How Psoriatic Arthritis Affects Your Feet

A common feature of PsA in your feet is the swelling of one or more toes. This condition is known as dactylitis of the toes. The swelling tends to affect your entire toe rather than a single joint.

Tenosynovitis (inflammation of the tendon sheath) is largely responsible for the swelling. It can give your toe a sausage-like appearance, sometimes referred to as “sausage toe.”

You may also notice swelling in your ankles or heels.

Swelling is sometimes accompanied by color changes, especially the development of a red or purple tint. Swollen areas may be warm to the touch and extremely tender.

People with PsA often develop a condition known as enthesitis, which is inflammation at the points where tendons and ligaments connect with bone. In people with PsA, enthesitis frequently affects the Achilles tendon, which is the hard band connecting your heel to your calf muscles.

You may experience tenderness and pain at the back of your heel or notice swelling in your ankle. You may also notice stiffness in your ankle in the morning or after periods of rest.

Enthesitis can also cause pain in the soles of your feet. The plantar fascia is a sheet of connective tissue on the bottom of your foot that attaches your heel to the front of your foot. It runs along the bottom of your feet.

If you have pain and tenderness at the bottom of your heel, especially after waking, this may be the cause.

Inflammation of this connective tissue is also known as plantar fasciitis. It’s a common condition in people with and without PsA.

Nail problems are common among people with PsA, especially those with nail psoriasis. You might notice that your nails have pitting, ridges, flaking, or discoloration or that they’re lifting from the nail bed (onycholysis). You might also find that you develop more bacterial or fungal infections in your nails.

Nail changes occur as a result of inflammation and cellular disruption caused by PsA.

The goal of treating PsA is to reduce pain and prevent permanent bone damage. Without treatment, your feet may become permanently damaged. A number of medications can help 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 your joints.
• Biologic agents: Biologics are a newer generation of arthritis drugs, formed through genetic engineering, that target inflammation in your body.

You may be able to manage PsA symptoms in your feet with the oral medications mentioned above, depending on the severity of your symptoms. These drugs treat inflammation throughout your body, including in your feet.

However, for severe flare-ups in your feet, you may want to consider a more localized approach such as:

• Cortisone injections: You can receive cortisone injections 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 reduce inflammation in the joints of your feet. You can try rolling your foot on a frozen water bottle wrapped in a towel or applying an ice pack to the affected area for 20 minutes. You can repeat the process 2–4 times per day.
• Medicated foot powders: Cracks in your nails or skin can provide openings for infections that can trigger PsA flare-ups. A medicated foot powder can help manage moisture while addressing fungus and bacteria.
• Night splints: A night splint prevents you from relaxing your plantar fascia while you sleep, which may help 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 and can help 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 flare-ups
• wearing shoes with high and wide 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 manage swelling
• making efforts to reach or maintain a moderate weight, which can help reduce stress on the joints in your feet

You’re more likely to experience flare-ups of PsA in the joints you use the most, which means your feet are a more likely area to be affected. If you’ve had previous fractures and sprains in your feet that have healed, those could also be a trigger.

There are a number of other known risk factors that can make you more likely to develop PsA in general, including in your feet. These include:

• consuming alcohol
• having obesity
• smoking
• being 30–50 years old
• having a family history of PsA
• having a history of psoriasis, gout, or uveitis
• having had previous throat inflammation or skin infections

All of the above can also trigger a flare-up of PsA. Other possible triggers include:

• experiencing stress
• stopping or skipping your medications
• taking certain other medications
• being exposed to cold temperatures
• eating certain foods, such as those containing gluten or dairy
• experiencing changes in your intestinal microbiome

Will I end up in a wheelchair with psoriatic arthritis?

Severe cases of PsA can be disabling, and if it affects your feet, it could affect your ability to walk. But, there are treatments that can help reduce the severity of symptoms.

What test confirms psoriatic arthritis?

To diagnose PsA, your doctor will order various blood tests to check for inflammation and the presence of certain proteins. They will likely also order imaging tests, such as X-rays or MRIs, so they can look at your joints.

What does a psoriatic arthritis flare-up feel like?

During a PsA flare, your symptoms can vary from joint pain, swelling, and stiffness to fatigue and inflammation in your eyes. You may experience fatigue and throbbing pain. Your tendons may hurt, and you might notice swelling in your fingers and toes, along with worsening skin issues.

PsA can lead to a range of uncomfortable symptoms in your feet. But, there are several medications that can help manage PsA symptoms.

You can also take steps at home to reduce pain and lower your risk of experiencing a flare-up. Talk with your healthcare team to learn more about supportive steps you can take to manage PsA.