PSA and bone health/healing
Broke my ankle three weeks ago. Over the past 12+ years I've broken several toes and three fingers. The toes (earliest of the broken bones) took over six months to heal. The fingers (broken in the past five years) took 6-12 months to heal. After the last one which was still swollen and discolored 12 months later, I spoke with a PA who deals with a lot of autoimmune patients and she believes that immune issues, especially coupled with arthritis (RA, PSA) can delay bone healing, especially when the inflammation takes so much longer to diminish.
I'm inclined to agree with her given my own experiences.
Yesterday (and the past three visits) when I've attempted to discuss this with the Orthopedic doc, I was met with a smirk and the suggestion that at my age I should be scanned for osteoporosis.
Does anyone know of any studies on PSA and bone health/healing?
In spite of my last injection (May 2😎, plus ibuprophen, ice, and elevation, the swelling has not gone down at all. And yesterday's x-rays showed no bone growth at the break.
What I want to do is take the boot off at night and use lidocaine to help reduce the swelling, which worked wonders on my last broken finger, but this was also met with a very firm, "Don't take off the boot except to shower."
And I'm supposed to be starting physical therapy a week from tomorrow because "your ankle is too stiff." Well of course it's too stiff, it's swollen up like a softball!
I'm so over this. Any information on studies that will back up my theories would be greatly appreciated!
I am so sorry to hear that you broke your ankle. I hope that you get to feeling better soon. 
oh my gosh, that must be so frustrating. I am not sure about studies regarding this, do you think that you could get a rheumatologist to back up your feelings or experience on this? It is so difficult when a doctor is dismissive or does not hear and address your concerns. I don't imagine how you must start pyshio if the bone has not healed yet.
We are here for you.
Warmly, Clair ( Team Member)Hi
! Recovery is going well. I only went to one PT appointment - she was helpful and I've been doing the exercises, but I think the biggest help has been actually using the ankle. She told me the bone isn't a "load bearing" bone - yes, it does carry weight to some degree, but putting weight on it won't cause additional damage (as long as I don't twist it or put weight while bending it).
So for the past few weeks I've been walking around the house without the boot, using a crutch as needed, and flexing it regularly while sitting at my desk working. Each day it seems to get a little stronger. It's still discolored and still a bit swollen, which I think can be attributed to PsA as much as the actual break, but I'm getting around a lot better than I was even three weeks ago. I'm careful, of course, and I use a crutch on the steps or while outside. I also wear the boot when I have to go anywhere just in case I were to trip or have to walk on an uneven surface, or have to walk further or stand longer than anticipated. If I overdo it, I elevate and put ice on it, but I'm being pretty careful. I also have a small splint that I put on and put a muck boot over it that allows me to take care of the chickens and go pick vegetables from my garden, which has really helped - both physically and my state of mind. Just being able to get outside has been tremendous!
I just have to accept that it's going to take longer to heal than it would most people and keep doing what I'm doing.
Hope all is well with you!I wanted to circle back and see how you are doing at the moment? Has there been any significant improvement since we last spoke? I hope so.
Warmly, Clair ( Team Member)
, oh my goodness, I actually hate that dismissive smirk that comes in response to us sharing our experiences/theories. It feels extremely belittling. I'm sorry that this orthopedic doctor wasn't receptive to your input. I was able to find lots of studies on RA and delayed wound healing, but not much on PsA (which isn't surprising as it sometimes feels like PsA is a bit neglected when it comes to research). I did find the following brief abstract which mentions poor wound healing as a potential complication of surgery, associated with PsA: https://journals.lww.com/jaaos/abstract/2012/01000/psoriatic_arthritis.4.aspx I'm hoping someone else may be able to find something useful for you. I did notice that our lovely Cynthia mentioned taking longer to heal from various physical traumas in the following article: https://psoriatic-arthritis.com/living/delay-everyday-tasks Hoping your ankle feels much better soon. It sounds awfully painful. Soft hugs! -Catherine, Community Moderator Hey Catherine!
The PT session was better than I expected. She started me on some small muscle movements in my foot to build strength and said we'll work up to being weight-bearing. The exercises aren't painful, just slight difficult due to not using them for over a month. She wants to see me weekly.
She did say that I likely still won't be able to drive a week from now, when I was supposed to be going to my class reunion and to visit my oldest friends. I'm a bit crushed about that and trying to figure out a way to make it work.
I hope things are going well with you. How's the fatigue and pain? Have you managed to enjoy any yoga? 😁, oh I am relieved that the PT session was better than expected! Getting those smaller muscles moving again sounds like a good idea. Hopefully strengthening those muscles might take some of the strain off of your ankle whilst it heals too? It's good to hear that they aren't painful anyway. You've reminded me - I need to get back into a routine of doing strength exercises for my feet again. My plantar fasciitis has been playing up a bit again lately.
Oh that is upsetting about the trip you had planned 😢 Is there anyone else going from anywhere near you? I hope you can find a way to go. It's so disheartening when things like this happen. Not only do we have to deal with the pain/inconvenience of the injury/symptom, but we also have to deal with its effect of getting in the way of things we want to be doing. Ugh! Sending all the positive vibes for finding a solution.
I haven't enjoyed any more yoga (or done any either 😉). Still feeling a bit rough with the fatigue but hoping to maybe do something tomorrow. Either the yoga or perhaps walk over to the beach (it's just at the end of my road). We'll see! Have you noticed any effect on your fatigue levels and PsA pain with the ankle injury? Hoping the weekend treats you kindly! -Catherine, Community Moderator
Have you had a bone scan? Having PsA puts one at greater risk for osteopenia, so it's a short ride to osteoporosis. I fractured my sacrum in 2022, and subsequently was diagnosed with prednisone induced osteoporosis. I've since increased my bone mass, and an back to a state of osteopenia, hoping to have even better bone mass at my next scan in August.
1,000-1,200 mg dietary calcium a day, and calcium supplements when I am unable to meet that goal. My diet includes a lot of low fat and non fat dairy, and I take magnesium, K2, and get lots of D by spending time outdoors. I also do resistance training; lunges, stair steppers, squats with light weight, and other body weight resistance exercises. thank you!
