How Does Psoriatic Arthritis Affect Your Feet?

Every person experiences psoriatic arthritis (PsA) differently, but if you have this chronic inflammatory condition, your feet will likely be affected, too. As many as 50-70% of people with PsA will have foot abnormalities, and 65% will experience swelling in their toes (dactylitis).

When you have psoriatic arthritis (PsA), your feet may be the first place where you start to see symptoms. Having painful, swollen toes is a common sign of the condition. One or more of your toes may appear enlarged or sausage-shaped, called dactylitis. You may also have some swelling in your ankles.

It is also common for your toes to look shortened or claw-like and for your big toe to hyperextend, pointing up or slightly backward. The arch of your foot may flatten, and your ankle may roll inward, putting stress on the outside of your foot.

Some people also get corns over the interphalangeal joints, which are the joints between the bones of the toes. You may have psoriasis patches on your feet that look similar to psoriasis on other areas of your body.

In addition, nail changes like onychomycosis (toenail fungus) are common in PsA. This can result in toenails that are thick, crumbling, break easily, or have a bad odor.

If your PsA affects your feet, they may ache, swell, and feel uncomfortable or painful. Your mobility may be affected, making it difficult to walk and move around. Other signs and symptoms may include:

• Warm, swollen toes that are sausage-like
• Swollen, tender ankles
• Pitted, tender nails that separate from the nail bed
• Achy heels or soles similar to plantar fasciitis
• Painful red patches or white buildup
• Stiffness in your feet and ankles
• Painful calluses or sores on the joints
• Locking feeling in the joints
• Pain when walking or standing for a long time

Your foot contains 26 bones and 33 joints that are tied to various muscles, ligaments, and tendons. Inflammation can occur in any of these spots, making walking or standing for long periods uncomfortable. Your shoes may feel tight due to the swelling or may not fit properly due to the changes in your toes. 

If your PsA is not properly managed, it can lead to long-term joint damage, affect your mobility, and reduce your overall health and quality of life. You may also experience plantar fasciitis and pain in your Achilles tendon.

PsA can be a fast-moving, widespread condition, significantly impacting health and longevity. People with PsA have an increased risk of death from heart-related conditions like angina (chest pain) and heart attack. They are also more likely to have metabolic syndrome, depression, and heart disease. Maintain your health and follow your treatment plan so you can improve foot function and stay active. 

There is no single test to diagnose PsA in the feet. Instead, your healthcare provider will use a variety of tests and exams to diagnose your condition. In addition to a physical exam, they may look at your medical history, take X-rays and other images, and perform some bloodwork.

During the physical exam, your doctor will look at your feet for joint pain, swelling, warmth, tenderness, and changes to the skin and nails. They may also order X-rays to view your bones and joints.

They may order blood tests, like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), to look for inflammation. Other tests, like rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), are used to rule out rheumatoid arthritis.

Tests around the joints can also help rule out gout or an infection. Looking at all of this information together, the doctor will be able to determine if you have PsA in your feet.

Because PsA is not curable, a treatment plan will likely focus on managing symptoms. Here are some treatment options your healthcare provider may discuss with you:

• Take medications as prescribed: Your healthcare provider may recommend or prescribe medications to alleviate your pain and prevent your PsA from getting worse. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) to address pain and inflammation, disease-modifying antirheumatic drugs (DMARDs) to slow the progression, and biologics that affect your immune system. 
• Corticosteroid injections: In some cases, your healthcare provider may recommend these steroid injections to help reduce inflammation and improve mobility. These shots are strong inflammation-fighting drugs that are injected directly into the affected joints.
• Manage your weight: Because your feet must support your weight, you may be able to reduce some pain and inflammation by maintaining a weight you and your doctor have determined is healthy for you. If you are overweight or obese, losing weight can help reduce the strain on your joints and improve your body’s response to medications.
• Prioritize low-impact exercise: Experiment with different types of exercise to see what works for you. Activities that tend to put less pressure on the joints include yoga, swimming, cycling, water aerobics, or tai chi.
• Wear supportive footwear: Talk to a healthcare provider, like a medical doctor specializing in foot and ankle conditions known as a podiatrist, about what type of footwear you should purchase. Wearing supportive, well-fitting shoes can reduce the stress and strain on your feet.
• Ask about foot soaks: While evidence is mixed, some people find that soaking their feet in Epsom salts relieves and reduces pain. Talk to your doctor before using a foot soak.
• Avoid smoking: Research shows that people who smoke tend to have worse symptoms than those who do not. If you are having trouble quitting, talk to your healthcare provider about options that may help.
• Get support: Having PsA in your feet can feel frustrating and overwhelming, so consider joining a support group or seeing a therapist to learn how to manage any negative thoughts and feelings you may have.

At least half of the people with PsA will experience symptoms in their feet, such as swelling, pain, and tenderness. You also may have painful red patches, stiff feet and ankles, painful calluses or sores on your joints.

Unmanaged PsA on the feet can affect your longevity and quality of life. You are also at a greater risk of depression and heart-related issues. To manage your condition, follow your healthcare provider’s advice. This includes taking the medications recommended or prescribed, managing your weight, exercising consistently, and getting support.