From healthcentral.com
This chronic disease can cause pain, swelling, and damage to your distal interphalangeal joints. Here's what you can do about it
If you’re living with psoriatic arthritis, you’re no stranger to joint pain, especially in the smaller joints in your body. Among its many pain points, psoriatic arthritis (PsA) can affect your digits, causing joint aches, swelling, and permanent damage. It often affects distal interphalangeal joints (otherwise known as your toes) and can be really uncomfortable, making walking and mobility in general a challenge.
But you don’t have to take psoriatic arthritis toe pain lying down. Learn what the experts say causes it—then find out what you can do to manage the pain.
Can Psoriatic Arthritis Affect the Toes?
Even though symptoms of PsA vary from person to person, many will observe the disease in their feet. According to the Archives of Medical Science, 50% to 70% of those with psoriatic arthritis experience foot abnormalities.
For example, swelling of the toes (dactylitis) occurs in more than half (65%) of people with psoriatic disease. “Some of the first signs of psoriatic arthritis may appear in the feet,” says William Spielfogel, M.D., chief of podiatry at Northwell Lenox Hill Hospital in New York City. In addition to being one of the first signs, toe involvement may also indicate higher disease activity and more severe joint damage, according to the Journal of Rheumatology.
What Does Psoriatic Arthritis in the Toes Feel Like?
Psoriatic arthritis can attack your feet in a variety of ways, says Dr. Spielfogel. “The toes may have a sausage-like appearance,” he says, that leads to a deep pain when pressure or weight is applied to them.
“You may also experience pain in areas where tendons attach to bones, for example in the back of the heel and/or the bottom of the heel,” he explains. If your psoriatic arthritis has gone untreated, you may experience multiple swollen joints and even structural damage that can be seen on digital imaging.
What are the First Signs of Psoriatic Arthritis in Toes?
If you suspect your toes are being impacted by your psoriatic arthritis, there are several things to be on the lookout for, according to Dr. Spielfogel:
Pain when you bend your toes
Pitting of toenails
Skin plaques
Swollen digits
Tendon attachment pain
Thickening or lifting of toenails
“Issues that would cause one to suspect psoriatic arthritis would be pain at tendon attachments to bone,” Dr. Spielfogel says, along with swelling and pain. Nail involvement—typically in the form of pitting, thickening and lifting of your toenails—is also an indication of early disease.
“These signs in combination with shiny, scaling plaques on the skin would indicate a suspicion of psoriatic arthritis and should be referred to a rheumatologist for a full work up,” adds Dr. Spielfogel.
Swelling (Dactylitis) in Psoriatic Arthritis
Dactylitis describes swelling or inflammation of an entire finger or toe. This is sometimes referred to as sausage-digits. Dactylitis is about three times more likely to impact the toes than the fingers. Beyond being incredibly uncomfortable, dactylitis may also indicate more severe disease.
In a 2022 study, researchers found that those who had early onset of psoriatic arthritis (before age 40) were more likely to develop dactylitis, and dactylitis has been associated with more severe radiological damage. Among those with early onset, 45% had dactylitis compared to only 8% of those developing psoriatic arthritis after the age of 40.
Of equal importance, dactylitis may provide your doctor with a host of clues about the course of your psoriatic arthritis. “Dactylitis is a unique feature and helps define the spectrum of the disease,” says Elizabeth Schulman, M.D., a rheumatologist at Hospital for Special Surgery in New York City. “The presence of dactylitis certainly can help guide treatment.” Similarly, observing any changes in the toes can be an indication of disease advancement, which may help inform the treatment decisions you and your provider make.
“People tend to overlook the health of their feet in general and toes in particular—but toe involvement can raise a red flag, for sure, signifying sub-optimal treatment for psoriatic arthritis,” explains Dr. Schulman.
Hammer Toes in Psoriatic Arthritis
A hammer toe refers to a deformity in the shape of the toes. “The toe is typically contracted (bent) at the joint, thereby resembling a hammer,” Dr. Spielfogel explains. How does it happen? Each of us has a lining that covers our joints, known as synovium. This lining lubricates the joints. If the lining swells and becomes inflamed from your psoriatic arthritis, it can lead to joint destruction and weakened ligaments and tendons. These weaknesses can then cause joint deformities such as hammer toe. “Hammer toe can be associated with psoriatic arthritis, but not always a sign of it,” says Dr. Spielfogel.
How to Manage Psoriatic Arthritis Toe Symptoms
Toe involvement can be more than uncomfortable—it can make walking and standing next to impossible. Fortunately, there are things you can do to get back on your feet sooner than later. Start with these tips.
Follow Your Treatment Plan
“Working with your provider to get your disease under control is the first step in managing PsA toe involvement,” says Dr. Schulman. If you are waiting for a new treatment to work, non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce symptoms, she adds.
Do Joint-Friendly Exercises
Exercising with psoriatic arthritis toe involvement can seem beyond challenging. Looping in a physical therapist can be helpful in pain reduction, joint mobility, and providing exercise ideas that don’t involve extra stress on the toes (hydrotherapy as an example).
Consider Cold Therapy
The thought of immersing your foot into an ice bath may not sound like fun. It is also not for everyone, according to the journal Pain and Therapy. However, for a certain segment of the population, cold therapy (also known as cryotherapy) has demonstrated effectiveness with swelling reduction related to rheumatic diseases.
Wear Comfortable Shoes/Orthotics
“Switching to supportive footwear can help with the mechanical stress on the feet,” says Dr. Schulman. Give your toes a little extra breathing room by wearing, at least temporarily, a shoe with a wider toe box (possibly a man’s sneaker sized for a woman, for example). This may reduce further aggravation to the toes, which can compound their already inflamed state.
Keep Your Toenails Trimmed
If psoriatic arthritis has impacted your toes, nail care is paramount. Keeping your toenails as short as possible will help prevent them from rubbing or pressing against the end of your shoes, which will apply extra pressure to your toes, making your pain worse.
When to See a Doctor
Dr. Schulman says that if there is toe involvement, this is a time to let your provider know right away. “Not only does this indicate active psoriatic arthritis, but it can also indicate other conditions such as an infection,” she says. “If your psoriatic arthritis is impacting your toes, it is important to obtain a prompt evaluation from your provider.”
Bottom line? Psoriatic arthritis can attack multiple joints all over your body. But when it strikes your toes, the pain can literally be immobilising. The sooner you see your doctor and start on treatment, the faster you’ll be able to walk pain-free.
https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-toes
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