Clinical trials reveal the best shoes to manage osteoarthritis pain

From independent.co.uk 

Kade Paterson The Conversation & Rana Hinman

• New research challenges the common belief that stable, supportive shoes are always the best option for people with osteoarthritis.
• A recent clinical trial found that for hip osteoarthritis, flat flexible shoes were no more effective than stable supportive shoes in reducing pain.

• People with hip and knee osteoarthritis are advised to wear “appropriate footwear” to minimise their pain.

  Does that mean heels are out? Does it matter if you wear runners or something a little stiffer? How about using insoles?

  Our research, including our latest clinical trial published today in Annals of Internal Medicine, provides some answers.

• We show that stable, more supportive shoes aren’t necessarily the best option, despite what you might have heard.

  What is osteoarthritis?

  Osteoarthritis is a condition that affects the tissues in and around a joint, including bone, cartilage, ligaments and muscles. It is more common in older people, and people with excess body weight. It causes joint pain and stiffness, and can lead to disability.

• About 2.35 million Australians have osteoarthritis and this number is predicted to increase as the population ages and obesity rates rise.

  

  Osteoarthritis is a condition that affects the tissues in and around a joint (PA)

  Osteoarthritis commonly affects the hip and knee joints, making it difficult to walk. There is no cure, so self-management is important.

  That includes wearing the right type of shoes.

  How can shoes affect symptoms?

  There are many causes of osteoarthritis, but excessive force inside the joint when someone is walking is thought to play a role. Excessive joint forces can also increase the chance of osteoarthritis worsening over time.

• Shoes are our connection to the ground and can influence how forces are transmitted up the leg during every step. Some shoe features are particularly important.

  Shoes with higher heels increase joint forces. For example, shoes with six-centimetre heels increase knee forces by an average 23% compared to walking barefoot.

• Some shoes come with supportive features, such as insoles that support the arches. Other supportive features include being made with a stiffer material in the sole or heel.

  Many people, and clinicians, think these stable and supportive shoe features are best for people with osteoarthritis.

  But biomechanical research shows shoes with these supportive features actually increase knee force by up to 15% compared to shoes without them. Arch-supporting insoles also increase knee force by up to 6% when added to shoes.

  So, are flatter, flexible shoes without stable supportive features – such as ballet flats – better for knee and hip osteoarthritis?

  Not necessarily. We also need to look at people’s pain.

  What we found

  Our biomechanical research from 2017 in people with knee osteoarthritis showed flat flexible shoes reduced knee forces by an average 9% compared to stable supportive shoe styles.

  This suggests flat flexible shoes could be better for osteoarthritis. To find out, we conducted two clinical trials to look at people’s pain levels.

  Our new clinical trial involved 120 people with hip osteoarthritis.

  They were randomised to wear different types of flat flexible shoes, such as flexible ballet flats, or different types of stable supportive shoes, such as supportive runners. People were asked to wear their shoes for at least six hours a day. After six months we measured the change in hip pain when they walked.

• We found that flat flexible shoes were no better than stable supportive shoes for reducing hip pain.

  These findings differ to those from our 2021 clinical trial in 164 people with knee osteoarthritis. In that trial, we found wearing stable supportive shoes for six months reduced knee pain when walking by an average 63% more than wearing flat flexible shoes.

  It’s unclear why findings differed between the knee and hip. But it might be because joint forces are higher in knee compared to hip osteoarthritis, and so there may be greater potential for stable supportive shoes to reduce knee forces, and therefore knee pain.

  In both trials, more complications, such as foot pain, were reported by people who wore flat flexible shoes. This might be because these shoe styles provide less protection for the feet.

  So which shoes should I wear?

  For people with knee osteoarthritis, stable, supportive shoes are likely to be more beneficial than flat, flexible ones.

  For people with hip osteoarthritis, neither shoe type is better than the other for improving hip pain.

  But for all older people – including those with hip and knee osteoarthritis – it is sensible to avoid ill-fitting shoes, as well as shoes with high or narrow heels, due to an increased risk of falls.

  For younger people with knee or hip osteoarthritis but who are not at risk of falls, it may still be advisable to avoid high heels given their potential to increase joint forces.

• Who should you talk to?

