Our feet, often overlooked, are the unsung heroes of daily life. They carry us through work, play, and rest. Yet their importance becomes glaringly clear when something goes wrong. For individuals living with rheumatic diseases, such as ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and other forms of spondyloarthritis (SpA), the feet are both a foundation and a battleground.
Dr. Lindsey Cherry, a specialist podiatrist in rheumatology at the University of Southampton, provides care across all stages of disease. She treats individuals whose foot issues may lead to diagnosis as well as those managing ongoing symptoms.
“Feet are a marvel of engineering, bearing the weight of our entire body while enabling movement and balance,” Dr. Cherry says. “Ignoring their health is not an option when managing these rheumatological conditions.”
Skin and nail symptoms can often indicate underlying rheumatic diseases.
“Changes in the nails, such as pitting or separation from the nail bed, could be early warning signs for psoriasis and psoriatic arthritis,” says Dr. Cherry.
These changes, common in PsA, often correlate with more severe joint involvement. The National Psoriasis Foundation reports that nail changes occur in over 80% of PsA patients.
“With immune system changes, often due to medications, we might see delayed healing from injuries like cuts or blisters,” Dr. Cherry explains.
While fungal infections like athlete’s foot are common, distinguishing between fungal and bacterial issues is crucial. Bacterial infections may require antibiotics, while fungal infections will not respond to them. Dr. Cherry advises keeping open wounds covered to minimize infection risk and using over-the-counter antifungal treatments for conditions like athlete’s foot.
Addressing Dactylitis
Dactylitis, or “sausage toes,” is characterized by swelling, heat, and discoloration in the toes due to inflammation.
“Dactylitis occurs where the tendons attach to the bones in the toes,” Dr. Cherry says. “When these attachment sites become irritated, the body sends an influx of cells to heal the area, causing swelling.”
Common in PsA and AS, dactylitis requires managing inflammation to alleviate symptoms. Cold compresses and anti-inflammatory gels can help, while oral medications, such as NSAIDs or corticosteroids, may be necessary for severe cases.
Physical therapy exercises to maintain range of motion and reduce stiffness can also benefit people experiencing dactylitis, and shoe inserts may help redistribute pressure and provide support. Avoiding high-impact activities, like tennis or squash, further prevents irritation. Although swelling often resolves, some residual thickening may remain, a normal sign of healing.
Neuropathy, or nerve damage, can cause tingling, burning, or numbness in the feet, often starting in the toes. Dr. Cherry advises against assuming these symptoms are normal or solely related to rheumatic diseases.
“Tingling, numbness, or burning require investigation to rule out conditions like diabetes or anemia,” she says.
Lifestyle adjustments, such as a balanced diet and staying active, often help address neuropathy. Regular movement and hydration, especially during sedentary activities, are essential. For burning pain, creams like capsaicin can offer relief, though persistent symptoms should be evaluated by a healthcare provider.
Enthesitis, or inflammation where tendons and ligaments attach to bones, is a hallmark of spondyloarthritis. It frequently affects the Achilles tendon and plantar fascia, resulting in discomfort and pain.
However, the impact often extends beyond the feet. Foot issues like plantar fasciitis can lead to knee problems and other joint discomfort, according to Dr. Cherry. Reduced tendon elasticity can compromise shock absorption, leading to compensatory movement patterns that can affect even your neck and shoulders, usually due to posture.
“When you have pain, you walk differently, loading joints unevenly and causing complications like joint pain and stiffness,” she adds.
Staying active is key to preventing further complications. “Movement is vital for maintaining joint health,” Dr. Cherry emphasizes, countering the myth that rest is always the best remedy for foot pain.
How can people keep moving despite pain and discomfort? Persistent symptoms may require tailored interventions to support mobility. Disease-modifying antirheumatic drugs (DMARDs) as well as nonsteroidal anti-inflammatory drugs (NSAIDs) can play a significant role in managing enthesitis. By reducing systemic inflammation, these medications can help address the underlying causes of enthesitis, providing relief and preventing long-term joint damage.
Targeted physical therapy, supportive shoe inserts, and stretching routines focused on the calves and plantar fascia may further support recovery and mobility.
Footwear Matters
Choosing the right footwear is essential for individuals with rheumatic diseases. Supportive shoes with proper cushioning, shock absorption, and arch support can alleviate pain and prevent further joint damage. Features like a wide toe box and a rocker sole—designed with a curved shape to help the foot roll forward smoothly—reduce pressure and strain on the forefoot and heel, providing additional relief for those with joint or mobility issues.
Custom-made orthotics can be a useful tool, providing individualized support for each patient’s needs. At the same time, Dr. Cherry highlights the value of insoles that can be purchased in your local pharmacy.
“The technology and design of off-the-shelf orthotics have greatly improved over the years,” she says. “They can provide excellent support and cushioning for most people and serve as a great introduction to shoe inserts.”
Exercise and Mobility: Balancing Activity with Care
Exercise is critical for managing rheumatic diseases but requires thoughtful planning. “Low-impact activities like walking on flat terrain, water-based exercises, or even seated exercises can keep joints healthy without exacerbating symptoms,” Dr. Cherry advises.
Stretching, especially focusing on the calves and plantar fascia, can help alleviate stiffness and enhance flexibility. Many assume that stretching and exercise demand significant time and effort, but incorporating small, simple movements into your daily routine can yield substantial benefits.
“Take a moment in the morning to stretch while waiting for the kettle to boil. Shift your weight, spread your toes, flex your ankles,” Dr. Cherry says.
A Collaborative Approach to Foot Health
Effective management of rheumatological foot issues often requires a team effort, especially when surgical interventions are considered. Eric Cantz, featured in “Your Stories” on page 16, recalls being advised to undergo surgery for his feet, severely damaged by undiagnosed AS. Ultimately, he declined, as the surgeon failed to provide a clear diagnosis and seemed to view surgery as a quick fix rather than part of a broader treatment plan.
Experts say that surgery for SpA-related foot issues is rare and should always be part of a comprehensive plan that includes preparation and rehabilitation.
“There’s an important shared decision-making space where we try to be honest about what we know, what we don’t know, and the available options,” Dr. Cherry says. “When surgery is necessary, it should involve a coordinated team. This team might include a surgeon, podiatrist, physiotherapist, radiologist, and pharmacist, all working together to support the patient.”
Many experts agree that coordinated care is essential for managing rheumatological foot issues, regardless of the required intervention. After all, while the feet are our foundation, they don’t work in isolation. A collaborative approach not only enhances outcomes but also ensures that interventions align with the patient’s overall health and treatment goals.
Foot-Friendly Exercises to Relieve Discomfort
These low-impact exercises are easy to do at home and can enhance flexibility, reduce stiffness, and support overall foot health. Consult your healthcare provider to determine if these exercises are appropriate for you.
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