Areas of the body (ankles & feet)

How are ankles and feet affected by arthritis?

Any joint in your ankles, feet and toes can be affected by arthritis, causing joint pain, swelling and stiffness. Arthritis in the feet can make standing and walking painful. You may find your feet and/or toes change shape, which can make it harder to fit into shoes.

Pain in the heel or sole of the foot

People with psoriatic arthritis (PsA) often experience pain and swelling at the back of the heel and in the sole of the foot (plantar fasciitis). This pain is caused by enthesitis. Enthesitis is an inflammation of the point where a ligament or tendon attaches to a bone. This causes pain at the affected site that gets worse with movement.

Swollen toes

In many people with PsA the small joints of the fingers and/or toes (the digits) and surrounding tendons can become inflamed and swollen. This is called ‘dactylitis’ but is sometimes referred to as ‘sausage digits’. The whole of the finger or toe becomes swollen, making it painful and hard to bend.

Changes to the toenails

People with PsA can also find that their toenails and fingernails are affected. Pitting of the nails, and a condition called ‘onycholysis’ where the nail lifts away from the nail bed, are common. These conditions are related to psoriasis and are often referred to as ‘nail psoriasis’.

Things you can do to help protect your feet

Exercise

Exercise is important to keep your joints moving. However, you may need to try different types of exercise if you have painful feet. For example, exercising in water. The buoyancy of the water takes pressure off your ankles and feet and you may find you can move more freely than you can on land. Strength training and cycling are also good forms of exercise that do not put extra pressure on sore feet. If you are walking or standing, make sure you wear supportive, comfortable shoes.

Weight loss

One of the best ways to take pressure off painful ankles and feet is to lose any extra body weight. Being overweight can make your symptoms worse as your joints need to carry more weight. Losing weight can improve both your joint symptoms and your psoriasis. It can also make your medicines more effective and reduce your risk of developing other health conditions.

You may find it useful to see a dietitian for advice about healthy eating. To find a dietitian, talk to your doctor, contact Dietitians Australia on 1800 812 942 or use the ‘find an APD’ (Accredited Practising Dietitian) service on their website.

See a podiatrist

Podiatrists specialise in conditions affecting the feet. They can give you advice about footwear, nail care and orthoses (inserts for your shoes that may help reduce foot pain). You will need a referral from your doctor to see a podiatrist in the public system. You can consult a private podiatrist at any time without a referral from your doctor.

The Australian Podiatry Association website has helpful information about when to see a podiatrist, common foot problems and advice on footwear. The website can also help you find a podiatrist in your local area.

Footwear

The most important thing you can do to protect your feet is to wear supportive shoes that fit your feet properly. Keep these tips in mind when buying new shoes:

Ask an experienced footwear salesperson for help in choosing the right shoe and size. Remember, your shoe size may change if your feet are affected by arthritis. If your feet tend to swell during the day, it helps to have your feet measured when your feet are swollen, to ensure your shoes have enough room.
Try shoes on with any insoles or orthoses you normally wear. Some orthoses may need extra depth, particularly in the toe area.
Your toes should not touch the end of your shoes as your toes or nails could become damaged. Make sure there is a 1cm gap at the end of your longest toe.
Look for shoes with synthetic or rubber soles for better grip and shock absorption.
Look for shoes that can be secured on to your feet with laces and straps. Velcro straps, elastic shoelaces and zips can make shoes easier to fasten. There are also many devices to help you put on and do up your shoes. Contact an Independent Living Centre for advice.

If it is hard to find shoes that fit because of swollen or misshapen joints, try extra depth footwear. Contact your local arthritis office or an Independent Living Centre for retailers or see a podiatrist for advice.

What else can I do?

There are other treatments that may help you deal with pain and stiffness:

Medicines: Many different types of medicines can help the symptoms of arthritis. Your doctor or pharmacist can help you understand which medicines are right for you and how best to use them. Your rheumatologist may recommend cortisone injections to help reduce local inflammation.
Heat and cold: Applying heat, such as a hot pack (microwaveable wheat pack), heating pad or hot water bottle, to stiff, painful joints may help relieve these symptoms. If your joints are hot and swollen, you may find it useful to apply an ice pack. Try applying heat or cold to the painful area for 15 minutes. Always have a layer (such as a tea towel) between your skin and the heat or ice pack. You can repeat this whenever you need to throughout the day. Make sure the temperature of the skin returns to normal in between applying heat or ice pack. You can repeat this whenever you need to throughout the day. Make sure the temperature of the skin returns to normal in between applying heat or ice packs to prevent damage to the skin. Be careful when using hot or cold therapy. If you have other conditions, such as diabetic neuropathy, Raynaud's disease (a disease that cause blood vessels to contract) or Cryoglobulinemia (a condition that causes inflammation of blood vessels, that can restricts blood flow) you should seek advice form a health professional before starting heat or cold therapy.
Creams: Applying creams or ointments containing anti-inflammatory medicines may help control pain. Talk to your doctor or pharmacist about these types of creams.
Fish oils: Fish oils may be helpful for people with inflammatory forms of arthritis like PsA. Always let your doctor know if you are taking fish oils or any other natural medicines.