“Psoriatic arthritis can affect the joints of the feet and ankles, and it can also affect the structures that support those joints,” says M. Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic in Ohio. Roughly 50 percent of people living with psoriatic arthritis experience enthesitis, which refers to inflammation of the entheses (located where ligaments or tendons connect to bones), according to the National Psoriasis Foundation (NPF). Common locations for enthesitis include the bottoms of the feet and the Achilles tendon. Pain and stiffness caused by enthesitis may start even before joints are affected. If you’ve been diagnosed with psoriasis, let your doctor know if you experience any stiffness, pain, swelling, redness, or other symptoms in one or both feet or ankles — signs you may have developed psoriatic arthritis and enthesitis. Nearly one-third of people with psoriasis also have psoriatic arthritis, according to the NPF. Not everyone with psoriatic arthritis develops psoriasis first, though, and some people with psoriatic arthritis never get psoriasis. 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. Psoriatic arthritis feet problems may include: Plantar fasciitis Located on the bottom of the foot, the plantar fascia is a dense band of connective tissue, or ligament, connecting the heel to the front of the foot. Plantar fasciitis is inflammation of this band of tissue, which can cause pain in the sole of the foot, explains Husni. Plantar fasciitis with a heel spur (a bony growth that often occurs with plantar fasciitis) is a common cause of psoriatic arthritis foot pain. You may feel pain on the bottom of the foot near the heel, especially when you take your first steps in the morning. Achilles tendinitis Enthesitis that affects the area where the Achilles tendon attaches to the bone is known as Achilles tendinitis. This condition causes psoriatic arthritis 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 Sometimes referred to as “sausage digits,” dactylitis is the swelling of the tendon that runs along the length of a toe or finger. “This swelling can make toes or fingers look like sausages,” explains Husni. About 40 percent of people living with psoriatic arthritis experience dactylitis, according to the NPF. The condition is more likely to affect toes than fingers. Nail and skin changes People with psoriasis and psoriatic arthritis may have a form of skin psoriasis called pustular psoriasis, which can be characterized by small, pus-filled bumps and redness and tenderness on the soles of the feet. Psoriatic nail disease can cause toenails to become pitted or start to lift away from the nail bed, says Husni. Foot deformities When untreated, psoriatic arthritis can lead to long-term foot changes. These include shortened or clawing toes, upward bending of the big toe, and some in-rolling of the ankle with flattening of the metatarsal arch (the transverse arch at the ball of the foot), according to the Psoriasis and Psoriatic Arthritis Alliance.
How to Relieve Psoriatic Foot Symptoms
Treating psoriatic arthritis symptoms in feet will include many of the therapies used in managing psoriatic arthritis elsewhere. The aim of therapy is to reduce inflammation and psoriatic arthritis pain and avoid permanent disability. Treatment can range from occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs) to more powerful drugs like disease-modifying anti-rheumatic drugs (DMARDs) and biologics, explains Husni. Self-management is another key component of caring for psoriatic arthritis feet. Try these 10 simple strategies to help your feet feel — and look — their best.
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. They can provide specialized foot care and advise you about the best footwear for psoriatic arthritis feet.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. Shoving feet into shoes without any wiggle room means you’re putting constant pressure on nails and joints, which can increase pain and nail problems, says the NPF.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,” says Husni.Look for ankle support. If you have weakness or psoriatic arthritis pain in your ankles, get shoes with high ankle support or consider ankle splints.Do some stretching exercises for psoriatic arthritis. Try lying flat with your feet extended off the end of the bed. Holding your legs 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.Try out a cane or crutches. If you’re going through a painful foot flare, consider using a cane or crutches until inflammation subsides.Massage your feet. To ease plantar fasciitis pain, try rolling the bottom of your foot back and forth across a water bottle (this works best if the water is icy cold or frozen), recommends the Arthritis Foundation.Try a foot bath. “Foot soaks can help relieve pain,” notes Husni. “You can do a hot soak or a cold soak — whatever feels better.”
Additional reporting by Julia Califano.
