They say that to truly understand someone you need to have walked a mile in their shoes. Well, we’re pretty certain that walking a mile in the shoes of someone with PsA could teach people a LOT about what it’s really like living with the condition. While it can sometimes feel like nearly every bone in the body is affected by PsA, there are numerous ways in which it can manifest in the feet, so it’s really important to be aware of these signs and speak with your doctor at the first sign of discomfort in order to avoid potential bone deformities occurring1.
We’ve broken some of the most common conditions into bite-sized chunks below. Read them all, or jump feet first (pun very much intended) into the sections that interest you!
PsA causes inflammation to joints (as with arthritis) and to the points at which tendons and ligaments attach to bone2 (called entheses). Enthesitis is inflammation caused by a PsA related immune system response that attacks bone and the surrounding tissue in response to stress at the site3 . It often results in pain felt next to a joint, or spread out over a wider area. In PsA, inflammation of the entheses can affect multiple joints and tissues, the most common of which are the Achilles tendon and the plantar fascia.
A person’s Achilles heel is said to be their biggest point of weakness. This rings all to true for many with PsA as Achilles tendonitis, which is usually associated with sports injuries, can develop with no known cause. The tell-tale signs of Achilles tendonitis are pain and swelling at the back of the heel4.
That radiating heel and arch pain felt when first standing up after inactivity- it could be plantar fasciitis, which is actually the most common cause of all heel pain5. The plantar fascia is the tissue that connects the heel to the toes and, when inflamed, can cause a painful limp to develop.
Rest can help both Achilles tendonitis and plantar fasciitis to improve, but may not always be an option! You may want to try cold packs (make sure to wrap it up in a tea towel) or rolling the bottom of your foot along a cold water bottle6. Wearing comfortable shoes and cushioned inserts should also help to alleviate some of that pain.
Have you noticed that some, but not all of you toes are swollen? You’re not alone! As many as 40% of people with PsA experience a condition called dactylitis, or ‘sausage digits’, caused by swelling and inflammation around tendons in the finger or toe area7 . The word dactyl actually derives from the Greek word for finger (even though the toes are more likely to be affected in PsA8). Swelling is often non-symmetric so different toes can swell on each foot9. A quirk of dactylitis means that the fourth toe is the most likely to swell10. It has been suggested that the presence of sausage toes can signal that PsA is more advanced10, so ensure you mention it to your doctor if the symptoms begin to develop!
PsA may seem like a serious pain in the… foot, but the good news is that your doctor will be able to help assess the best form of pain management for you, so be sure to speak with them at the first sign of discomfort.