Psoriatic arthritis (PsA) is a form of arthritis (joint inflammation) that affects people suffering from psoriasis. While psoriasis is most commonly perceived as a dermatological condition, causing red patches of the skin and silvery scales, it is actually an autoimmune disease that can just as easily cause the body to attack healthy joint tissue. It is common for people to develop dermatology symptoms first and later experience psoriatic arthritis, though joint problems can precede skin lesions.
Psoriatic arthritis can affect the feet in several ways. Toe joints can become inflamed, swelling the entire length of the digits to appear “sausage-like.” This condition is called dactylitis. Individuals with psoriatic arthritis usually experience pain at the arch of the foot or in the heel. Foot pain associated with psoriatic arthritis can be severe enough to cause disability.
In a small percentage of PsA patients, enthesopathy may accompany psoriatic arthritis and this usually requires specific treatment for symptom control, including the formation of heel spur growths.
Psoriatic Arthritis Symptoms
Early symptoms of psoriatic arthritis of the feet often include pain, swelling, warmth, and stiffness. These symptoms can persist throughout the day, without easing up. Foot pain can increase later in the day, forcing individuals to change shoes to relieve pressure and discomfort, or curtail activities altogether.
Sometimes toenails are affected by psoriatic arthritis causing pitting on the nail surface. Nails can also thicken and become brittle, which is often mistaken for fungal infection. In some cases, the nail may lift and detach from the nail bed.
Over time, psoriatic arthritis can lead to flatfoot, claw toe, over-pronation and other foot deformities as the joints deteriorate. The changes in foot mechanics can cause corns, calluses and other skin lesions, including foot ulcers. Foot ulceration can be particularly troublesome to patients suffering from any degree of neuropathy.
However, when compared to Rheumatoid arthritis, the symptoms of PsA tend to be milder and less disabling.
Diagnosis of PsA
Psoriatic arthritis can be diagnosed mainly through clinical evaluation. A physician will conduct a physical examination of the feet, evaluating signs of pain, swelling and reduced range of motion. They may also look for signs of psoriasis on the feet and elsewhere. PsA has a stronger genetic correlation than other forms of arthritis, so a full family history and lab work should be expected. Because of PsA’s effects on joints, your doctor may also order X-rays, ultrasound or MRI diagnostic tests to image the bone ad soft tissue, and verify a diagnosis.
Psoriatic Arthritis Treatment
Treatment of psoriatic arthritis in the foot and ankle revolves primarily around addressing symptoms and disease self-management. Initial foot and ankle treatment must include a full observation and assessment of the joints and tendons involved.
When indicated, patients should promptly take any prescribed suppressive drugs. Because these drugs act slowly (sometimes up to 3 months to see results), any delay in initiating treatment can accelerate joint degeneration and deformity.
Minor pain and stiffness can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs) during the early stages of PsA. However, patients should seek professional counsel from a podiatrist, who can best formulate a treatment strategy.
In moderate to severe cases of PsA, targeted treatments of diseased joints will alleviate symptoms and prevent disease progression. Specifically, this refers to the use of Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in treatment.
If a deformity has developed, orthotics (shoe inserts or pads) may be required. Surgical shoes and sophisticated splints are rarely necessary except in the most advanced cases.
Surgery to repair a damaged joint or affected bone is only considered when other alternatives have failed.
Physical Therapy and Self-Management
Early diagnosis and treatment are critical for effective management of psoriatic arthritis. Once diagnosed, patients should take responsibility for protecting their joints. They can do so by engaging in exercise that keeps joints flexible and functional, while helping them maintain a healthy weight. They should also rely on supportive, comfortable footwear that relieves unnecessary pain or pressure on the feet.
Dr. Gabriel Maislos, DPM, FACFAS, is a leading Houston podiatric surgeon with over 14 years in private practice. He has helped countless patients suffering from psoriatic arthritis to manage symptoms and protect their joints – and their mobility – through effective treatments. This may include the treatment of existing foot deformities like claw toe, or the appearance of heel spurs. Trust Dr. Maislos to provide the quality of care you expect a renowned podiatrist.
Call (713) 541-3199 if you experience:
- joint pain or stiffness in the foot or ankle
- swollen, “sausage-like” toes
- psoriasis symptoms on feet or toenails