- Essentials for Foot Care and Psoriatic Arthritis
- Inflammation Symptoms in the Feet
- How to Take Care of Your Feet With PsA
- How Psoriatic Arthritis Affects Your Feet
- Central Call Center: 301-942-7600
- What Psoriatic Arthritis Does to Your Feet, and 6 Ways to Keep Them Healthy
- How Psoriatic Arthritis Affects the Feet
- What Does Psoriatic Arthritis in the Feet Feel Like?
- How to Keep Your Feet Healthy with Psoriatic Arthritis
- Keep Reading
- Hand/Foot Pain: How Can I Manage Psoriatic Arthritis Pain?
- The 5 Types of Psoriatic Arthritis
- Psoriatic arthritis
- Symptoms and treatment of psoriatic arthritis rash
Essentials for Foot Care and Psoriatic Arthritis
For some people, foot pain is the worst part of psoriatic arthritis (PsA) — and that makes the right foot care essential.
“Psoriatic arthritis can affect the joints of the feet and ankles, and it can also affect the structures that support those joints,” said M. Elaine Husni, MD, MPH, vice chair of rheumatology and director of the Arthritis & Musculoskeletal Center at the Cleveland Clinic in Ohio and an assistant professor at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. When psoriatic arthritis and inflammation affect tendons that support joints, the condition is called enthesopathy. Pain and stiffness caused by psoriatic arthritis enthesopathy may start before actual joints are affected.
Inflammation Symptoms in the Feet
“Foot and ankle symptoms from psoriatic arthritis can be confused with injuries,” said Dr. Husni. “But in most cases psoriasis skin symptoms start before arthritis symptoms, which makes the diagnosis easier.”
Conversely, it can be harder for you to get the right diagnosis of psoriatic arthritis of the feet or ankles if you don’t have skin psoriasis. About 15 percent of people with psoriasis develop psoriatic arthritis, and in some cases psoriatic arthritis comes before any skin symptoms. In rare cases, someone can have psoriatic arthritis without ever having psoriasis.
Foot involvement with psoriatic arthritis may include:
Plantar fasciitis. “This causes pain in the sole of the foot from inflammation of the supporting tissue,” said Husni. Plantar fasciitis with a bone spur on the heel is a common cause of psoriatic arthritis foot pain. Pain may be felt on the bottom of the foot near the heel, especially when you take your first steps in the morning.
Achilles tendinitis. “Enthesitis is inflammation at an area where tendons attach to bones,” Husni said. “The Achilles tendon attachment is a common site causing heel pain.” Achilles tendonitis causes pain in the back of the lower leg, near the heel. The pain gets worse with exercise that involves ankle movement, and there may also be tenderness and swelling.
Dactylitis. “Dactylitis is swelling of the tendon that runs along the length of a toe or finger,” Husni said. “It can cause swelling that makes toes or fingers look like sausages.” Dactylitis affects about a third of those who have psoriatic arthritis, and toes are more commonly affected than fingers.
Nail and skin change. “People with psoriasis and psoriatic arthritis may have skin psoriasis called pustular psoriasis on the soles of their feet. “Toenails can become pitted or start to lift away from the nail bed,” said Husni.
Foot deformities. Long-term foot changes can occur if psoriatic arthritis goes untreated. These include clawed toes, upward bending of the big toe, flat foot, rolling of the ankle, and calluses or ulcers on the soles.
RELATED: Don’t miss these lifestyle tips from people who have PsA. Find answers on Tippi.
How to Take Care of Your Feet With PsA
“Treatment can range from occasional anti-inflammatory pain medications like Advil or Motrin to more powerful drugs like DMARDs, which stands for disease-modifying antirheumatic drugs, and biologics,” said Husni. Self-management should also be part of your foot care for psoriatic arthritis.
Here are 10 foot care tips to master:
- Avoid weight-bearing exercises that make your feet ache. “When your feet start to hurt, you need to get off them,” Husni said.
- Get help from a physiotherapist or podiatrist along with your psoriasis doctors for special foot care and to learn more about psoriatic arthritis and shoes.
- Have your feet measured, for both length and width. This will help you choose the right shoes.
- Make sure your shoes are wide enough and long enough to allow room for some swelling.
- Make sure your shoes have good arch and heel support. “You can try over-the-counter insoles from the pharmacy, or you can have orthotics fitted and made specially,” said Husni.
- If your ankles are weak or painful, get shoes with high ankle support or consider ankle splints.
- Stretching exercises are important for psoriatic arthritis. Try lying flat with your feet extended off the end of the bed. With your legs held still, move your feet up and down and then around in circles; repeat for a total of 10 times. Do your foot-stretching exercises at least once every day.
- If you’re going through a painful foot flare, try using a cane or crutches until inflammation subsides.
- A good foot massage can improve circulation and help relieve foot pain.
- “Foot soaks can help relieve pain,” Husni said. “You can do a hot soak or a cold soak — whatever feels better.”
Psoriatic arthritis often involves the feet and ankles, causing both pain and swelling. Treatment works, but foot deformities can develop if treatment is delayed. If you’ve been diagnosed with psoriasis, always let you doctor know about any foot or ankle symptoms.
And remember that psoriatic arthritis sometimes occurs without any skin symptoms, so don’t ignore your feet. They have a big job to do, and they need all the support they can get.
