February 28, 2021

Psoriatic Arthritis in Feet: Symptoms, Diagnosis, and Management

Written by: Syed Naqvi, MBBS
Reviewed by: Mubashar Rehman, PHD

What is Psoriasis?

Before moving on to psoriatic arthritis of the feet, one should know what psoriasis is. Psoriasis is, what we in the medical community call, an autoimmune disease. This means that the body’s immune system goes berserk and starts attacking its own cells. Think of it as a coup that the body’s own army starts. We do not yet know what exactly causes it, but several researchers [1] have noted an association of the autoimmune disease with infections, damage to tissues, gender, and genetics.

Psoriasis is a skin condition characterized by red and patches of silvery scales on the body. It may occur anywhere from the ankle to the knee, elbow, scalp, and back. Approximately 50% [2] of the patients may also have involvement of nails with nail pitting and separation of the nail plate. Several patients may also have a yellow-reddish discoloration of the nail.

A study revealed that every 1 in 4 patients with psoriasis has psoriatic arthritis[3].Initially, the body’s immune system attacks only the skin cells but may end up attacking the joints underneath the skin as the disease progresses.

Symptoms of Psoriatic Arthritis of the Feet

Let us put a picture of a foot’s anatomy in your mind to help you better understand how the symptoms will look like. Each foot is made up of 26 bones with several ligaments (bands of tissues holding bones together) holding them together. The arch of your sole is made by a band of tissue called the plantar fascia. When the immune system starts attacking, the whole foot becomes its battleground, and damage to any part of the foot is anticipated. Psoriatic arthritis foot pain may present with tenderness and swelling of feet. Like other rheumatic diseases (e.g., rheumatoid arthritis) patients may experience stiff joints in the morning for more than an hour. Unlike rheumatoid arthritis, where joints on both sides of the body (i.e., symmetric) are affected, psoriatic arthritis characteristically involves random joints (i.e., asymmetric). That means one of your feet may be affected while the other foot is normal. Several other symptoms may be seen apart from pain, tenderness, and swelling of the feet:

Heel Pain:

Psoriatic arthritis can affect the Achilles tendon, a band of tissue on the back of your heel that connects the muscle to the bone. The point where a tendon connects to a bone is inflamed, leading to swelling of the heel and pain.

Sausage Toe:

Sausage toe occurs due to inflammation of small joints in the toe. Medically, it is referred to as dactylitis and characterized by pain and swelling in the toe. Patients with gout may also experience dactylitis. However, gout is not associated with psoriatic skin lesions and usually affects a single joint instead of multiple asymmetric joints.

Sole Pain:

When the immune system attacks plantar fascia, it leads to inflammation on the arch of the sole. Also known as plantar fasciitis, this makes walking and working difficult.

Nail Changes:

Psoriatic arthritis is commonly associated with nail pitting, nail discoloration, and nail separation from the nail bed. It is characteristically seen in a majority of patients with psoriatic arthritis.

Arthritis Mutilans:

Arthritis mutilans is a severe complication of psoriatic arthritis that leads to destruction and permanent deformity of the joints. Patients may end up losing joint function and thus need the help of assistive device like a mobility cane.

Diagnosis of Psoriatic Arthritis

Psoriatic arthritis is a clinical diagnosis. Psoriatic arthritis can also affect ankle joints and the spine. Therefore, your doctor may advise X-ray to look for other joints’ involvement. Understanding the pattern of the joint involvement may help your doctor give the correct diagnosis and assess the severity of your condition.

Management of Psoriatic Arthritis

Just like other autoimmune diseases, there is no available cure for psoriatic arthritis. However, we can manage the symptoms and slow the progression of the disease with medications and home remedies. As is the case for most home remedies, scientific evidence does not fully back up their claims; yet, many patients found it effective in managing their symptoms. However, you should consult your doctor before starting any home remedy for your arthritis. 

Medications:

Your doctor may prescribe you two medications. The first drug alleviates inflammation and pain to enhance the quality of life. The second drug slows down the progression of the disease to prevent long-term disability. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to decrease inflammation and pain, while disease-modifying anti-rheumatic drugs (DMARDs) are used to slow down the progression of the disease.

