From healthcentral.com
There’s no one right shoe for PsA-affected feet, but these recommendations can help you find the right fit
If you or someone you love is living with psoriatic arthritis (PsA)—a chronic autoimmune disease that causes inflammation of the joints, tendons, and ligaments as well as skin symptoms (psoriasis)—finding the best shoes goes beyond style, fit, and fashion. In fact, the right shoes can help you battle PsA foot pain, swelling, and tenderness. Proper footwear can also make a difference when it comes to inflammation and joint damage.
“The most important component of foot protection in PsA is to control the underlying systemic [body-wide] inflammation with the correct treatment regimen,” says Elizabeth Schulman, M.D., a rheumatologist at Hospital for Special Surgery in New York City. “However, PsA can also have multiple clinical manifestations in the feet and the right footwear can make a significant difference to prevent mechanical strain that can further trigger inflammation and cause joint damage.”
The number one goal: Finding a fit that provides good arch and toe support, says Dr. Schulman. For more guidance on what to look for, start with these expert-backed tips for finding the best footwear for psoriatic arthritis.
Why Footwear Matters for Psoriatic Arthritis
Simply put: Footwear matters because PsA can do a number on your feet. A recent study of 40 people with PsA in Foot and Ankle Surgery found that 95% of the participants observed the disease in their feet. And while symptoms vary from person to person, the study found PsA in the feet can have an impact on quality of life, leading to pain, deformities, and walking and mobility difficulties.
“Foot issues are a huge problem with PsA,” says Jody Quinn, a patient advocate from Plymouth, MA, who was diagnosed with PsA in 2024. “Before I was officially diagnosed, I had plantar fasciitis, which I eventually found out is a common symptom of PsA. I also had swollen toes, commonly called “sausage like digits,” swollen feet, and ankles along with tremendous pain in the many joints in my feet. The feet are definitely an area of the body where PsA pain can strike and can prevent you from enjoying daily activities.”
The disease often attacks the smaller joints in the feet (the distal interphalangeal joints), the ankle, and the entheses, where tendons and ligaments attach to bone. Issues include:
Bunions, bony bumps at the base of the big toe, can be painful when the bone presses against your shoes, and affect other toes and ball of the foot, according to the American Academy of Orthopedic Surgeons.
Dactylitis (a.k.a. “sausage digits”) can cause foot or toe pain, a feeling of “heat” in the foot, skin discoloration, and difficulty moving or bending your toes, according to the Cleveland Clinic.
Enthesitis, or inflammation in the enthesis, can cause pain and burning where the Achilles tendon attaches to the back of the heel and at the plantar fascia ligament, which stretches along the bottom of your foot, causing plantar fasciitis.
Hammer/claw toes, caused by damage in joints from chronic inflammation, can result in changes in shape and alignment of the toes.
Pitting, or shallow or deep holes in the nail plate, often start as a cosmetic issue but can lead to thickening of the toenails or infection due to pressure on the nail bed.
The best shoe for PsA will largely depend on your individual symptoms, so it’s best to check with your rheumatologist or podiatrist for guidance.
That said, both experts and people living with PsA agree that good arch and ankle support, a supportive heel counter (for shock absorption), and a wide and deep toe box are must-haves. “Unsupportive footwear can put extra strain on the ligaments, bones, joints, and tendons leading to worsening inflammation and overtime damage,” says Dr. Schulman.
Sari Priesand, D.P.M., a clinical assistant professor at the University of Michigan in Ann Arbor and spokesperson for the American Podiatry Medical Association (APMA), suggests looking for shoes with the APMA Seal of Acceptance and Seal of Approval, which are reviewed by a group of APMA podiatrists to ensure foot health.
Get Professionally Fitted
Since everyone’s feet are a little different, it’s best to get expert guidance to measure for supportive footwear for PsA, says Dr. Schulman. A proper in-store fitting can make a big difference—and may just become a regular part of your shoe-buying routine. After all, sizing varies among manufacturers and the location of PsA inflammation can change quickly.