The differential diagnoses for heel pain in a healthy active 50-year-old male typically include achilles tendinopathy and retro calcaneal bursitis. Retrocalcaneal bursitis is an inflammation of the retrocalcaneal bursa and can also cause pain at the posterior heel.8 Achilles tendonopathy is a degeneration and failed healing of the tendon that can cause pain at the insertion on the calcaneus, as well as within the mid substance of the tendon. While these diagnoses are typical, practitioners might consider the other systemic differential diagnoses that are possible. To help in the diagnosis of a systemic inflammatory problem, the practitioner may also identify constitutional symptoms, morning stiffness, elevated acute-phase reactants and worsening of symptoms despite activity modification.9 Additionally, if the mechanism of injury is absent or not proportional to the injury, this may also suggest an underlying disease.9 In this case, even though the chief complaint was reproduced with palpation of the enthesis of the Achilles tendon and aggravated by a squat, the presence of skin and nail lesions and a mild dactylitis of the hallux led the clinicians to suspect a seronegative spondyloarthropathy.
Individuals with psoriatic arthritis test negative for rheumatoid factor but they may have an association with HLA-B27, especially those with involvement of the axial skeleton.10,11 This perhaps atypical case had a negative test for HLA-B27 and lacked any axial complaints yet the bone scan demonstrated multiple asymmetrical joint involvements.
There are many different diagnostic criteria available for psoriatic arthritis. The CASPAR criteria have specificity of 98.7% and sensitivity of 91.4%.12 To meet the CASPAR (Classification for Psoriatic Arthritis) criteria, a patient must have inflammatory articular disease (joint, spine or entheseal) with ≥ 3 points from the following 5 categories:
Evidence of current psoriasis, a personal history of psoriasis or a family history of psoriasis.
Typical psoriatic nail dystrophy including onycholysis, pitting and hyperkeratosis observed on physical examination
A negative test result for the presence of rheumatoid factor
Either current dactylitis, defined as swelling of an entire digit or a history of dactylitis recorded by a rheumatologist
Radiographic evidence of juxtaarticular new bone formation, appearing as ill-defined ossification near joint margins (but excluding osteophyte formation) on plain radiographs of the hand or foot.
Current psoriasis is assigned a score of 2, and all other features are assigned a score of 1.
Uncomplicated psoriasis arises in the second or third decade, with the arthritis typically settling in two decades later.3 In 15 to 20% of cases, the arthritis precedes the onset of skin lesions by as much as 2 years.5 Since this patient had never been diagnosed with psoriasis, it is difficult to know if the skin condition appeared before the arthritis. The patient’s age in this case coincides with the range for this disease, as the mean age of psoriatic arthritis onset ranges from 30 to 55 years.5 Psoriatic arthritis affects men and women equally.13 All forms of psoriasis are associated with arthritis, but classic psoriasis vulgaris is seen most frequently. Typical psoriatic lesions are erythematous plaques that produce scaling with scratching. Many patients with psoriatic arthritis have mild to moderate skin disease, but there has been no consistent correlation in the literature between the degree of psoriasis and the extent of joint involvement. The psoriasis may be subtle and careful examination of the entire skin surface may be required to visualize the skin lesions. The scalp, ears, periumbilical and perianal region should be examined carefully.5
The etiology of psoriatic arthritis is unknown. Genetic, immunologic and environmental factors all play a role in psoriatic arthritis.3 Individuals with a first degree relative with psoriatic arthritis are 50-fold more likely to develop the disease.13 A father with psoriasis is twice as likely to pass on the disease than a mother with psoriasis.13 Of note to the sports injury practitioner, psoriatic lesions have been known to arise at areas of trauma, which is also known as the Koebner phenomenon.13 It has also been suggested that environmental factors play a role and that they are additive to the genetic background.3 Immunology is also implicated which is shown in the aggressive nature of psoriatic arthritis in HIV patients.3
Most patients present with psoriatic arthritis that is considered oligoarthritis or monoarthritis.5 A typical patient will present with stiff, swollen and tender DIP joints, in an asymmetric fashion. The joints most often affected are the DIP joints, other small joints of the hands and feet, the sacroiliac joint and the spine. Knees, hips and shoulders are occasionally involved.10,14,14 In some patients dactylitis and enthesitis may be the only clinically apparent manifestations of psoriatic arthritis for months or years.16 The MCP joints and wrists are usually spared, which helps to differentiate this condition from rheumatoid arthritis.5 Without treatment, the destruction of joints will continue, which will be seen clinically with joint deformities and radiographically with the development of juxta-articular erosions, joint space narrowing and in some cases, bony ankylosis.5
The enthesis is the attachment site of tendons, ligament and joint capsule into bone. Their function is to reduce stress concentrations during the transmission of force.17 Enthesitis is inflammation at the site of the insertion of tendons, ligaments or capsules and is a feature of up to 40% of patients with psoriatic arthritis. However, it is also found in other spondyloarthropathies. This enthesitis can occur anywhere in the body, but it most commonly occurs at the achilles tendon, the calcaneal insertion of the plantar fascia and at the insertion of the hamstrings on the ischial tuberosity.18 Physical examination will reveal soft tissue swelling, usually accompanied by tenderness to palpation and sometimes erythema and warmth over the area. Entheseal inflammation may lead to destruction of the adjacent bone and joints.5 Entheses are prone to experience high mechanical stresses that make them vulnerable to microdamage. It has been suggested that biomechanical stress and microdamage at the enthesis may be the trigger that causes enthesitis,14 much like the Koebner phenomenon in skin lesions. Theoretically, this is important to note as athletes with psoriasis would be at a higher risk of being affected by enthesitis and possibly psoriatic arthritis.