  If you are concerned about your hip or knee osteoarthritis, talk to your GP or other health-care provider, such as a podiatrist or physiotherapist.

  Other non-surgical treatments, such as exercise, weight management, nutrition and some pain medicines can help.

• https://www.independent.co.uk/life-style/arthritis-best-shoes-knee-osteoarthritis-b2926484.html
  

This Treatment Could Help Relieve Your Arthritis Pain Without Any Medication

From healthdigest.com

If you're one of the more than 54 million Americans living with arthritis pain (per the Centers for Disease Control and Prevention), you know how much it can impact your daily life. Arthritis isn't just a little joint soreness after a tough workout (here's how to tell if there's more to your joint pains than you initially thought). It's a condition that can affect mobility, independence, and overall quality of life. Of the more than 100 types of arthritis, osteoarthritis is the most common. Osteoarthritis not only wears down the cartilage in a joint but also affects the bone and connective tissue around it, making movement painful and stiff.

Many people with osteoarthritis turn to over-the-counter or prescription medications to manage their symptoms, but new research suggests there may be another option. A 2025 study in The Lancet Rheumatology found that retraining the way you walk could help reduce knee pain from osteoarthritis. With guidance from a physical therapist (or at least someone trained to observe your stride), even a small adjustment to your foot angle might lower pain, reduce stress on the joint, and potentially protect the cartilage from further damage.

Changing the angle of your foot in your walking stride can reduce osteoarthritis pain

                                                                                                   Carlos Barquero/Getty Images

Osteoarthritis might stem from an old sports injury, like a torn ACL, or from years of physically demanding work in jobs such as farming or construction. It can also be linked to factors like obesity, a sedentary lifestyle, or even an unhealthy diet. Whatever the cause, osteoarthritis pain can affect how you move. For example, osteoarthritis knee pain often changes the way you walk without you even realizing it.

At the start of the study, researchers had participants with knee osteoarthritis walk on a treadmill so they could analyse their gait, or walking mechanics. Each person also underwent an MRI to measure cartilage damage. Based on the gait analysis, some participants were instructed to slightly adjust their foot angle — either outward or inward — to see which position best reduced stress on the knee. A control group, on the other hand, was told to keep walking as they normally would.

Those who practiced the foot-angle adjustment did so in the lab for six weeks, long enough for the change to start feeling natural. After a year, this group reported pain relief on par with taking a pain reliever. One participant shared their excitement that the improvement came without relying on drugs or devices. "It's just a part of my body now that will be with me for the rest of my days, so I'm thrilled with it," the participant said in a news release.

https://www.healthdigest.com/665561/things-your-doctor-wants-you-to-stop-doing/

Tips for Finding the Best Shoes for Psoriatic Arthritis

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

                                                                                          GettyImages/sf1nks

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 good news: If caught early, many of these foot issues can be prevented and treated with simple self-care, including investing in the right shoes. “Ideally you care for your feet the way you care for your other body parts,” says Dr. Schulman. “Our feet bear the pressure from the rest of our body so proper hygiene, foot support, rest, and strengthening are key.”

Tips for Buying the Best Shoes for Psoriatic Arthritis

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)

https://www.healthcentral.com/condition/psoriatic-arthritis/best-shoes-for-psoriatic-arthritis

How to Prevent Damage from Rheumatoid Arthritis

From healthcentral.com 

When RA reaches later, more advanced stages, certain changes of the hands and feet become more common. Here’s what you need to know

On top of the joint pain, swelling, tenderness, and stiffness that occurs in rheumatoid arthritis (RA), there’s a potential complication to have on your radar: changes to your joints (previously referred to as joint deformities).

“There are three things to know about rheumatoid arthritis: It’s autoimmune, it’s inflammatory, and it can be very destructive,” says rheumatologist Sana Haseeb, D.O., an assistant professor at Loyola Medicine and internal medicine physician based in Burr Ridge, IL.

Deformities—which is an outdated term that physicians rarely use anymore in reference to RA—can affect the hands and feet, are most common in advanced disease once inflammatory cells have existed in joints for a long time, leading to damage.

Fortunately, severe joint damage is becoming less common in RA, though it can and does still happen. Learn more about the issues that affect hands and feet with RA, along with treatment and prevention measures.

