“My boyfriend got me a wheelchair for the days it hurts too much to walk. It was nice on his part, but makes me feel like I’m an invalid,” shared one member of MyPsoriasisTeam. Psoriatic arthritis (PsA) is a long-term inflammatory form of arthritis that can affect the feet, causing severe pain, stiffness, and swelling. Although there’s no cure, PsA is treatable, especially when diagnosed early. Up to 30 percent of people with psoriasis may develop PsA, according to the National Psoriasis Foundation.

Members of MyPsoriasisTeam whose feet have been affected by PsA struggle with inflammation and deformity, making it hard to walk or move. Because PsA often appears between the ages of 30 and 50, it has been life-changing for many people when it affects their feet, ankles, and toes. The pain and swelling during flares can make it hard to move, affecting daily activities. “I periodically use a walker to take some weight off my feet,” said one MyPsoriasisTeam member.

Coping with pain and limited movement has taken an emotional toll on many members: “I’m too young to feel this way, and now I have great depression and grief!” Another member said, “It’s frustrating trying to make people understand, and tiring trying to ‘act’ fine when you’re not. It helps to talk to others who ‘get it.’”

Psoriatic Arthritis and Your Feet: What Is It?

PsA can inflame any of the foot’s 26 bones, 33 joints, and connective tissues that surround the joints. “I have so much pain where my toes and foot connect. Feels like a constantly moving charley horse in my foot,” said one member.

Similar to rheumatoid arthritis, joints may feel warm, sore, and tender. Members report that stiffness is often worse in the morning. “Getting out of bed, I have a lot of pain in my feet,” said one member.

“I woke up with pain in my ankle. Thanks, psoriasis,” said another member. Unlike rheumatoid arthritis, PsA often only affects one side of the body, so just one foot or toe may be affected.

Although PsA can develop slowly with mild symptoms, several members of MyPsoriasisTeam report rapid and severe onset. “I was diagnosed with psoriatic arthritis very quickly after discovering my first tiny sign of psoriasis, and unfortunately, it progressed quickly,” explained one member. Another said, “This disease came out of nowhere! I was literally fine, then boom, my feet started hurting and getting worse and worse.”

PsA flares — on-and-off periods of worsening symptoms — can make coping with foot PsA even more challenging, say members of MyPsoriasisTeam. “Some days, I am totally fine and other days, the flares are so bad I can barely walk,” said one member. “During a flare, I need walking sticks to help me along,” said another.

Common Symptoms of Psoriatic Arthritis in the Feet

Common PsA foot symptoms reported by members of MyPsoriasisTeam include swelling, pain where the tendons attach to the bone, and dactylitis.

Dactylitis

Also known as “sausage toes,” dactylitis is one of the main signs of PsA. Up to 40 percent of people diagnosed with the disease experience swelling of the entire toe or finger, making it hard to move or use it. Although it can affect both hands and feet, as shown in a study in Annals of the Rheumatic Diseases, toes are affected more frequently. Dactylitis usually indicates that PsA is getting worse. “My toes look like, ugh, sausages,” wrote one member. Another shared, “I have two toes with dactylitis that get quite sore at times. Seeing my podiatrist weekly helps.”

Enthesitis

Swelling of tissues (entheses) that connect ligaments and tendons to the bone often causes foot discomfort in members of MyPsoriasisTeam. It most commonly affects the sole (called plantar fasciitis) or back of the heel (known as Achilles tendinitis). Enthesitis can make it hard to walk, run, or climb stairs.

“My Achilles tendons feel like they could separate from my bones! I’m in constant pain,” reported one member. “The enthesitis in my feet is awful. It feels like I could rupture my tendons if I pushed myself to do something,” lamented another.

General Swelling

Another common PsA foot symptom is swelling, sometimes accompanied by red or purple color on the skin, depending on your skin tone. Swollen areas may be warm to the touch and extremely tender. MyPsoriasisTeam members report severe ankle swelling during humid weather or after standing too long.

Diagnosing Psoriatic Arthritis in the Feet

Because there’s no definitive test for PsA in the feet — and symptoms are similar to other forms of inflammatory arthritis — some members of MyPsoriasisTeam go months, even years, before receiving a correct diagnosis. “My feet are my worst part, with so much pain in one deformed foot,” said one MyPsoriasisTeam member who waited more than a year to get a diagnosis.

A 2018 study found about 17 percent of people with PsA waited more than five years for a diagnosis after seeking medical help for the first time. “In my experience, PsA can be difficult to diagnose unless you have all the standard symptoms,” pointed out one MyPsoriasisTeam member. “I was told if blood tests come back negative, it doesn’t mean you don’t have it.”

Early recognition, diagnosis, and treatment of PsA in the feet is critical to preventing disease progression. Delaying treatment by as little as six months can result in permanent joint damage.