A review of the literature revealed a similar case report of a 39-year-old kicker in the National Football League who developed mild pain in the medial right knee during the preseason.10 His injury was thought to be mechanical and he was able to finish the season with the help of NSAIDs. A large knee effusion developed while he was resting during the off-season. A corticosteroid injection and a knee arthroscopy, only provided temporary relief from the swelling. It was then noted that the player had several small patches of psoriasis on his elbows. The diagnosis of psoriatic arthritis was made and he was treated with pharmacotherapy.10 The case is similar to this presentation, as it is an example of a common sports injury presentation that leads to a diagnosis of psoriatic arthritis and points to how easily the correct diagnosis may be missed.
Dactilytis is the swelling of a single digit of the hand or the foot and it is also known as a “sausage digit”. It is found in spondyloarthropathies and is common in psoriatic arthritis. It is found in 1/3 to1/2 of patients at some point during the disease. It is more commonly found in the toes than in the fingers.5 It is caused by a combination of tenosynovitis and enthesitis of the tendons and ligaments as well as synovitis involving the entire digit.18 On rare occasion, the patient may present without joint involvement, but with considerable enthesitis, as evidenced by multiple sites of aching and stiffness, which may be confused with fibromyalgia or overuse tendonitis.18
Nail involvement may be the only indication of psoriasis. Psoriatic nail changes include ridging, pitting, onycholysis and hyperkeratosis. Nail changes are most likely associated with psoriatic arthritis involvement of the DIP joint of that digit.5
Other spondyloarthropathies exhibit extra-articular manifestations, such as ocular inflammation (conjunctivitis, iritis, scleritis and episcleritis), oral ulcerations and urethritis. These also occur with psoriatic arthritis, but less frequently.3
There are no diagnostic laboratory findings for psoriatic arthritis, however, considering the systemic inflammatory nature of this disease C-reactive protein and the erythrocyte sedimentation rate may be elevated, but to a lesser degree than other inflammatory arthritides.5 Elevation of these reactants may correlate with disease activity, more commonly in patients with multiple joints affected by psoriatic arthritis.3 Psoriatic arthritis patients are generally rheumatoid factor negative, yet 10% may test positive. A positive rheumatoid factor test does not exclude psoriatic arthritis,5 but psoriasis is an exclusion factor for seronegative rheumatoid arthritis.3
Radiographic signs include joints space narrowing and marginal bone erosions. The entheses are subject to similar erosions and bone proliferation, especially in the calcaneus, hand and foot.15 Periarticular osteopenia is usually absent in psoriatic arthritis, which in fact is another feature that helps distinguish psoriatic arthritis from rheumatoid arthritis.5 Non-marginal syndesmophytes can be found in the spine, along with paravertebral ossification. Together, these two types of ossification can fuse to adjacent vertebral bodies causing bony ankylosis.15
When comparing individuals with psoriasis to healthy control groups, individuals with psoriatic arthritis have a reduced quality of life and functional capacity. 18 Early diagnosis of psoriatic arthritis may lead to better management and therefore increased quality of life and ability to engage in physical activity.
Medical treatment for psoriatic arthritis includes several different types of medications. NSAIDs have commonly been used to control mild symptoms of synovitis.19 Intra-articular injections of glucocorticoids have also been used. However, systemic glucocorticoids need to be used with caution as they are associated with the occasional risk of post steroid psoriasis flare.20 Methotrexate is one of the most commonly used systemic medications for psoriatic arthritis.20–23 Tumor Necrosis Factor (TNF) blockers, such as Infliximab and Etanercept, have shown to be an important mediator of inflammation in the skin and synovitis of psoriatic arthritis patients.24,25 Sulphasalzine has also shown some benefit for patients with peripheral joint activity, but does not seem to have a significant effect on axial disease.19, 26–28
Considering arthritis can appear before the psoriatic skin lesions, diagnosing psoriatic arthritis can be challenging. The varying presentation patterns and possibility of overlap with other rheumatic syndromes also add to the difficulty of diagnosis. A thorough physical examination with a careful assessment of nails and skin may help the clinician. Future research may investigate if psoriatic arthritis is more prevalent in athletes with psoriasis when compared to sedentary individuals with psoriasis.
Jaime Lyn M., 42
Detroit Living with psoriatic arthritis is like playing Pac-Man. You gobble up dots (do your daily activities) before the ghosts (psoriatic arthritis symptoms) get you. Cherries are like medicine — they turn the ghosts invisible for a little while. Cynthia C., 50
Moreno Valley, CA I thought that exercising would increase the pain in my hips, but movement has actually decreased the inflammation and has increased my mobility. Now I take two walks daily. Michele S., 68
Cornville, AZ While others may not be able to understand fully the pain and challenges you face, it doesn’t mean they can’t care. Talk openly and share your struggles and strengths with those who ask. Cynthia C., 50
Moreno Valley, CA Don’t let pain keep you from moving your body. Start slow by doing what you can, even just 5-minute walks. Then make it a daily habit and increase as your body allows. Josh B., 39
Tampa, FL My chronic pain got so bad that I couldn’t hold a pencil. My wife and I decided as a team that the potential benefit to my quality of life was worth the risk of trying a biologic. Two weeks later, I was able to resume my normal work routine. Jaime Lyn M., 42
Detroit Psoriatic arthritis is the hidden component of the psoriasis that people can’t see. I try and educate everyone I can on the chronic pain so they understand what I deal with, often daily. Chad V., 42
Atlanta I’ve been on several different medications, all with their pros and cons, but thanks to trial and error, my skin is now clear and I can move. It’s worth pushing through until you find the treatment you need. Rich W., 57
South Brunswick Township, NJ When trying something new, tell your doctor about anything that comes up. Do blood tests on a regular basis. And give treatments time to work — it can sometimes take months to see a change. Amie R., 33
Maricopa, AZ I’ve been able to connect with so many people going through what I’m going through because of social media. It’s so helpful to talk to others who understand not only the physical toll, but the emotional toll this condition can take. Amie R., 33
Maricopa, AZ I was so used to covering my psoriasis up, I thought I could mask the arthritis, too. But soon, both elbows were an issue and my fingers and knees were swelling. Don’t put off treating your symptoms in hopes that they’ll go away. Get the help you need. Chad V., 42
Atlanta I ignored my symptoms because I was embarrassed. Now I allow anyone and everyone to see me for me and my struggles because I know I’m not alone. It’s lifted a huge burden off my shoulders and makes days with flares much easier. Josh B., 39
Tampa, FL I would encourage anyone with this disease to explore support options, like those available through the National Psoriasis Foundation. It could change your life!