Causes of Joint Changes with RA

Rheumatoid arthritis is an autoimmune disease, which means that the body's own immune system mistakenly attacks its tissues. In the case of rheumatoid arthritis, the joints (often small joints, such as those in the hands and feet) are affected.

How so? Inflammatory cells move into the joints and cause inflammation in synovial fluid, which is a thick liquid in between your joints, says Donald Kimpel, M.D., a rheumatologist at UVA Health in Charlottesville, VA. “These inflammatory cells set up shop, causing swelling. The longer inflammation has settled in, the more likely it is to cause joint damage or damage to the ligaments and tendons around the joint,” he says.

With this damage, the disease can wreak havoc on the connective tissues and eat away at part of the bone, which is called an erosion, says Dr. Haseeb. If left untreated, you may see the physical impact of the disease with joints “swaying” or knuckles or fingers twisting in abnormal ways, she says.

These joint setbacks typically show up in later stages of the disease, says Dr. Haseeb. And fortunately, thanks to advancements in medications to treat rheumatoid arthritis, including biologics, joint destruction is becoming less common, she says.

Common Rheumatoid Arthritis Foot Changes

The feet bear the brunt of your weight, and in RA, that can contribute to pain and tenderness along the base of the toes, middle of feet, heels, and ankles, says Dr. Haseeb. “Patients will start to mention that their toes are curling up or extending in ways that are not comfortable,” she says. Wearing shoes can become difficult. Joint issues that may affect the feet include:

Bunions

A prominent and painful bony bump at the base of the big toe, bunions can cause the big toe to angle toward other toes, says Charis F. Meng, M.D., a rheumatologist with Hospital for Special Surgery in New York City. Although bunions have been shown to be one of the most common foot changes in RA, according to an earlier study, they are also a frequently experienced foot issue among the general population. As such, it’s important to note that having a bunion does not mean you have RA.

Flat Feet

You might also hear this called a fallen arch. In one small study, two out of three people with RA had an arch that was lowered or flattening, making it one of the most common foot problems in RA, per the International Journal of Environmental Research and Public Health in 2021. It occurs when rheumatoid arthritis damages the talonavicular joint, which helps create the “arch” in your foot; once the joint is damaged, the arch can collapse.

Hammertoe

In hammertoe, the joint in the middle of the toe bends down like a hammer, describes Dr. Meng. Hammertoe can also affect people without RA–in fact, wearing improperly fitting footwear is one of the main causes of hammertoe, according to Mayo Clinic.

Claw Toe

A claw toe is similar to a hammertoe. With claw toes, toes are bent upward at the joint at the ball of the foot, they bend downward at the middle toe joint, and the top toe joint may also curl downward, according to the American Academy of Orthopaedic Surgeons.

Treatments for Arthritis Foot Changes

Pain, stiffness, and destruction of foot joints from RA can significantly impact mobility and quality of life. Managing these changes effectively often requires a combination of treatments tailored to the specific needs of the individual. Here are some common approaches to treating arthritis-related foot changes, according to the American Academy of Orthopaedic Surgeons:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like ibuprofen and naproxen can help reduce inflammation and pain in the affected joints.

• Corticosteroids: These can be administered orally or through injections directly into the affected joints to reduce severe inflammation.

• Disease-modifying antirheumatic drugs (DMARDs): For rheumatoid arthritis, DMARDs can slow the progression of the disease and prevent joint damage.

• Custom insoles and orthopaedic shoes: Specially designed insoles and shoes with a wide toe box can provide extra support and cushioning, helping to alleviate pain and redistribute pressure on the foot.

• Toe splints or supports: These devices can help correct deformities like bunions or hammertoes and improve alignment.

• Physical therapy: Targeted exercises and stretches can help strengthen the muscles around the foot and ankle, providing better support and reducing pain.

Common Rheumatoid Arthritis Hand Changes

People with RA often describe their hand symptoms as a lack of grip strength, with difficulty holding their coffee mug, gripping a steering wheel, or holding a pen for an extended amount of time, says Dr. Haseeb. Joint damage can make these issues worse. Here are three hand changes that may affect those with RA:

Swan-Neck Joints

With swan-neck fingers, the joint at the base of the finger bends, the middle joint is straight, and the joint at the tip of the finger bends. RA is the most common cause of this deformity.

