Psoriatic arthritis, sometimes misdiagnosed as osteoarthritis, gout, or rheumatoid arthritis, is a form of arthritis accompanied by psoriasis, a condition which causes scaly red and white patches on your skin. This form of arthritis can cause swelling in your toes, frequently described as making them look like sausages.
Psoriasis is a condition in which the body’s immune system goes into overdrive and attacks healthy tissue in the skin, creating an overproduction of skin cells. In psoriatic arthritis, the immune system also attacks your joints, causing persistent, painful inflammation, in addition to the skin condition. It typically affects the larger joints in your feet or ankles, but may affect the smallest joints in the toes as well. Swelling of the joints in the toes can be quite extreme, taking on the appearance of sausages, a condition called dactylitis.
Psoriatic arthritis can also cause discoloration and “pitting” in your toenails – depressions or separation from the nail bed. As these symptoms appear similar to a fungal infection, it’s often misdiagnosed. In later stages, toenails may crumble or suffer other damage.
Why the immune system turns on healthy tissue is still somewhat of a mystery, but it appears that genetic and environmental factors are at play. Many patients who suffer with psoriatic arthritis have a family history of the disease, or a family history of psoriasis. In others, physical trauma, or a viral or bacterial infection may trigger psoriatic arthritis.
One of the characteristics of psoriatic arthritis is Enthesitis – pain in the heel or the sole, where ligaments and tendons join the bone. In some cases, this is the cause of plantar fasciitis or Achilles tendinitis. Research suggests that the continual inflammation from psoriatic arthritis causes significant joint damage, so early diagnosis and treatment is important.
If you’re experiencing heel pain, arch pain, or joint pain in your ankles or feet, and you suffer from psoriasis, please inform your podiatrist, as your treatment plan may vary.
Just as with rheumatoid arthritis, the pain and stiffness in joints affected by psoriatic arthritis is progressive, which means it will worsen over time. The pain and stiffness may at times subside and vary in intensity. Additionally, some patients also experience mood changes, fatigue, muscle weakness, and anemia.
Osteoarthritis may accompany psoriatic arthritis, and bones in the feet, ankle, or toes may deteriorate. Your podiatrist can use ultrasound imaging to determine this even before other symptoms occur.
Unfortunately, psoriatic arthritis becomes extremely painful as the condition progresses. Toes and feet may become swollen and tender, and they may no longer fit into your shoes. Your podiatrist may recommend special footwear in this case.
Symptoms of psoriatic arthritis in the foot and ankle
- Joint pain. Joints may also be swollen or warm to the touch
- Joints in the toes may develop dactylitis, a unique type of swelling. Dactylitis sometimes develops before pain or stiffness occurs.
- Toes may become deformed and nails become discolored or pitted
- Achilles tendinitis or plantar fasciitis may develop
- Unlike other forms of arthritis, psoriatic arthritis is more likely to cause pain in the tendons of your feet
Who is most likely to develop psoriatic arthritis?
- People with a family history of the disease. Men and women are equally affected.
- People with psoriasis, especially those who have psoriasis lesions on their toenails
- Those between the ages of 30-50, but it may also occur in children
Treatment for psoriatic arthritis
- Mild exercise like walking, biking, or swimming keeps joints flexible and reduces pain
- Stretching exercises
- Custom orthotics (shoe inserts) to relieve pressure on painful areas
- Wear comfortable footwear like athletic shoes,or if severe, diabetic shoes
- Over the counter anti-inflammatory pain relievers like ibuprofen (Motrin, Advil), or naproxen (Aleve)
- Cortocisteroid injections from your podiatrist to reduce joint swelling
- Prescription medicines used to treat Rheumatoid arthritis
- Podiatric surgery to replace or repair damaged joints