Caring for Your Feet with Psoriasis

Psoriasis is a chronic autoimmune condition that causes rapid skin cell turnover, leading to red, scaly patches on the skin. When it affects the feet, it can cause significant discomfort and impact daily activities. Proper care and management are essential to minimise symptoms and maintain foot health. This guide by Manly Cove Podiatry will provide you with practical advice and treatment options for caring for your feet with psoriasis.

Understanding Psoriasis and Its Impact on Foot Health

Psoriasis is characterised by the immune system attacking healthy skin cells, accelerating their production and causing a buildup of cells on the surface of the skin. When psoriasis affects the feet, it can lead to thickened, cracked, and painful skin that is prone to infection. 

Common types of psoriasis that affect the feet include plaque psoriasis and palmoplantar psoriasis. The condition can make walking and standing painful, significantly affecting quality of life. Managing psoriasis on the feet requires a combination of medical treatments, self-care strategies, and regular podiatric care.

Recognising Symptoms of Psoriasis on the Feet

Psoriasis on the feet can manifest in various ways. Identifying these symptoms early can help in managing the condition more effectively. Common symptoms include:

  • Red Patches of Skin:
    • Well-defined red patches covered with silvery-white scales.
    • These patches can be itchy and painful, often appearing on the soles of the feet.
  • Thickened Skin:
    • Areas of the skin may become thickened and hardened due to the rapid turnover of skin cells.
    • This can lead to painful cracks, especially on weight-bearing areas.
  • Blisters and Pustules:
    • In some cases, small blisters or pus-filled bumps (pustules) can develop.
    • These are more common in palmoplantar psoriasis and can be very painful.
  • Cracking and Bleeding:
    • The skin on the feet can become so dry and thick that it cracks and bleeds.
    • Cracks can be deep and painful, increasing the risk of infection.
  • Nail Changes:
    • Psoriasis can also affect the toenails, causing pitting, discoloration, and separation from the nail bed (onycholysis).
    • Nails may become thickened and crumbly.
  • Swelling and Stiffness:
    • Inflammation from psoriasis can lead to swelling and stiffness in the joints of the feet, a condition known as psoriatic arthritis.
    • This can cause additional pain and difficulty in movement.

Recognising these symptoms early and seeking podiatric care can help manage psoriasis effectively and prevent complications.

Diagnosis of Psoriasis on the Feet

Diagnosing psoriasis on the feet involves a thorough examination and several diagnostic procedures to confirm the condition and rule out other skin disorders. Here are the key steps:

  • Medical History:
    • Detailed review of the patient’s medical history, including any family history of psoriasis or autoimmune conditions.
    • Discussion of symptoms, their duration, and any factors that seem to trigger or worsen the condition.
  • Physical Examination:
    • Visual and tactile examination of the feet to identify characteristic signs of psoriasis, such as red patches, scaling, and thickened skin.
    • Assessment of the nails for any changes indicative of nail psoriasis.
  • Skin Biopsy:
    • In some cases, a small sample of skin may be taken and examined under a microscope to confirm the diagnosis.
    • This helps differentiate psoriasis from other skin conditions with similar symptoms.
  • Imaging Tests:
    • If psoriatic arthritis is suspected, imaging tests like X-rays or MRI scans may be used to assess joint damage and inflammation.
  • Lab Tests:
    • Blood tests may be conducted to check for markers of inflammation and other signs of autoimmune activity.
    • These tests help in ruling out other conditions and in the overall assessment of the patient’s health.

Early and accurate diagnosis allows for effective treatment planning, tailored to the specific needs of individuals with psoriasis on their feet.