How Psoriatic Arthritis Affects Your Feet
The goal of treating PsA is to reduce pain and prevent permanent damage to the bones. Without treatment, the feet can become permanently damaged. A number of medications can help to reduce inflammation and protect your joints, including those in your feet.
Common medications for PsA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), help reduce inflammation and treat pain.
- Disease-modifying antirheumatic drugs (DMARDs). DMARDs, such as methotrexate (Trexall), leflunomide (Arava), sulfasalazine (Azulfidine), tofacitinib (Xeljanz), and apremilast (Otezla) work to prevent PsA from permanently damaging the joints.
- Biologic agents. Biologics are a newer generation of arthritis drugs, formed through genetic engineering, that target inflammation in the body.
PsA symptoms in the feet are managed with oral medications mentioned above, biologics, and NSAIDs based on the severity of symptoms. These drugs treat inflammation throughout the body, including the feet and heels.
For severe flare-ups in the feet, however, you may want to consider a more localized approach, such as:
- Cortisone injections. Cortisone injections can be given directly into your heels, the soles of your feet, or a single inflamed toe. They can reduce inflammation and treat painful flare-ups.
- Ice. Ice can also help to reduce inflammation in the joints of the feet. Roll your foot on a frozen water bottle wrapped in a towel or apply an ice pack to the affected area for 20 minutes. You can repeat the process two to four times a day.
- Medicated foot powders. Cracks in your nails or skin can provide an opening for infections that can trigger PsA flare-ups. A medicated foot powder can help control moisture while fighting fungus and bacteria.
- Night splints. A night splint prevents you from relaxing your plantar fascia while you sleep, which may help to prevent heel pain.
- Custom orthotics. Orthotics are inserts for your shoes that help you maintain a good posture while protecting the joints of your feet. They’re designed specifically for you to relieve foot, ankle, and heel pain.
Other steps you can take to manage PsA symptoms in your feet and prevent future flare-ups include:
- consulting a podiatrist (foot doctor) in addition to your rheumatologist (arthritis doctor) and dermatologist (skin doctor)
- avoiding ill-fitting shoes that may trigger a flare-up
- wearing shoes with high toe boxes, extra cushioning, wide sizes, and removable inserts
- using over-the-counter heel pads or heel cups to add cushioning and support to your shoes
- wearing compression socks to reduce and control swelling
- losing any extra weight, which helps to reduce the amount of stress on the joints in your feet
Central Call Center: 301-942-7600
• Regular stretching is often beneficial, but may be difficult to do on your own; working with a physical therapist may help you to properly stretch the plantar fascia.
• Orthotics (shoe inserts) may be helpful, especially if you have flat feet or a high arch.
• Night splints may also be useful and work to stretch the tendon by putting the foot in dorsiflexion (pulling the toes up).
• Medications or disease modifying agents (DMARDs) which treat psoriatic arthritis may help to treat inflammation of the plantar fascia.
Despite these measures, your heel pain may persist and more targeted therapy may be needed.
Corticosteroids (cortisone) are powerful anti-inflammatory medications that can be injected directly into the plantar fascia and can be very effective to locally reduce inflammation and pain.
However, these should not be administered repeatedly, since repeated corticosteroid injections may cause heel pad atrophy or rupture of the plantar fascia tissue.
If more conservative treatments fail, a fasciotomy or fasciectomy can be performed.This is a surgical procedure where the fascia is cut to relieve tension or pressure. In some cases, ultrasound guidance may be used to perform a less invasive percutaneous (through the skin) fasciotomy to treat plantar fascitis.
Ultrasound guidance is often used for both corticosteroid injection and percutaneous fasciotomy to
make sure medication is properly delivered to the right location, avoiding multiple steroid injections, or to target appropriate surgical measures.
As a forerunner in the specialty of rheumatology, the physicians of Arthritis and Rheumatism Associates, P.C. have been using musculoskeletal ultrasound (MSK US) since 2007 and are nationally recognized as experts in this field.
ARA has incorporated the use of ultrasound as a diagnostic tool as well as a procedural treatment modality for aspirations and injections.
While the technology of ultrasound has been around for approximately 50 years, it has not been widely utilized by rheumatologists until recently.
With ultrasound our physicians can execute a procedure with more precision and more comfort to a patient.
Click here for a downloadable pdf.
What Psoriatic Arthritis Does to Your Feet, and 6 Ways to Keep Them Healthy
Psoriasis you can usually spot: the autoimmune disease often causes red patches of skin topped with thick, silvery scales. It occurs when your body’s immune system goes into overdrive, attacking healthy tissue and causing an overproduction of skin cells. But what you can’t see is that same abnormal immune response may also cause inflammation in your joints.
About one-third of people with psoriasis develop psoriatic arthritis (PsA) — a chronic, inflammatory disease of the joints and entheses, or places where tendons and ligaments connect to bone.
