How Does Psoriatic Arthritis Affect the Feet?

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Psoriatic arthritis (PsA) is a chronic condition that creates inflammation in the joints. Because each foot has 26 different bones and 30 joints, it is a prime target for pain in people living with PsA.1

PsA causes problems for the feet, ankles, heels, toes, toenails, and the arch of the foot. This can lead to pain and difficulty walking. Symptoms can occur in only one foot or both feet at the same time.1

What are the symptoms?

PsA affects the feet in several ways. The initial symptoms are pain, swelling, warmth, and stiffness. Stiffness and swelling can make walking and standing difficult.2

Inflammation in the joints, as well as in the attachment points of the tendons and ligaments (enthesitis), can cause the following symptoms:1,2

  • Dactylitis – The joints in the toes become inflamed, causing the toes to swell and giving them a sausage-like appearance.
  • Plantar fasciitis – A thick band of connective tissue that runs from the bottom of the heel to the toes becomes inflamed. It causes pain in the arch of the foot or pain in the heel. The pain is often worse in the morning or after a period of inactivity.
  • Achilles tendonitis – Inflammation, heat, and pain in the tendon run from the heel up to the calf. The pain may improve slightly with initial activity but worsens with exercise.
  • Bone spurs – Bony growths may form due to the inflammation of the tendons and ligaments. Bone spurs can fuse to joints, leading to mobility problems and deformity. They are more likely to form from other conditions like osteoarthritis, but they are sometimes related to enthesitis.
  • Nail changes – PsA can affect the toenails and fingernails as well. Pitting, thickening, lifting of the nail from the nail bed, and pain are common symptoms of PsA.

How is it diagnosed?

If you are experiencing any pain or swelling in your feet, see your doctor or a rheumatologist. They will examine your feet, and they may perform diagnostic tests to rule out other medical conditions like gout or rheumatoid arthritis.2

How is PsA in the feet treated?

As with most symptoms of PsA, treating the foot begins with treating the underlying disease. For mild cases of PsA and minor foot pain, non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling. Steroid injections can help as well.1,2

For moderate to severe foot pain, systemic treatments that target joint disease can reduce symptoms and prevent progression of your PsA. Recommended treatment options may include:1,2

  • Disease-modifying anti-rheumatic drugs (DMARDs) – DMARDs are drugs that help reduce symptoms and prevent or slow joint damage.
  • Biologics – These are drugs that fight the inflammation that comes with PsA.
  • Anti-tumor necrosis factor (TNF) agents – These drugs also work to stop inflammation. Anti-TNF agents are a possible treatment method if DMARDs or biologics are not working.

Besides drug treatment, there are other lifestyle habits you can adopt to help with your overall health and foot pain. Here are some to try:1-3

  • Exercise. Regular, gentle exercise can help relieve stiffness and maintain range of movement. Try low-impact activities such as swimming and walking.
  • Use hot and cold treatments. Try wrapping your feet in warm towels or heat packs, or soak your feet in a hot bath. Heat can help with sore joints. A cold compress, ice pack, or cold bath can be used to reduce swelling.
  • Consider losing weight. If you are overweight, losing weight can help ease the pressure on your feet.
  • Adopt an anti-inflammatory diet. Reduce the amount of sugary, highly processed foods you eat. These can create inflammation in the body. Instead, opt for a balanced diet of lean protein, whole grains, and lots of vegetables. The Mediterranean diet is a great diet for people with PsA.
  • Wear comfortable shoes. Avoid high heels. They can cause added stress on the heels, arches, and toes. Open-toed shoes or shoes with a large toe box can provide more room for swollen toes. Add cushioned shoe inserts, or wear thick soles with extra cushioning to give your feet extra support.

If you have PsA and start to experience foot pain, talk to your doctor about treatment options. They may recommend drug treatment along with non-drug therapies like regular exercise and physical therapy.1,2

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