Treatment Options for Psoriasis on the Feet

Managing psoriasis on the feet requires a multifaceted approach to reduce symptoms and prevent flare-ups. Treatment options include:

  • Topical Treatments:
    • Corticosteroids: These anti-inflammatory creams and ointments reduce redness, swelling, and scaling. They are often the first line of treatment for mild to moderate psoriasis.
    • Vitamin D Analogues: These synthetic forms of vitamin D slow down skin cell growth. Examples include calcipotriol and calcitriol.
    • Coal Tar: An older treatment that helps reduce scaling, itching, and inflammation. Available in various forms such as creams, ointments, and shampoos.
    • Retinoids: Topical forms of vitamin A, like tazarotene, can help reduce scaling and inflammation.
  • Phototherapy:
    • UVB Light Therapy: Exposure to ultraviolet B light under medical supervision can slow down the rapid skin cell turnover associated with psoriasis.
    • PUVA Therapy: Combines a photosensitising drug (psoralen) with UVA light to enhance the effectiveness of light therapy.
  • Systemic Treatments:
    • Oral Medications: For moderate to severe cases, oral medications like methotrexate, cyclosporine, and acitretin can be prescribed to reduce inflammation and slow down skin cell production.
    • Biologic Drugs: Target specific parts of the immune system to reduce inflammation. Examples include adalimumab, etanercept, and infliximab. These are usually reserved for severe cases that do not respond to other treatments.
  • Moisturisers and Emollients:
    • Regular use of moisturisers helps maintain skin hydration, reduce scaling, and prevent cracking. Look for products with ingredients like urea, lactic acid, and salicylic acid.
  • Pain Relief:
    • Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain associated with cracked or inflamed skin.
  • Infection Management:
    • If there are signs of infection, antibiotics or antifungal treatments may be prescribed to address secondary infections caused by cracked skin.

The Role of Podiatry in Managing Psoriasis

Podiatrists play a crucial role in managing psoriasis on the feet. At Manly Cove Podiatry Sydney, we provide specialised care to help patients manage their condition effectively. Our services include:

  • Accurate Diagnosis: Comprehensive evaluations and diagnostic tests to confirm psoriasis and differentiate it from other skin conditions.
  • Customised Treatment Plans: Development of personalised treatment plans that may include topical treatments, orthotics, and advice on footwear.
  • Ongoing Monitoring: Regular check-ups to assess the effectiveness of treatments and make necessary adjustments.
  • Patient Education: Providing education on self-care practices, trigger management, and lifestyle modifications to help patients manage their condition at home.
  • Advanced Therapies: Access to advanced treatment options such as phototherapy and systemic medications for severe cases.

When to Seek Professional Help

While self-care and over-the-counter treatments can help manage psoriasis on the feet, there are times when professional intervention is necessary. Seek help from a podiatrist or healthcare provider if you experience any of the following:

  • Severe Pain or Discomfort: Persistent or worsening pain that interferes with daily activities, despite using home remedies and over-the-counter treatments.
  • Significant Skin Cracking and Bleeding: Deep cracks in the skin that bleed or cause severe discomfort, increasing the risk of infection.
  • Signs of Infection: Redness, warmth, swelling, or pus in the affected areas, indicating a possible infection that requires medical treatment.
  • Rapid Spread of Lesions: Rapid development or worsening of psoriatic lesions, covering larger areas of the feet or spreading to other parts of the body.
  • Unresponsive to Treatment: Lack of improvement or worsening of symptoms despite following a treatment plan, indicating the need for stronger or alternative therapies.
  • Nail Changes: Significant changes in the nails, such as thickening, discoloration, or separation from the nail bed, may require specialised treatment.
  • Joint Pain and Swelling: Development of joint pain, swelling, or stiffness, which could indicate psoriatic arthritis and needs immediate attention.
  • Quality of Life Impact: Psoriasis significantly affects your quality of life, making it difficult to perform daily tasks or causing emotional distress.

At Manly Cove Podiatry, our team of experienced podiatrists is dedicated to providing comprehensive care for psoriasis and other foot conditions. We offer a range of treatments tailored to your specific needs, ensuring the best possible outcomes. If you are experiencing any of the above symptoms, contact us today to schedule a consultation and take the first step towards better foot health.