Most people with psoriatic arthritis develop psoriasis first, and are later diagnosed with psoriatic arthritis. But joint problems from psoriatic arthritis can sometimes begin before skin signs appear. Or sometimes skin issues are so mild that patients don’t connect psoriasis with joint pain and realize they could have PsA. (That’s what happened to psoriatic arthritis patient Frances Downey.)
Psoriatic arthritis can cause pain, stiffness, and swelling in any joint in your body, from your hands to your back — and often, in your feet. You can read here about common psoriatic arthritis symptoms.
How Psoriatic Arthritis Affects the Feet
Each foot contains 26 bones and 33 joints that are controlled by a number of muscles, tendons, and ligaments. Inflammation from psoriatic arthritis can occur in any one of those spots, explains says Alex Kor, DPM, podiatrist with Witham Health Services in Indiana. Ankle joints can also be affected by psoriatic arthritis, as well as tendons that pass around the ankle and connect the bones with the muscles that move them.
What Does Psoriatic Arthritis in the Feet Feel Like?
When your feet are affected by psoriatic arthritis, you may have pain, tenderness, and swelling in your foot. This occurs when the membranes that line the joints, tendons, and connective tissue in the foot become inflamed. Similar to other forms of inflammatory arthritis, such as rheumatoid arthritis, joints may feel may warm to the touch, and stiffness may be worse in the morning or after periods of inactivity.
Symptoms may also flare, then go into periods of remission. Here’s more information about coping with psoriatic arthritis flares.
But unlike with rheumatoid arthritis — where symptoms typically occur in the same joints on both sides of your body (or symmetrically), PsA is usually asymmetrical. “You can have psoriatic arthritis in the ankle joint of one foot and the toe of another,” explains Dr. Kor, who also serves as spokesperson for the American Podiatric Medical Association.
Specific foot problems caused by PsA include:
Medically speaking, it’s called dactylitis, a condition that refers to swelling of an entire toe (or finger), which gives it a sausage-like appearance. Dactylitis happens when the small joints in the toe, as well as the entheses of the surrounding tendons, become inflamed. An enthesis is the point of insertion of a tendon, ligament, joint capsule, or fascia to bone. Inflammation of the entheses is common in psoriatic arthritis.
Gout — another form of arthritis — also causes pain and swelling in the toes. But with gout, symptoms are sudden, severe, and often target the joint at the base of the big toe. “Psoriatic arthritis can affect multiple joints, and is seen a little more in the third, fourth, and fifth toe joint,” adds Dr. Kor. Here’s more information about gout symptoms.
In psoriatic arthritis, heel pain stems from inflammation of the Achilles’ tendon, where the tough band of tissue connects your calf muscle to your heel bone. It’s a common spot for inflammation of the entheses when you have PsA.
Pain on the sole of your foot
The plantar fascia is a thick tissue that runs along the bottom of your foot. It connects the toes to the heel bone, and often becomes inflamed when you have psoriatic arthritis. It’s common for people to assume they have only plantar fasciitis, or inflammation of the plantar fascia, when they actually have psoriatic arthritis.
Toe nail changes
Your nails may lift off the nail bed; they may also have pitting (or small indents), discolor, or thicken — similar to a fungal infection. These psoriatic arthritis nail changes occur from abnormalities in the growth of tissue in the nail bed.
How to Keep Your Feet Healthy with Psoriatic Arthritis
Psoriatic arthritis is a chronic condition that can get worse over time. A small percentage of people with PsA develop arthritis mutilans, which is a severe and painful form of the disease that can lead to deformity and disability. Though there’s no cure for psoriatic arthritis, you can take steps to manage symptoms, control inflammation, and protect your joints. To help keep your feet healthy:
1. Stick to your PsA treatment plan. Your rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation, disease-modifying antirheumatic drugs (DMARDs) to help slow the progression of psoriatic arthritis, or biologics, which are complex, targeted DMARDs that act on certain immune system pathways, to manage psoriatic arthritis symptoms and help prevent disease progression.
2. Lose weight if you need to. Maintaining a healthy weight reduces the amount of stress on the joints in your feet, which can help relieve pain and improve your walking gait. Excess body weight can also increase inflammation, and potentially make arthritis symptoms worse. Check out these weight loss tips that are especially helpful when you have arthritis.
3. Get active. Exercise can help keep joints flexible, boost energy, and burn more calories. Physical activity can also improve vasodilation (or widen blood vessels), which can increase blood flow to the joint to help flush out inflammation, adds Dr. Kor. You don’t have to walk, run, or jump if it hurts, he says. Choose activities that are less stressful on the joints in your feet, such as swimming, doing water aerobics, using a stationary bike or elliptical machine.
Stretching exercises, especially ones that are focused on the source of your foot pain, such as the plantar fascia or Achilles’ tendon, can help relieve pain. Talk to your doctor or podiatrist about exercises that are safe for you.
4. Ice after exercise. Cold constricts blood vessels, which decreases blood flow to the joint to help reduce swelling and inflammation, explains Dr. Kor. Grab an ice pack, frozen bag of veggies or stick cubes in a reusable bag — just be sure to use towel or other barrier between the cold pack and your skin to prevent irritation. Here are more ways to use cold therapy to manage arthritis.
5. Toss flimsy shoes. And don’t walk barefoot, advises Dr. Kor. Sturdy shoes with good support and a large toe box can help reduce pressure on inflamed areas and swollen toes. Extra cushioning and wide widths may help too. Your podiatrist may also recommend custom orthotics. These shoe inserts are specifically designed to provide more comfort and reduce pressure on bones and tendons in your feet.
Talk to your doctor to determine the best footwear for you. Here are some tips about picking the right shoes when you have arthritis.