If possible, invest in a couple of options based on your daily activities to be sure you’re always as comfortable and supported as possible. For example, Quinn tends to wear clogs to prevent heel pain when her plantar fasciitis flares and boots with a cushioned footbed in the fall and winter to support her ankle and reduce the swelling that often develops during colder weather.
When shopping for shoes, keep in mind that your feet tend to swell throughout the day, so it’s best to schedules fittings later in the day when swelling is more significant, rather than in the morning when feet tend to be less swollen, says Dr. Priesand.
Shop for Shoes with Removable Insoles
Comfort often starts by removing the factory insoles and replacing them with customized orthotics to better support your feet and correct any deformities. Your podiatrist can evaluate your pain points and gait (the pattern of how you walk), and fit you for insoles or orthotics or even create something custom for you. Some insurance companies will cover the cost of customized ones. If not, ask your doctor for an over-the-counter recommendation.
Opt for Lightweight Options
When you pick up a shoe, it should feel light in your hand. Lightweight shoes can help reduce joint fatigue and make day-to-day walking easier. A heavy shoe, on the other hand, will make it harder to lift your foot off the ground, increasing joint strain and potentially altering your gait. “Lightweight doesn’t mean minimalist,” warns Dr. Priesand. Lightweight shoes still need to be supportive. A good test for support: Try to bend the shoe in half. It should only bend at the forefront where the toe bends naturally.
Say Yes to Slip-Resistant Soles
The swelling, inflammation, and deformities that occur with PsA in your feet can change the way you walk, increasing your risk of falls. To help you stand and move around safely, say no to slippery leather soles and instead go for rubber ones or those with a secure grip built into the sole.
Consider Finger-Friendly Footwear
Psoriatic arthritis can cause stiffness and reduced range of motion in the fingers and wrists. If PsA affects your hands, consider Velcro closings or elasticized laces so you can easily slip into your shoes.
Look for Soft and Flexible Uppers
Dr. Priesand suggests looking for shoes with soft, flexible uppers, including materials like neoprene, mesh, or knit fabric, to accommodate any swelling, toe deformities, or skin issues. “Avoid leather because it’s not very forgiving—it doesn’t allow for much movement, which can be harmful,” she says.
When someone with PsA has swollen toes from dactylitis, wider toe boxes and more flexible materials can help prevent excess pressure and avoid stress on the foot, adds Dr. Schulman.
Pay Attention to Heel Height
Overall, it’s best to avoid heels higher than two inches, notes the APMA. More than that and it may affect your balance and stability. High heels also put extra pressure on the arches and stress on joints. If you want a little lift, kitten heels (less than one inch) are the most foot-friendly, especially if they have a generous toe box area and extra cushioning at the front of the shoe.
Test Them Out
Even the best shoes for psoriatic arthritis have to be broken in slowly. Dr. Priesand recommends wearing them for an hour the first day and then increasing by an hour a day for the first week. Check for red spots on your skin and note how your feet feel as they swell throughout the day.
And once you find the right fit, remember to periodically assess the sole for wear and tear—it’s a sign that it’s time to change them or discuss any patterns with your podiatrist, says Dr. Priesand.
“I would recommend replacing shoes every six to 12 months or whenever there are signs of wear,” adds Dr. Schulman.
Alert Your Doctor to Foot Symptoms
If you notice any new or worsening symptoms in your feet, your first step should be to talk to your doctor. Changes in the toes can be a sign that your PsA is advancing or not well-controlled, informing your treatment decisions. “Many people tend to ignore their foot and ankle symptoms until they are severe and preventing ambulation,” warns Dr. Schulman.
Here are a few signs of PsA in your toes and your feet:
Pain when bending your toes
Swollen digits
Tendon attachment pain
Toenail changes (thickening or lifting of toenails or pitting)
