How can psoriatic arthritis affect the feet?

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PsA can affect any of the 26 bones in the foot, plus the ankle bones and synovial membranes that surround the joints.

The condition can develop in just a few joints or in several. It can make the joint or joints it affects inflamed, sore, and tender.

The feet are among the body parts that PsA most commonly affects. 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
• dactylitis, also known as sausage toes or sausage digits, which is a condition that causes entire toes to swell up
• heel pain, similar to plantar fasciitis, which is inflammation in the Achilles tendon
• bending and shortening of the toes, making them look like claws
• overextending of the big toe
• painful calluses or sores over the joints
• flattening of the foot 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 the affected area turning red or purple

The joints that PsA affects typically get 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 of these phases. Treatment can prevent the condition from progressing.

In the later stages of the condition, the joints can become so damaged that the toe bones fuse together.

The diagnosis process for PsA can be complicated because the symptoms can be similar to those of other arthritic conditions, such as gout or rheumatoid arthritis.

The process typically begins when a person visits a doctor about pain in their joints. To determine the cause of the problem, the doctor may try:

• looking for a history of psoriasis, which is associated with PsA
• looking for pitting and other changes in the nails
• looking for signs of dactylitis, heel pain, and other symptoms of the condition in the feet
• using MRI, ultrasound, or X-ray scans to look for any PsA-related joint injuries
• using blood tests to rule out other types of arthritis

In addition, the doctor may also look for signs of asymmetrical joint pain. The joint pain of PsA 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.

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.

Medications

A treatment plan for PsA-related foot problems aims to reduce pain, lower inflammation, and prevent permanent damage to the joints.

Some medical treatments for symptoms in the feet and elsewhere in the body include the following:

• For milder pain, people can get nonsteroidal anti-inflammatory drugs over the counter or as a prescription medication from a doctor.
• A doctor can also prescribe corticosteroids as an oral medication or as an injection. These medications can reduce inflammation when the symptoms are more severe.
• There are also more powerful medications called disease-modifying antirheumatic drugs (DMARDs) for long-term use. People can get these as oral medications, injections, or infusions. DMARDs include traditional DMARDs, which target the whole immune system, and other types such as biologics, which only target specific parts of the immune system.
• A person can also try oral small molecule drugs, which are an alternative to biologics.

When the effects of PsA are severe, a person may need surgery.

Diet

Since psoriatic disease, which includes psoriasis and PsA, is an inflammatory process in the body, it may affect more than the skin, joints, or feet.

People who are prone to psoriatic inflammation may be more at risk of health issues such as obesity, higher cholesterol, higher blood pressure, heart disease, and insulin resistance. A person with PsA should consult a doctor and attend regular checkups to monitor their overall health.

In addition, a person may choose to eat a balanced diet and maintain a moderate weight. Foods that may help reduce inflammation include fish rich in omega-3 fatty acids, green tea, fiber-rich foods (such as beans), nuts, seeds, fruits, and vegetables.

At the same time, a person may wish to avoid foods that can trigger inflammation, such as processed meats, sugar, alcohol, white bread and rice, and fried foods.

Home remedies

In addition, some people with arthritis have also found the following remedies helpful:

• acupuncture
• massage therapy
• electrical stimulation
• aromatherapy
• visualization

As with many alternative healthcare practices, scientific research does not fully back up these techniques. People with psoriatic foot pain should consult a doctor before trying any of these remedies.

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, and this 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 help relieve pain and inflammation and prevent permanent damage to the joints for most people.