Feet: PsA & Psoriasis

General
1

My PsA started in my feet and in spite of moderate improvement on Simponi my feet are continuing to cause me pain. I 'manage' this as best I can with soft, cushioned footware. I find FitFlops most comfortable, over the summer it was open sandals and when I need a more enclosed shoe I wear their clog styles. Anything with an open back is great as I get alot of heel and achilles pain.

And therein lies the problem! Over the summer I have developed psoriasis around my heels as well as elsewhere on my feet. The skin is dry, hard, sore and develops deep painful cracks. Walking sometimes brings tears to my eyes. And it seems (reading on the internet) that my choice of going barefoot in open backed footware has contributed to this happening because the air dries the skin and the heel and heel fat pad is not supported. A catch 22 situation!

I've been gently using a foot file to exfoliate the dry skin, applying a cracked heel balm (with urea) and slathering on a rich emolient at least twice daily, under socks and at night I've even been wrapping my feet in food wrap or plastic bags (very attractive!!!!!). This is helping but not very much or very quickly.

Have read about doing short 15 minute soaks in a weak vinegar/warm water solution up to three times a week and wondered if anyone else has tried this and how you got on?

If anyone has any experience of this problem and found any other treatments/solutions that helped I would appreciate your comments.

Thanks. J

2

Hi Jules! Is your pain neuropathy? Hot, painful--as I always described, a feeling of walking on a bed of burning coals and hot spikes? If that's the case, for me, my doctor put me on a small dose of Nortriptyline (sp), which in larger doses is used as an antidepressant. It helped....IDK how long I took it--maybe several months, but it stopped the neuropathy. That was a couple years ago. I occasionally have a little burning sensation, but not bad. Left over, though, is soreness and some pain on the tops of my feet. If that's part of your pain, I can't tell you what to do about that. I sometimes apply ice packs, which helps temporarily. It's usually not too bad that I think I need pills for it. The heels--yes, they are dry and yucky right now--but it's not psoriasis. I need to use my "ped egg" quite often if I want them to look nice.

I remember the days when I had to wear really soft slippers....I even had a pair that had inserts which could be heated in the microwave and would be a warm cushion for several minutes. I hope you find a solution, because that pain can be unbearable!

3

Hello Grandma J. No, I don't think my pain is neuropathy just good 'ole inflammed joints and tendons. Unless I am wearing my cushioned shoes every step feels as if I've got bones grinding together. I'm used to dealing with this aspect but what has got me stymied is this recent development of the horrible painful psoriasis around my heels and underneath my worst MTP joint. Initially I thought it was just hard skin but when it got worse and worse inspite of using my pedi-file and moisturiser I began to think psoriasis and checked it out on dermnet.

It hasn't escaped my attention that the psoriasis has developed where my PsA is bad but I'm trying not to read too much into this. In theory my biologic should be controlling both the psoriasis and PsA better than it is ..... but hey, ho that is another whole issue which will have to await my rheumy appointment in January.

4

Ugh, Jules. What a situation. There’s no winning this one, is there? Wish I had some brilliant suggestions for you, but alas …

5

I'm so sorry, that sounds awful! I also have a lot of foot involvement, and it's currently making my life much more interesting.

When I get really bad dry patches, I will use gobs of straight shea butter and cover it up (socks/gloves) overnight. It's gross looking and incredibly greasy, but it works wonders. I'm not sure I'd put it on big cracks, though, unless I'd made sure to put some triple antibiotic on them first.

6

Hi Jules,

as you know my feet were pretty grotty back in August. At the moment they seem a fair bit better. Not sure if this is down to the humira because I still have a couple of red itchy patches on my legs that have not improved at all. The plastic bag trick definitely helps, but I'd say avoid exfoliating because I think this will just traumatise the basal layer of the skin more and make it worse.

7

Thank you Seenie, Rosen and Ali for your replies.

I've never tried shea butter (in fact if I'm honest I didn't even know what it was) but I like that it is a natural product so will get some to replace my white petroleum based Epaderm that I'm using now.

I wondered about the exfoliating, Ali, given that trauma/Koebner (sp?) can cause psoriasis, and certainly has done elsewhere on me. What I've read about the dilute vinegar soaks is that the acetic acid in the vinegar acts as an exfoliant so I think maybe I'll give that a try instead and see what happens .... I'm sure I'll be able to find something on TV this afternoon for a 15 minute soak.

Will let you all know how I get on.

8

UUUMMMMMMm…don’t know if I should even mention this. But rather than exfoliating, what about one of those fish pedicures? That would be gentle, if you aren’t squeamish.

9

Haha! I think that would work well, except it seems a bit unsanitary...

Seenie said:

UUUMMMMMMm...don't know if I should even mention this. But rather than exfoliating, what about one of those fish pedicures? That would be gentle, if you aren't squeamish.
10

Never having had a fish pedi, I looked it up, and found this article:
http://en.m.wikipedia.org/wiki/Doctor_fish
It even specifically mentions psoriasis. Imagine that.

11

Fishies ...... certainly an option I hadn't thought about. But now I've thought about it I don't think I could! I've heard about hygiene/infection issues too and with cracked open skin it's not a risk I'd be too keen on.

