciitis, or inflammation of the ligaments and tendons. Dactylis of the toes is also characteristic of PsA in the feet.
How to manage PsA in the feet
People with significant foot pain due to PsA may find it helpful to work with their physician or a podiatrist to help them find the right sort of footwear for their condition. Using shoe inserts can provide symptom relief and make it easier to walk.
People with PsA in their feet can experiment with different options to find a balance between rest and regular physical activity that does not aggravate their symptoms.
Strengthening exercises and stretches can help relieve symptoms. People can think about the following when considering exercises for PsA:
- doing exercises that involve slow, gentle, strength-building movements, such as yoga and tai chi, because they may be better than higher-impact exercises such as running
- wearing shoes that support the feet and do not pinch or bind areas of inflammation
- trying physiotherapy to build strength, work through stiffness, and maintain mobility in the feet
Treatments and home remedies
Treatment plans for PsA-related foot problems aim to reduce pain, lower inflammation, and prevent permanent damage to the joints.
Medical treatments for PsA in the feet, and elsewhere in the body, include:
- taking nonsteroidal anti-inflammatory pain relievers, available as over-the-counter or prescription medications
- taking corticosteroids, which can reduce inflammation but may cause long-term side effects
- taking biologics, which are specific medications that suppress the immune system
- taking disease-modifying antirheumatic drugs, which can reduce symptoms by suppressing the inflammatory response
- undergoing surgery, in extreme cases
Eating a healthful diet can also help people manage the symptoms of PsA.
Although there is no official diet for PsA, the Arthritis Foundation reports that the following foods may be helpful:
- fish rich in omega-3 fatty acids
- green tea, which can help reduce inflammation
- fiber-rich foods, such as beans, brown rice, and oatmeal
In addition to conventional treatments and basic healthcare practices, such as good nutrition and getting appropriate exercise, some people with arthritis have found the following natural therapies helpful:
- massage therapy
- electrical stimulation
As with many alternative healthcare practices, scientific research does not fully back up these techniques. People with psoriatic feet pain should consult with their doctor before starting any natural remedies.
People cannot take direct action to keep from developing PsA, but they can take steps to limit the impact of this condition and its associated foot pain on their lives. Such steps include:
- maintaining a healthy weight and monitoring blood pressure, cholesterol, and blood sugar levels, as psoriasis can increase the likelihood of problems in these areas
- getting regular exercise to keep the joints functioning and promote general health
- wearing appropriate shoes and using walking aids as needed to minimize demands on the feet
The feet are among the areas most often affected by PsA. The condition can cause inflammation, swelling, and pain in the foot and ankle joints, which can limit a person’s movements.
PsA is a chronic, progressive condition, and there is currently no cure for it.
However, the wide range of treatments available can relieve pain and inflammation for most people and prevent permanent damage to the joints.
Dr. Dang H. Vu, DPM is a Baltimore Podiatrist with more than 15 years of experience. He completed his residency at Sinai of Baltimore. He furthered his surgical expertise and now holds privileges at Northwest Hospital. He offers services from three Baltimore Locations in Reisterstown, Towson and in the Rotunda Building in Hampden. You can find directions and request an appointment on his website FamilyPodiatryofMD.com