Psoriatic arthritis (PsA), a chronic inflammatory form of arthritis, can affect the feet, causing severe pain, stiffness, and swelling. While there’s no cure, PsA is treatable, especially when diagnosed early. Up to 30 percent of people with psoriasis may develop PsA, according to the National Psoriasis Foundation.
Members of MyPsoriasisTeam whose feet have been affected by psoriatic arthritis struggle with inflammation and deformity, making it hard to walk or move. Because psoriatic arthritis often appears between the ages of 30 and 50, developing this condition in the feet, ankles, and toes has been life-altering for many members.
Psoriatic arthritis in the feet frequently causes mobility issues, particularly during a flare. “My boyfriend got me a wheelchair for the days it hurts too much to walk. It was nice on his part, but makes me feel like I’m an invalid,” shared one member. Another said, “I periodically use a walker to take some weight off my feet.”
Coping with pain and limited movement has taken an emotional toll on many members: “I’m too young to feel this way, and now I have great depression and grief!” Another member said, “It’s frustrating trying to make people understand, and tiring trying to ‘act’ fine when you’re not. It helps to talk to others who ‘get it.’”
Psoriatic arthritis can inflame any of the foot’s 26 bones, 33 joints, and connective tissues that surround the joints. “I have so much pain where my toes and foot connect. Feels like a constantly moving charley horse in my foot,” said one member.
Similar to rheumatoid arthritis, joints may feel warm, sore, and tender. Members report that stiffness is often worse in the morning. “Getting out of bed, I have a lot of pain in my feet,” said one member. “I woke up with pain in my ankle. Thanks psoriasis,” said another member. Unlike rheumatoid arthritis, PsA often only affects one side of the body, so just one foot or toe may be affected.
Although PsA can develop slowly with mild symptoms, several members of MyPsoriasisTeam report rapid and severe onset. “I was diagnosed with psoriatic arthritis very quickly after discovering my first tiny sign of psoriasis, and unfortunately, it progressed quickly,” explained one member. Another said, “This disease came out of nowhere! I was literally fine, then boom, my feet started hurting and getting worse and worse.”
Psoriatic arthritis flares — on-and-off periods of worsening symptoms — can make coping with foot PsA even more challenging, say members of MyPsoriasisTeam. “Some days I am totally fine and other days, the flares are so bad I can barely walk,” said one member. “During a flare I need walking sticks to help me along,” said another.
Common PsA foot symptoms reported by members of MyPsoriasisTeam include swelling, pain where the tendons attach to the bone, and dactylitis (“sausage toes”).
Also known as “sausage toes,” dactylitis is one of the cardinal signs of foot PsA. Up to 40 percent of people with foot psoriatic arthritis experience swelling of the entire toe, making it hard to move or use it. Dactylitis usually indicates that PsA is getting worse. “My toes look like, ugh, sausages,” wrote one member. Another shared, “I have two toes with dactylitis that get quite sore at times. Seeing my podiatrist weekly helps.”
Swelling of tissues (entheses) that connect ligaments and tendons to the bone often causes foot discomfort in members of MyPsoriasisTeam. It most commonly affects the sole (called plantar fasciitis) or back of the heel (known as Achilles tendinitis). Enthesitis can make it hard to walk, run, or climb stairs.
“My Achilles tendons feel like they could separate from my bones! I’m in constant pain.” reported one member. “The enthesitis in my feet is awful. It feels like I could rupture my tendons if I pushed myself to do something,” lamented another.
Another common psoriatic arthritis foot symptom is swelling, sometimes accompanied by red or purple color on the skin. Swollen areas may be warm to the touch and extremely tender. MyPsoriasisTeam members report severe ankle swelling during humid weather or after standing too long.
Because there’s no definitive test for psoriatic arthritis in the feet — and symptoms are similar to other forms of inflammatory arthritis — some members of MyPsoriasisTeam go months, even years, before receiving a correct diagnosis. “My feet are my worst part, with so much pain in one deformed foot,” said one member who waited more than a year to get a diagnosis.
