How to Cope When PsA Strikes Your Feet

Feet don’t fail us now…check out our heel-to-toe plan for when psoriatic arthritis targets your tootsies.

by Megan McMorris Health Writer

We don’t tend to think much about our feet until they start acting up—and with a whopping 118 bones and joints between the two of them, there are a lot of ways they can do just that. For those living with psoriatic arthritis (PsA), that can spell increased pain, swelling and tenderness. “No one really knows why psoriatic arthritis affects the feet so often, but we do know that the disease tends to attack the smaller joints, which makes the feet particularly susceptible, and it also can affect the area where tendons and ligaments attach to the bone,” says Doug Tumen, D.P.M., a podiatrist in Woodstock, NY, and author of Ask the Foot Doctor. “Podiatrists, in fact, can sometimes even be the first to have a clue that someone might have the disease.”

We asked experts how psoriatic arthritis affects your feet, plus their go-to pain-relieving strategies designed to put you back in action—stat.

Show Us Where It Hurts

There are a variety of ways that psoriatic arthritis can creep into your feet, but the most serious issue is with your toes. “Approximately 50 percent of patients with psoriatic arthritis will have what we call ‘sausage digits,’ where the toes are swollen,” says Delamo I. Bekele, M.D., a rheumatologist at the Mayo Clinic in Rochester, MN. “This is really important to treat aggressively, because the inflammation can become bad enough that it can actually cause structural changes in the joints, which can set you up for pain and deformity.” Tendons are another PsA hotspot, adds Dr. Bekele. The Achilles tendon at the back of your heel and the plantar fascia on the bottom of your heel are two main areas that can become swollen and inflamed. Tendons on the top of the feet and the ankle are also susceptible.

Generally less serious—but still annoying!—are the ways that PsA affects your skin and toenails. According to a study published in the journal Rheumatologia, 80% of PsA patients have “pitting,” which looks like small dents on the nails.
“This usually starts as a cosmetic concern, but there are complications that can occur, such as thickening of the nails which can become painful in shoes, or localized nail infections from pressure on the nail bed,” says Dr. Tumen. PsA can also impact the actual foot skin itself (typically on the bottom of the feet), which can lead to irritation.

Give Your Feet A Little Love

OK, so now that you know what you might be dealing with, we’ve got some good news: There are plenty of things you can do to treat your feet right. Here are a few ideas:

  • Use it or lose it. Make it your new routine to devote five minutes every morning and evening to a foot workout—rotating your ankle, pointing and flexing your feet, and dexterity exercises like picking up a pencil with your toes, for example. “Keeping mobility in your toes is so important to alleviate stiff, achy feet,” says Dr. Tumen.

  • Soak things up. Speaking of routines, adding a regular soaking regime to the mix before bed can also soothe inflammation. “Warm water with Epsom salts is a wonderful therapy for those with arthritic feet,” says Dr. Tumen. (Simply add about 1-2 cups of salts to your bath, and enjoy!)

  • Find roomy (and cushy!) footwear. “I recommend wearing well-cushioned running shoes, because they are designed to absorb the shock of running, so they will provide extra protection for those with PsA,” says Dr. Tumen. Look for a wide, round toe box to give your digits some wiggle room, he adds. (Brands like Brooks, New Balance, Altra, Oofos and Hoka are all good choices.)

  • Opt for orthotics. Customized orthotics—which your podiatrist will create specifically for your foot after analyzing your personal pain spots and gait—can go a long way toward soothing your soles. “They can help you offload a certain joint that has arthritis, and can accommodate your specific painful areas, which can really make a difference in your daily comfort.” If your insurance doesn’t cover the cost of more spendy customized ones, ask your podiatrist for recommendations on over-the-counter inserts.

  • Seek treatment sooner than later. The most important piece of advice is to do something about your foot pain. “Sometimes, people think, ‘Oh, I’ll just pop some Advils and wait it out,’ but the quicker you get rid of the flare-up, the less likely you are to have long-term damage,” Dr. Tumen says. “If you have a flare-up, call us, get it taken care of, and go back to your life. We can help put you into remission, relieve pain, and minimize long-term joint destruction.”

  • Build your own foot entourage. In addition to regular appointments with your rheumatologist—who can create your overall treatment plan and monitor your medications—adding a podiatrist to the mix when you have foot-related symptoms can provide a one-two punch. “If you have arthritis, you’re obviously going to have a rheumatologist, who is so important for your treatment and medication, but remember that a podiatrist is there for when you have a flare-up, and we can offer immediate pain relief,” says Dr. Tumen. “The most common pain-relieving treatment I give is corticosteriod injections, which will take the pain away either immediately or within a day or two.”

Above all, just remember: If PsA does decide to go after your feet, there is light at the end of the tunnel. “If there’s one thing I want people to know, it’s that you don’t need to suffer, or live with painful feet,” says Dr. Tumen. “By seeking early treatment, you can slow or stop the advancement of your arthritis, and it can even go into remission. It’s a myth to think you’re just going to be doomed or have painful feet for life.”

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Megan McMorris