Your doctor will take your medical history and may order a physical exam, blood tests, an MRI scan, and X-rays of joints. They may also refer you to a rheumatologist, a doctor who specializes in arthritis. “I went to podiatrists and orthopedic doctors trying to figure out what was happening,” explained one member. “All of their treatments failed. My primary doctor took one look and said, ‘Something else is going on. I’m referring you to a rheumatologist.’”

Medications for Psoriatic Arthritis in Your Feet

Over-the-counter and prescription medications are available to treat PsA in the feet. They range from oral medications that reduce inflammation and swelling to injected or infused biologic drugs that help the immune system fight the disease. The medication prescribed typically depends on how severe your symptoms are, how active your disease is, your associated diseases, and many more factors. The doctor should fully explain your treatment options, and then you’ll decide together which is best for you.

It can often take several tries to find the right treatment, according to members of MyPsoriasisTeam. “Praying to find the right meds that will work for me long term. I’ve had many that work for a short time, but after a few months, they just stop working,” said one member.

Nonsteroidal Anti-Inflammatory Drugs

Over-the-counter pain medications or prescription painkillers are typically first-line medications for temporary relief of PsA foot pain. This category of medication is also referred to as nonsteroidal anti-inflammatory drugs (NSAIDs). A common over-the-counter example is ibuprofen. “When I get swelling accompanied by pain in my ankles, ibuprofen eases it for me,” said one member. Another, who uses an NSAID, mentioned, “I had swelling and inflammation on both big toes, but after two days on it, I feel a lot better.”

Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs) alter underlying disease by suppressing the immune system to prevent permanent joint damage from PsA.

One member said that a DMARD “helped my PsA foot pain, but my stomach couldn’t tolerate it.”

Biologics

Biologic drugs target different pathways in the body that create inflammation.

Biologics “have been like a miracle helping my joints,” shared one MyPsoriasisTeam member.

Another member saw ankle swelling disappear initially with their biologic medication but reported that it didn’t last.

Yet another member expressed frustration with their biologic: “My enthesitis keeps getting worse. That seems to be the general consensus, that none of the meds work — or work very long.”

JAK Inhibitors

JAK inhibitors are a class of drugs that work on a specific part of the immune system that causes inflammation in both psoriasis and PsA. Inflammatory cells receive a signal to create inflammation from JAK enzymes. JAK inhibitors block the JAK enzymes from sending and acting on this signal. JAK inhibitors are highly effective in reducing inflammation and preventing PsA symptoms.

If you’re taking a JAK inhibitor, you may experience common symptoms including infection, weight gain, dizziness, nausea, and diarrhea. Avoid JAK inhibitors if you’re over 65 years old and have a cardiac problem, as studies have shown that cardiac adverse events were more common with JAK inhibitors.

Other Treatments for Psoriatic Arthritis

Members of MyPsoriasisTeam also use several nonprescription treatments to ease PsA pain, including ice and topical painkillers, and lifestyle changes to their diet and exercise habits.

• Topical painkillers — “Icy Hot with lanolin helps my feet. The sprays are great for sleeping,” shared one member.
• Ice — Rolling your feet on a small bottle of frozen water wrapped in a towel or applying ice packs to sore areas can help reduce inflammation in foot joints.
• Apple cider vinegar — “I soak in a half cup of apple cider vinegar and water (as hot as I can tolerate) every other day for 15 minutes. It’s an anti-inflammatory that helps soothe my feet,” one member said.
• Diet and exercise — Adopting a healthy diet and gentle exercise program can help manage symptoms and contribute to overall well-being. Members say losing weight helps them keep stress off their joints. Slow gentle movement, such as yoga and tai chi, as well as physical therapy, helps build strength, reduce stiffness, and maintain foot mobility.

Always check with your doctor before starting any new diet or exercise program.

Protecting Your Feet

Finding comfortable shoes is a hot topic among members of MyPsoriasisTeam. Crocs with their wide shape and high toe box are the footwear of choice for many. Others prefer Dr. Martens. “I’ve had a pair for 14 years that I swear by. They were originally made as an orthopedic shoe,” explained one member.

A podiatrist can advise on the best footwear and design a custom orthotic for individual foot issues. Heel pads can add cushioning and support, while compression socks may help reduce swelling. Night splints are also an option for preventing heel pain with plantar fasciitis. They keep the foot at a 90-degree upward angle while sleeping to gently stretch the fascia.

Doctors also recommend avoiding injuries to the feet. The Koebner phenomenon, which is when new skin lesions appear after an injury, can cause psoriasis and PsA flares.

PsA in the feet and toes can cause a lot of pain and swelling and make it hard to move around. Even though there is no cure, getting diagnosed and treated early can help manage the symptoms and protect your joints. Always consult your doctor to find the best treatment plan, and make sure to take care of your overall health.

Find Your Team

MyPsoriasisTeam is an online support system for people with psoriatic arthritis and psoriasis and their loved ones. More than 130,000 members come together to ask questions, give advice, and share their experiences of life with PsA or psoriasis.

Have you had foot symptoms with psoriatic arthritis? What has worked best to relieve your pain? Share your experience in the comments below or by posting on your Activities page.