6. Ask about a cortisone shot. These injections can help reduce swelling and inflammation in your heels, the soles of your feet, or a single toe joint. “It’s not a cure-all,” says Dr. Kor. “Used judiciously, cortisone shots can help reduce a flare for some patients.” Learn more about getting cortisone shots to manage arthritis.
- How Different Kinds of Arthritis Affect Your Feet
- Psoriatic Arthritis Diet: What to Eat to Manage PsA
- How Doctors Diagnose Psoriatic Arthritis
Hand/Foot Pain: How Can I Manage Psoriatic Arthritis Pain?
Hugh Duckworth MD
Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine
Sep 28, 2018 7 min read
Psoriatic Arthritis Facts and Figures
Affecting men and women almost equally, psoriatic arthritis is often confused with rheumatoid arthritis, and sometimes gout. Many symptoms overlap. The age of onset is similar in all three. And the diseases are progressive. However, one of the key distinguishing factors of psoriatic arthritis over its similar counterparts is the presence of psoriasis.
In over 85% of cases of psoriatic arthritis, psoriasis is also present. Does this mean that if you have psoriasis you will get psoriatic arthritis? Not necessarily. Thirty percent of individuals living with psoriasis will go on to be diagnosed with psoriatic arthritis. However, if you have a family history of psoriasis, you stand an even greater chance of developing psoriatic arthritis later in life.
85% 85% of Psoriatic Arthritis Patients have Psoriasis
Most people who develop psoriatic arthritis are diagnosed between the ages of 30 and 50. And the trigger for the onset of the disease can be a viral infection (e.g., strep throat) or as a response to extreme stress. Psoriatic arthritis is an autoimmune disease, in which your body attacks its own healthy joints. Most common symptoms of psoriatic arthritis are painful and inflamed joints, that are warm to the touch. Very commonly, psoriatic arthritis is an asymmetric disease, affecting different joints on either side of the body. Some of the most significant joints that are affected by psoriatic arthritis are in the hands and feet.
Psoriatic Arthritis Hand Symptoms
The hands are often affected by psoriatic arthritis leading to swelling and pain in the fingers and changes in the nail bed. In fact, nail psoriasis is often one of the most telling signs of the onset of psoriatic arthritis. The most common symptoms of psoriatic arthritis affecting the hands are:
- Pain in the finger joints
- Joints that are “hot to the touch”
- A Sausage-like appearance of the fingers (dactylitis)
- Nail pitting
- Crumbling nails
- Splitting of the nails
- Blood spots under the nail
- Nails separating from the nail bed
- Discoloration or yellowing of the nails
In people diagnosed with psoriatic arthritis, 5 to 16% of them may experience a complication of the disease called arthritis mutilans. This development can result in such severe deformity of the hands, so severe they may become almost unusable. More commonly, people living with psoriatic arthritis will first experience hand problems when they notice opening a jar becomes painful, buttoning and unbuttoning a shirt becomes difficult, and counting out change becomes a chore.
With 27 joints in the hand, psoriatic arthritis can wreak havoc. What are some ways that you might seek relief?
Home Remedies of the Hand
If you’re experiencing psoriatic arthritis symptoms, there are a number of treatment options. Most commonly, NSAIDs and DMARDs are prescribed for pain management. Natural remedies are also great supplemental options for managing psoriatic arthritis symptoms.
In our daily activities, we use our hands constantly, so it’s vital to manage the pain you might be experiencing from psoriatic arthritis. In addition to treatment options prescribed by your doctor, you can self-treat at home as well to provide more relief for your painful joints and prevent nail injuries that can spark a flare-up of symptoms.
- Rest your hands often – if you’re typing, sewing, writing letters, etc., take breaks and take them often
- Massage stiff joints – you can get a professional massage or rub your own fingers and hands to relieve pain
- Use hot and cold compresses – cold compresses reduce swelling and hot compresses ease pain caused by the swelling
- Wear hand splints – these can help stabilize painful finger joints
- Exercise your joints – engage in exercises that stretch and strengthen your fingers and wrists to loosen stiff joints and increase the range of motion
- Keep your nails short/trimmed and moisturized – to prevent snags and other injuries to the nails
- Wear gloves – when doing the dishes, gardening, or any other activities that may result in nail injuries
- Use clear nail polish – dark polishes or any polishes with color can mask nail pitting and related symptoms of psoriatic arthritis
Psoriatic Arthritis Symptoms of the Foot
Toe swelling? Plantar fasciitis? Pain in your Achilles tendon? If you are living with psoriatic arthritis and are experiencing any of these symptoms, you are not alone. Psoriatic arthritis symptoms occur often in the feet. We use our feet just as much as our hands, so pain relief from psoriatic arthritis symptoms is important.
How does this disease present itself in the lower extremities of the body?
- Joint inflammation in the toes – causing a “sausage-like” appearance (dactylitis)
- Enthesitis – tendon and ligament inflammation causing pain, damage to the joints and surrounding tissue. Pain in the arch of the foot may be Plantar Fasciitis. Pain in the heel may be Achilles tendonitis.
- Nail pitting and other nail changes (resembling nail fungus)
- Pain when walking – caused by joint stiffness
- Joints that are hot to the touch
- Foot deformities – often occurring in individuals with arthritis mutilans or those that don’t seek immediate treatment for psoriatic arthritis symptoms
As with symptoms of the hands, psoriatic arthritis symptoms of the feet are often treated with NSAIDs and DMARDs. Natural remedies are also gaining traction with this disease as well. In the following section, we will discuss various remedies you can do at home for self-treatment and prevention.
