Psoriatic arthritis (PsA) can cause swelling, decreased mobility, and nail changes in your toes. You can support your toe health by following your PsA treatment plan and adopting some home treatments.

Psoriatic arthritis (PsA) is a form of arthritis in people with psoriasis. Like arthritis, it can cause joint pain, swelling, and stiffness. It can also feature the scaly plaques common in psoriasis.

PsA can affect joints throughout your body, including your toes. This can cause discomfort and problems with mobility.

Keep reading to learn more about the specific ways in which PsA can affect your toes and what you can do to manage symptoms.

PsA can cause distinct symptoms in your toes. There may be changes in the size or shape of your toes. You may also see changes on the surface of the toenail or the nailbed.

Swelling (dactylitis)

Dactylitis is when an entire digit, such as a finger or toe, swells due to an underlying condition or inflammation.

PsA can cause “sausage toes,” a type of dactylitis with severe and uniform swelling. It may be hard to tell whether the toe joint or other tissue is inflamed.

Dactylitis of the toes can be either acute or chronic.

With acute dactylitis, your toe may be swollen and tender. It may appear discolored, for example, reddish on lighter skin.

With chronic dactylitis, your toe may not be tender but may be swollen. This is also called “cold” dactylitis.

Dactylitis is also a sign of enthesitis, or swelling of the entheses. These are areas of your body where tendons and ligaments enter bone. According to the Arthritis Foundation, 1 in 3 people with PsA develop enthesitis.

Pitted toenails (nail psoriasis)

PsA can cause many changes in your toenails. In rare cases, it can lead to nail loss.

Signs of psoriasis in the nails include:

The most common sign of psoriasis in your nails is nail pitting. These small dents are of even size and depth but may have a random arrangement.

Not all nail pits are from psoriasis or PsA. Ten pits in one fingernail or toenail or more than 50 pits combined in all nails are evidence of psoriasis.

A rarer form of nail psoriasis called acrodermatitis continua of Hallopeau (ACH) can lead to severe symptoms if not treated. ACH is more common in fingernails than toenails. In either case, it can lead to the complete loss of the nail and osteolysis (loss of bone tissue) in the digit.

Hammer toes

PsA can cause toes to shorten or take on a claw-like appearance. This is called hammer toe, where the toe is bent at the middle joint.

Hammer toes come with signs and symptoms such as:

  • changes in the color of your toe
  • pain while walking
  • trouble straightening your toe

Wearing shoes that cover your toe can lead to corns or calluses on the toe with the bent middle joint, as it rubs against the interior of your shoe.

PsA is a treatable condition. You can manage its effects on your toes with medical treatment and lifestyle measures.

Follow your PsA treatment plan

Treating PsA overall can reduce symptoms in your toes. Your doctor may have already prescribed a course of disease-modifying antirheumatic drugs (DMARDs) or biologics for long-term management. You may also take over-the-counter anti-inflammatories like ibuprofen for temporary symptom relief.

Choose exercise that’s easy on the joints

Staying fit can help keep your joints flexible. It can also help to maintain a weight your joints can handle without putting extra strain on the toes. Consider joint-friendly exercises like swimming, water aerobics, and gym equipment like stationary bikes and ellipticals.

Use cold therapy

Cold can reduce inflammation. Apply cold packs or a bag of frozen vegetables covered in a cloth to your toes for 10 minutes at a time. This can help reduce the swelling and pain associated with PsA in the toes.

Wear comfortable and supportive shoes

Opt for open-toed shoes when you can to prevent crowding of swollen toes. Shoes with proper support and cushioning can help ease heel pain.

Consider custom orthotics

Orthotics tailored to your individual foot needs may help ease foot pain. A small 2022 study of 20 people with PsA found custom orthotics provided some pain relief and improved foot function.

Trim your toenails

Short toenails can help prevent the nail from scratching the surrounding tissue and causing a flare. Cut your toenails to keep them in check, but don’t trim them so short they cause bleeding.

When to contact a doctor

Speak to your doctor if your PsA toe symptoms are severe or don’t get better with lifestyle measures and home treatment. Your doctor may recommend remedies like:

  • antifungal medications if you have a nail fungal infection
  • cortisone injections to reduce swelling
  • changes to your PsA treatment plan

PsA can cause swelling of the toes and pits in the toenails, among other symptoms. Following your PsA treatment plan and using home remedies like cold therapy can reduce inflammation and help prevent flares. Your doctor can prescribe other medical treatments if symptoms are severe.