Boutonnière Joints

If you have boutonnière fingers, the middle joint is bent toward the palm and the tip of the finger joint bends away from the palm. Without treatment, stiffness, swelling, and range of motion problems can become worse, according to StatPearls.

Ulnar Deviation

With this kind of joint damage, “fingers drift toward the pinky side of your hand,” says Dr. Meng. Overtime, your wrist can also move toward that direction, too. This is also called “ulnar drift.”

Treatments for Arthritis Hand Changes

Living with arthritis in the hands requires a proactive and multifaceted approach. By combining medical treatments with physical therapy, lifestyle adjustments, and possibly surgery, individuals can manage symptoms, maintain hand function, and improve their quality of life. There are several options to manage hand issues with RA, many of which are the same as those for managing RA in the feet, according to Dr. Kimpel, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen and naproxen, are often used to reduce pain and inflammation in the joints of the hands.

• Corticosteroids: Administered either orally or through injections directly into the joints, corticosteroids can provide significant relief from severe inflammation.

• Disease-modifying antirheumatic drugs (DMARDs): For those with rheumatoid arthritis, DMARDs can help slow the progression of the disease and prevent further joint damage.

• Biologics: These newer medications target specific parts of the immune system to reduce inflammation and prevent joint damage in conditions like rheumatoid arthritis.

• Hand exercises: Strengthening and stretching exercises can help maintain mobility and reduce stiffness in the hands.

• Splinting: Wearing splints can help stabilize and protect the joints, particularly during activities that put stress on the hands. Splints can also reduce pain by limiting motion in inflamed joints.

• Adaptive devices: Occupational therapists can recommend tools and devices that make daily tasks easier and less painful, such as jar openers, thick-handled utensils, and button hooks.

Surgeries for RA Joint Problems

The treatment options above may make a big difference in your ability to do daily tasks comfortably, making surgery unnecessary. However, if they are not successful, “we might refer more advanced cases to a surgeon, but this is often an end-of-the-road option because surgery can be very invasive,” says Dr. Haseeb. Sometimes, surgery may help reduce pain and improve strength, especially if joint issues are severely limiting your function, but they won’t make hands look like they did before, she says. Ultimately, this will involve a conversation between you and the surgeon to discuss the amount of damage to a joint and weigh the risks and benefits of surgery.

Sometimes, your doctor may recommend a procedure called a synovectomy, which removes inflamed tissue in the joint, says Dr. Meng. “It’s not as common as before, but it’s still done,” she says. Synovectomy can lessen swelling and pain and take some pressure off the joints.

Other surgeries that may be used include joint replacement (where a damaged joint is replaced with an artificial one) and joint fusion (which is when two joints are fused together to improve stability of the joint.) Joint replacement surgery is often more successful in bigger joints (like knees) rather than smaller joints of hands, for instance, says Dr. Kimpel.

How to Prevent Joint Changes in RA

One of the best things that you can do–even if you haven’t been diagnosed with rheumatoid arthritis—is to talk to your doctor (such as a primary care physician or rheumatologist) about the joint symptoms you are experiencing, including pain, swelling, and redness, along with fatigue and low-grade fever. In addition to a physical and medical history, your doctor may recommend lab testing to confirm RA.

If you have been diagnosed with RA, it’s important to closely follow the treatment plan recommended by your rheumatologist. With more advanced therapeutic options (such as biologics) available, medication can help slow some of this damage down, and potentially prevent it, says Dr. Haseeb.

Takeaways

The terms joint “deformities” is rarely used today in rheumatoid arthritis. Instead, doctors talk about the joint damage or changes that can occur with RA, which are caused by long-term inflammation that damages bone and connective tissue to cause small joints in the hands or feet to bend and twist in ways that they otherwise normally would not. This can lead to a visual change, such as hammertoe, bunions, and swan-neck syndrome, among others. Thankfully, joint damage is becoming less common with the use of more advanced medications to control the disease. Early diagnosis and treatment can help prevent or limit joint damage in RA.

https://www.healthcentral.com/condition/rheumatoid-arthritis/joint-deformities

Can Psoriatic Arthritis Affect Your Toes?

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. 

                                                                           GettyImages/Doucefleur

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