Psoriatic Arthritis Home Remedies of the Foot
If you are suffering from foot pain associated with psoriatic arthritis, you can practice lifestyle changes that will make your everyday life more comfortable.
- Decrease any activities that are aggravating the pain – including running or any other type of repetitive movements. Consult with your physician and seek out activities that are beneficial but do not exacerbate the arthritis symptoms.
- Engage in regular stretching exercises – especially ones that are focused on where the joint pain is occurring (i.e., if you are living with plantar fasciitis, you can engage in exercises that stretch the plantar fascia)
- Orthotics – use shoe inserts to provide more comfort to your feet while you walk, especially ones that give support to the arch of the foot and the heel
- Night splints – wearing splints at night can help stretch the tendons while you sleep to reduce stiffness and pain
- Take frequent breaks – rest often, especially if you’ve been on your feet for a long time and they are starting to ache
- Go to a podiatrist – and seek advice for the type of shoes and inserts you should be wearing
- Buy wide width shoes – this allows for room for your feet when there is swelling
- Buy shoes with ankle support – this stabilizes the ankle, decreases pain, and reduces that chances of rolling the ankle
- Massage the foot – to increase circulation and alleviate pain
- Soak your feet – using Epsom salts
- Use clear or light toenail polish – darker colors mask nail changes
Joint stiffness is very common in psoriatic arthritis. The most common times that joint stiffness affects the feet is in the evening or after being on your feet for long periods of time. Swelling and pain can occur due to walking, requiring rest with your feet elevated. Shoes that are the wrong style or do not fit well may need to be changed.
Foot deformities can occur fairly rapidly. So treatment should be started as soon as possible after the diagnosis is made. Joint damage can occur as soon as six months after the onset of psoriatic arthritis. Deformities can include clawed toes, inrolling of the ankles, and hyperextension of the big toe.
Hand and Foot Care Tips
Whether it is your hands, your feet, or both; psoriatic arthritis can cause painful symptoms that flare-up and affect your ability to engage in everyday activities, affecting your quality of life. It’s important to seek your doctor’s advice on medications and other treatment options that will help alleviate the pain and inflammation. The tips provided below are useful as a supplement to treatments prescribed by your doctor.
- Cold compresses – can work wonders to alleviate painful joint swelling. You can use an ice pack or a pack of frozen vegetables. If the cold is too much for you, place a towel in between the cold and your skin. Alternating between 10 minutes of cold and 10 minutes off is the generally prescribed activity for optimal benefit.
- Use a foam roller or frozen water bottle – especially to massage the arch of your foot, your heel, or your wrist. The cool of the frozen water bottle is an added benefit to reduce swelling as you roll.
- Maintain your nails – because nail psoriasis occurs in over 80% of cases of psoriatic arthritis, keep your nails healthy. Trim them regularly, file them to decrease snags, and moisturize to reduce dead skin.
- Watch your cuticles – when maintaining your nails, or getting them professionally maintained at a nail salon, don’t push back your nail cuticles or use a cuticle trimmer. Doing so can cause tiny tears in your cuticle. Skin injuries, even as minor as this, can trigger flare-ups of psoriatic arthritis symptoms and may increase your chance of infection (especially if you are taking immune-suppressant drugs to treat the disease).
- Soak your hands and feet (but not for too long) – engaging in a hand or foot soak can alleviate pain and swelling. However, don’t soak for too long as it can dry your skin out, making your psoriasis worse. Always make sure to moisturize your skin after soaking.
- Choose your shoes wisely – in addition to wearing wide-width shoes, open-toed shoes are also recommended for individuals living with psoriatic arthritis. This gives room for your toes should inflammation occur. Avoid shoes with a pointy toe box and high heels, which can push toes forward and cramp them.
- Stay dry – fungus grows in damp conditions. Wear moisture-wicking socks. And keep your shoes dry – look for materials that are breathable. If your shoes are wet, let them dry and air out before putting them back on.
The 5 Types of Psoriatic Arthritis
Up to 30% of people with psoriasis will develop psoriatic arthritis, an autoimmune disease that can lead to pain, swelling, and stiffness in the joints. Psoriatic arthritis is generally divided into five subtypes, depending on which joints are affected and how many. But the system isn’t perfect. For instance, the five types don’t take into accountsymptoms such as dactylitis (when the fingers and toes swell into sausages) and enthesitis(inflammation of areas near the tendons and ligaments). You can also have one type of psoriatic arthritis initially only to develop a different type later on. Still, says Namrata Singh, MD, clinical assistant professor of medicine at the University of Iowa Carver School of Medicine, the types provide a good “bird’s eye view” of the condition and can also help guide therapy. Here, the five forms of psoriatic arthritis patients should know about.
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Asymmetric oligoarticular psoriatic arthritis (sometimes referred to as simply asymmetric psoriatic arthritis)affects about a third of people with the condition.It’s “asymmetric” because a joint on one side of the body can be affected while the mirror-image joint on the other side remains healthy.Although this type can affect any part of the body,it usually impacts no more than four or five joints.
Also known as symmetric psoriatic arthritis, this is the most common form of the condition and accounts for about half of all cases.This type is “symmetric” because it affects the same joint on both sides of the body, much like rheumatoid arthritis. It usually impacts five or more joints which, again, can be anywhere on the body.
Distal interphalangeal predominant
About 20%of psoriatic arthritis cases involve the body’s distal interphalangeal joints,meaning those at the ends of the toes and fingers. Because these joints are closest to the nails, symptoms can include nail changes such as spotting, pitting, or separating from the nail bed.