Comfortable Footwear:

Your doctor may advise you to start wearing comfortable shoes to decrease the pressure on your joints. Walking barefoot is not advised since it places direct pressure on your soles. Your podiatrist may suggest custom orthotics too. 

Use of Ice:

Cold temperatures cause the blood vessels to constrict. Constricted blood vessels have shown to decrease the flow of immune cells, leading to a decrease in inflammation and pain.

Healthy Nutrition:

“Healthy nutrition leads to a healthy body” is a widely known fact. Arthritis Foundation® suggests a Mediterranean diet to help with psoriatic arthritis[4]. A few examples are given below:

  • Fish containing omega-3 fatty acids
  • Vegetables and fruits
  • Use of olive oil daily
  • Whole grains
  • 1.5 ounces of nuts daily

Daily Exercise:

Exercise has been well-known to be beneficial for human health. In fact, a recent randomized controlled trial has shown that resistance exercise improves the functional capacity of patients with psoriatic arthritis [5]. From physical to psychological benefits, exercise is the one-stop to reap all the benefits of a healthy body. 

We may not have a magic pill to treat all the conditions but, thank goodness, we have exercise! 

Massage Therapy:

Massage has been linked to physical and psychological [6] benefits in psoriasis. It is associated with decreased pain in patients with psoriatic arthritis. “I often hear that people with psoriatic arthritis benefit from massage or occupational therapy once they go,” says Dr. Orbai, MD, a professor at Johns Hopkins University.

Prevention of Psoriatic Arthritis

A person may not be able to prevent psoriatic arthritis altogether if their genetic code makes them susceptible to the disease. However, they may take several preventive measures to decrease the severity of the disease and allow a healthy lifestyle with the following measures:

  1. Daily exercise
  2. Healthy nutrition
  3. Comfortable footwear
  4. Regular foot care

Summary

Psoriatic arthritis is an autoimmune condition that affects asymmetric joints in the body. Feet are one of the most common parts affected by psoriatic arthritis. One can manage the symptoms with medications and several home remedies. It is not a disabling disease if you do not let it disable you. Medical evidence has come so far as to manage and decrease the progression of the disease. If you’re someone with psoriatic arthritis, there is still hope of a healthy lifestyle.

References

  1. Orbai A. Autoimmune Disease: Why Is My Immune System Attacking Itself?. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/autoimmune-disease-why-is-my-immune-system-attacking-itself. Published 2021. Accessed January 27, 2021.
  2. https://www.jrheum.org/content/early/2021/02/10/jrheum.201471
  3. Alinaghi F, Calov M, Kristensen L et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-265.e19. doi:10.1016/j.jaad.2018.06.027
  4. Paturel A. The Ultimate Arthritis Diet. Arthritis.org. https://www.arthritis.org/health-wellness/healthy-living/nutrition/anti-inflammatory/the-ultimate-arthritis-diet. Published 2021. Accessed January 27, 2021.
  5. Roger-Silva D, Natour J, Moreira E, Jennings F. A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial. Clin Rheumatol. 2017;37(2):389-395. doi:10.1007/s10067-017-3917-x
  6. OLIVIER C, ROBERT P, DAIHUNG D et al. The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis. Arch Dermatol. 2010;146(8). doi:10.1001/archdermatol.2010.186
  7. Schons K, Knob C, Murussi N, Beber A, Neumaier W, Monticielo O. Nail psoriasis: a review of the literature. An Bras Dermatol. 2014;89(2):312-317. doi:10.1590/abd1806-4841.20142633
Article written by Syed Naqvi, MBBS
Dr Syed Naqvi is a graduate of King Edward Medical University which is one of the top medical schools in his country. He has a 10-year editorial experience working on different projects. He has spent countless hours in pursuing his lifelong dream as a doctor. Ever since clearing his United States Medical Licensing Exams, he has been pursuing different aspects of medical education to broaden his scope. His interests lie in medical education, philosophy, and writing. He likes to write books for personal use and recently finished a 3000-page medical book. He likes to spend his free time reading philosophy, psychology, and medical books.

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