A 2018 study found about 30 percent of people with psoriatic arthritis waited more than five years for a diagnosis after symptom onset. “In my experience PsA can be difficult to diagnose unless you have all the standard symptoms,” pointed out one MyPsoriasisTeam member. “I was told if blood tests come back negative, it doesn’t mean you don’t have it.”
Early recognition, diagnosis, and treatment of foot PsA is critical to preventing disease progression. Delaying treatment by as little as six months can result in permanent joint damage.
Your doctor will take a medical history, and may order a physical exam, blood tests, an MRI scan, and X-rays of joints. They may also refer you to a rheumatologist, a doctor who specializes in arthritis. “I went to podiatrists and orthopedic doctors trying to figure out what was happening,” explained one member. “All of their treatments failed. My primary doctor took one look and said, ‘Something else is going on. I’m referring you to a rheumatologist.’”
Over-the-counter and prescription medications are available to treat psoriatic arthritis in the feet. They range from oral medications that reduce inflammation and swelling to injected or infused biologic drugs that help the immune system fight the disease. The medication prescribed typically depends on severity of symptoms.
It can often take several tries to find the right treatment, according to members of MyPsoriasisTeam. “Praying to find the right meds that will work for me long term. I’ve had many that work for a short time, but after a few months, they just stop working,” said one member.
Over-the-counter pain medications, such as ibuprofen (Advil or Motrin) and naproxen (Aleve), or prescription painkillers are typically first-line medications for temporary relief of PsA foot pain. This category of medication is also referred to as nonsteroidal anti-inflammatory drugs (NSAIDs). “When I get swelling accompanied by pain in my ankles, ibuprofen eases it for me,” said one member. Another, who uses celecoxib (sold as Celebrex) said, “I had swelling and inflammation on both big toes, but after two days on Celebrex, I feel a lot better.”
Disease-modifying antirheumatic drugs (DMARDs) alter underlying disease by suppressing the immune system to prevent permanent joint damage from PsA.
Types of DMARDs for psoriasis include:
“Otelza helped my PsA foot pain, but my stomach couldn’t tolerate it,” shared a member.
This class of drugs targets different pathways in the body that create inflammation. Types of biologics for psoriasis include:
“Humira and a small dose of methotrexate have been like a miracle helping my joints,” shared one MyPsoriasisTeam member.
Another member saw ankle swelling disappear initially with Stelara, but reported that it didn’t last.
Yet another member expressed frustration with Cosentyx: “My enthesitis keeps getting worse. That seems to be the general consensus, that none of the meds work — or work very long.”
Members of MyPsoriasisTeam also use several nonprescription treatments to alleviate PsA pain, including ice and topical painkillers, and lifestyle changes to their diet and exercise habits.
Always speak to your doctor before starting any new diet or exercise program.
Finding comfortable shoes is a hot topic among members of MyPsoriasisTeam. Crocs — with their wide shape and high toe box — are the footwear of choice for many. Others prefer Dr. Martens. “I’ve had a pair for 14 years that I swear by. They were originally made as an orthopedic shoe,” explained one member.
A podiatrist can advise on the best footwear and design a custom orthotic for individual foot issues. Heel pads can add cushioning and support, while compression socks may help reduce swelling. Night splints are also an option for preventing heel pain with plantar fasciitis. They keep the foot at a 90-degree upward angle while sleeping to gently stretch the fascia.
Doctors also recommend avoiding injuries to the feet. The Koebner response can cause psoriasis and PsA flares after an injury of any kind.
By joining MyPsoriasisTeam, the social network and online support group for those living with psoriasis and psoriatic arthritis, you gain a support group more than 109,000 members strong. PsA in the feet is a frequently discussed topic.
How do you take care of your feet with psoriatic arthritis? Comment below or start a conversation today on MyPsoriasisTeam. You'll be surprised how many others share similar stories.