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In spondylitis, inflammation reaches the spine, causing stiffness as well as pain and difficulty moving the neck, lower back, and sacroiliac joints, which are the joints between the sacrum (the bone that supports the spine and is connected to your tailbone) and the pelvis.This type can also affect joints in the arms, legs, hands, and feet.
The most severe form of psoriatic arthritis, arthritis mutilans accounts for about 5% of cases and can seriously damage the joints in the hands and feet. Over time, it can lead to “telescoping” of the digits, when the fingers and toes become shorter, and can also contribute to bone loss. “Hopefully, we are seeing less and less because therapies are working well,” says Dr. Singh.
Psoriatic arthritis is a condition involving joint inflammation (arthritis) that usually occurs in combination with a skin disorder called psoriasis. Psoriasis is a chronic inflammatory condition characterized by patches of red, irritated skin that are often covered by flaky white scales. People with psoriasis may also have changes in their fingernails and toenails, such as nails that become pitted or ridged, crumble, or separate from the nail beds.
Signs and symptoms of psoriatic arthritis include stiff, painful joints with redness, heat, and swelling in the surrounding tissues. When the hands and feet are affected, swelling and redness may result in a “sausage-like” appearance of the fingers or toes (dactylitis).
In most people with psoriatic arthritis, psoriasis appears before joint problems develop. Psoriasis typically begins during adolescence or young adulthood, and psoriatic arthritis usually occurs between the ages of 30 and 50. However, both conditions may occur at any age. In a small number of cases, psoriatic arthritis develops in the absence of noticeable skin changes.
Psoriatic arthritis may be difficult to distinguish from other forms of arthritis, particularly when skin changes are minimal or absent. Nail changes and dactylitis are two features that are characteristic of psoriatic arthritis, although they do not occur in all cases.
Psoriatic arthritis is categorized into five types: distal interphalangeal predominant, asymmetric oligoarticular, symmetric polyarthritis, spondylitis, and arthritis mutilans.
The distal interphalangeal predominant type affects mainly the ends of the fingers and toes. The distal interphalangeal joints are those closest to the nails. Nail changes are especially frequent with this form of psoriatic arthritis.
The asymmetric oligoarticular and symmetric polyarthritis types are the most common forms of psoriatic arthritis. The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body, while the symmetric polyarthritis form affects the same joints on each side. Any joint in the body may be affected in these forms of the disorder, and symptoms range from mild to severe.
Some individuals with psoriatic arthritis have joint involvement that primarily involves spondylitis, which is inflammation in the joints between the vertebrae in the spine. Symptoms of this form of the disorder involve pain and stiffness in the back or neck, and movement is often impaired. Joints in the arms, legs, hands, and feet may also be involved.
The most severe and least common type of psoriatic arthritis is called arthritis mutilans. Fewer than 5 percent of individuals with psoriatic arthritis have this form of the disorder. Arthritis mutilans involves severe inflammation that damages the joints in the hands and feet, resulting in deformation and movement problems. Bone loss (osteolysis) at the joints may lead to shortening (telescoping) of the fingers and toes. Neck and back pain may also occur.
Symptoms and treatment of psoriatic arthritis rash
Many different treatments are available for people with a psoriatic rash. The choice of treatment will depend on the type and severity of the rash. Different people respond to different medications, and some people may require a combination of treatments.
Treatment options for a psoriatic rash include:
Doctors usually recommend topical treatments for mild or moderate psoriasis. These may include the following:
- Emollients are non-cosmetic moisturizers that help protect the skin and reduce dryness, itching, and scaling.
- Topical steroids vary in strength, and stronger topical steroids require a prescription. These creams and ointments work by reducing inflammation and slowing skin cell growth.
- Vitamin-D analogs work by slowing skin cell growth, and they can help remove scales and flatten thick plaques. Doctors often prescribe these in combination with topical steroids.
- Topical retinoids are a synthetic form of vitamin A, and doctors often prescribe them in combination with topical steroids. Retinoids help slow skin cell growth, decrease scaling, and reduce thick skin patches. Women who are pregnant should avoid retinoids.
- Coal tar comes in the form of shampoos, foams, and ointments, which are available over the counter. These medications can help reduce itching and scales.
- Calcineurin inhibitors include tacrolimus ointment and pimecrolimus cream. Doctors sometimes prescribe these medications to treat psoriasis, particularly plaque psoriasis on the face or inverse psoriasis.
Also known as phototherapy, light therapy uses ultraviolet (UV) light to treat a person’s skin. Light therapy usually takes place in a hospital or a special center, and a person may need two to three sessions a week for it to be effective.
Doctors often prescribe light therapy in combination with some topical treatments.
Light therapy can be beneficial for people with:
- nail psoriasis
- psoriasis on the palms of the hands and the soles of the feet
- scalp psoriasis
- thick plaques
- large areas of psoriasis
Different types of light therapy are available, including:
- Ultraviolet B (UVB) therapy. UVB therapy requires a person to stand in a light box and receive a dose of invisible light.
- Laser treatment. A doctor delivers high doses of light directly to the affected areas of a person’s skin.
- Psoralen plus ultraviolet A (PUVA). For this treatment, a person either takes a psoralen tablet or soaks in a bath containing psoralen. This chemical makes the skin more sensitive to UV light.
- At-home treatment. The individual uses a light box or handheld device at home.
Light therapy is a good option for people who cannot use other forms of psoriasis treatment. These people may include:
- pregnant and breastfeeding women
- people with a weakened immune system or an infection
Doctors do not recommend light therapy for people who:
- have or have had skin cancer
- have medical conditions that make them sensitive to UV light, including lupus and porphyria
- are taking medications that can increase their sensitivity to UV light, including certain antibiotics, diuretics, and antifungals