Psoriatic Disease and Foot Care: How a Podiatrist Can Help

Most people with psoriasis and psoriatic arthritis consult a dermatologist or a rheumatologist. But psoriatic disease often affects the feet, and that’s where a podiatrist can help manage potentially serious symptoms.

Podiatrists are trained physicians who specialize in treating all parts of the foot and ankle, including the skin, bone, muscles, tendons, and nails. “We have the knowledge base to make the diagnosis, and we can prescribe and develop an appropriate treatment plan,” says James Christina, doctor of podiatric medicine and executive director and CEO of the American Podiatric Medical Association.

Podiatry and Psoriasis

Podiatrists are often the first doctors to recognize the signs of psoriasis. When it affects the nails, psoriasis looks like nail fungus, and when it occurs between the toes, psoriasis can be mistaken for the fungal infection known as athlete’s foot.

A podiatrist might make a diagnosis through a physical examination or perform a biopsy, in which a small sample of the lesion is examined under a microscope. Depending on the condition, they can prescribe topical treatments or administer injections. Podiatrists are less likely to administer phototherapy, which dermatologists use for moderate to severe psoriasis, and they may want to consult with a dermatologist before prescribing systemic treatments.

To help decide if you should see a dermatologist, your podiatrist may examine your elbows and ask about any history of skin problems on the rest of your body.

Podiatry and Psoriatic Arthritis

One of the most common reasons people seek a podiatrist’s help is to ease pain from plantar fasciitis, an inflammation of the tissue on the bottom of the foot. The condition typically causes sharp pain in the heel or middle of the foot when you first stand after sleeping or sitting a long time. Pain may also worsen at the end of the day.

A podiatrist can treat plantar fasciitis with medication or other therapies, but also may recommend seeing a rheumatologist if the condition appears to be related to psoriatic arthritis, especially if you also have signs of psoriasis on the skin.

“It can be difficult to tell if plantar fasciitis is related to psoriatic arthritis, especially if it precedes painful, warm toes that have sausage-like swelling,” says Dr. Christina. “Or if it occurs before any skin lesions.” Asking about your family history of arthritis can help.

Other common problems associated with psoriatic arthritis that may prompt podiatrists to refer you to a rheumatologist include:

  • Achilles tendonitis, an overuse injury causing pain at the point where tendons and ligaments attach to bones
  • Psoriatic disease in the toenails
  • Pain in the toes, especially in the joints nearest your toenails, because psoriatic arthritis often affects these small joints

Similarly, a rheumatologist may send someone with psoriatic arthritis– related foot symptoms to a podiatrist for further treatment. “I absolutely refer psoriatic arthritis patients to podiatrists,” says Philip Mease, MD, rheumatologist with Swedish Medical Center in Seattle. “They really understand the nuances of gait issues and using orthotics [or shoe implants].” They can also help you find shoes that don’t aggravate painful, swollen joints.

For a gait analysis, your podiatrist may watch you walk across the room or on a treadmill. You could be altering the way you walk to protect a painful foot. Or you may have too little or too much movement in the joints.

Foot Care Tips

To prevent or ease skin-related symptoms on your feet:

  • Wear socks made of merino wool or a blended material that helps wick moisture away from your feet.
  • Change your socks during the day if your feet sweat a lot, and after exercise or sports.
  • Don’t wear the same athletic shoes every day, so you won’t have to put on shoes that may still be damp with sweat.

For comfortable shoes:

  • Keep pressure off your skin and nails with open-toed shoes or a roomy toe box. Make sure your feet have room from side to side and from back to front.
  • Buy shoes with removable insoles and add a cushier one that reduces pressure on your heel. Ask your podiatrist about the best type for you.
  • Avoid flats because they don’t give your foot enough support. But don’t get heels higher than 1.5 inches either. Any higher puts too much pressure on your foot and shoves your toes forward.
  • Choose shoes that can be adjusted, like with Velcro straps, so you can give swollen joints extra room.
  • Choose shoes that are stable, not ones that twist easily. “If you have pain primarily in the toes, reduce flexing movement,” Christina says.

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