Think I'll give the vinegar soak a try for a couple of weeks and see what happens. I've just done the first one and aside from smelling like a fish 'n' chip shop (I actually have an aversion to the smell of vinegar) it seems ok. Maybe I should have gone upmarket on the vinegar and bought apple cider vinegar rather than distilled malt, ha ha!

If this doesn't work then I'll have to book an appointment with the chiropodist and see what he can do ..... but as that usually involves scalpels with sharp blades it is a last resort.

This damn disease certainly seems intent on making me confront a whole load of stuff I'd rather just pretend doesn't exist.

12

Hi Jules,

I don't have anything near as bad as your problem, but at the end of every summer when I start wearing socks and "real" shoes, my feet peel in massive thick patches. It's really nasty. And that back of the heel part--man if that gets a crack in it I'm done for. It hurts so much.

May I suggest these little numbers that REALLY help over time: Aloe socks from Woolrich. They are cute, warm, fuzzy and they will soften your skin and keep it that way. I usually slather on lotion then slip these right over the top and sleep in them. They wash really well and don't seem to lose their ability to moisturize. It isn't a perfect solution but every little helps.

In the shoe area there have been LOTS of discussions on the site about who wears what and how comfy things are. You can search "shoes" and you'll get a barrage of responses. I have NEVER seem my spouse happier than when she discovered Skechers "Go Walk 2" shoes and sneakers. She has a few pairs and this summer rarely wore anything else.

No matter what you end up doing it seems like you have to get that heel skin softened up which means keeping it covered. Good luck in your quest. And I think I'd prefer the fish if they were battered and covered with salt and vinegar with a nice portion of chips.

13

Ouch!!!!! I understand your frustration and pain. There is nothing worse than foot pain because there is no way to fix it, it seems. I simply solved it by not wearing shoes. I know this isn't an option for most people but I was lucky enough to work in a field that allowed sock feet( infant care). I do buy up every pair of wear outside type of sock I can find. I even have socks that look like ballet slippers.I have resorted to diabetic shoes. they are not comfortable either but they do no damage.

The biggest issue is to keep the scales off if you have them, don't let them build at all. If you have cracks across your heal try putting your triamcinolone on it, then taping across the heal like a butterfly bandage for a few days to hold the skin together so it can heal. This will help the pain. I use this method on my toes when they split as well, actually anywhere the skin splits. I hope these few tips help you have a better day or two:) The vinegar will help and you can just put a cup in your bath water, it will help ALL of your skin as well, I do. Boxers use this trick to keep their hands/faces in good shape.

14

Hi Janeatiu and Notanymore, thank you for your replies. I've bought a couple of pairs of moisturising socks, I'm finding the bamboo/cotton ones best for sleeping in as they don't make me overheat too much and the fluffy micofibre are best for during the day when I'm at home. Only challenge with the microfibre is getting them in my slippers (I can't walk more than a few steps without any footware) but GREAT for sitting in front of the TV or reading.

Did buy a pair of the Skechers Go Walk 2 shoes for around the pool on holiday. Found them fine for this but not enough sole padding for me for general walking ..... maybe I'll buy shares in FitFlops as so far they are the only brand that make walking bearable, but they are expensive.

I had no idea vinegar was so good for skin. Won't be bathing in it, though, as it's years since I could get in/out of a bathtub. Ha, ha jsut thought if I got in and couldn't get out I could end up pickled :-)

15

I wonder what's the best vinegar to use. White? Apple cider? (and I mean for skin, not to pickle you, Jules!)

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From what I've read I don't think it matters. I didn't like the smell of the white but I don't know if apple cider smells any better?

janeatiu said:

I wonder what's the best vinegar to use. White? Apple cider? (and I mean for skin, not to pickle you, Jules!)

17

Hello Jules,

Believe me, I know the feeling...

I use Solum Öl from WALA or Aconit Öl from WALA (both available in Germany), it helps for a while to make it feel better...it is an oil that is used or pain....something that nature has to offer:-)....

18

I had the exact heel dryness, it was so painful:( my Dr said it was a skin fissure whatever that means lol… I had relief after putting triple ointment after trying the lotion and socks for days. Dr prescribed a steriod cream for future use. I too love to wear open heel shoes, which Im having to reconsider after that horrible pain! The area was sore and tender and I couldn’t walk.

19

The subject of my feet came up again in another thread yesterday so rather than hijack that with my woes I will post my update in its rightful place:

So I started this thread in November 2014 when my foot psoriasis had been a bit of a problem since summer. Here I am a year later and, sadly, my foot psoriasis is still a problem.

I hit rock bottom with self-management around February/March time and visited my GP for help. His advice was a daily regime of a 15 - 20 minute soak in warm water with a liquid emoillient additive to soften the plaques, followed by a lactic acid and urea cream to break down the plaques, followed by a betamethasone and calcipotriol steroid gel which following the two previous steps meant the steroid stood some chance of actually reaching the inflammed skin.

I did this every night and often also topped off with huge dobs of emoillient cream and wrapped my feet with cling film or sported a fashionable range of plastic bags on my feet to bed each night. Mornings were lactic acid/urea cream and emoillient cream. I can't describe what a mess a couple of carpets are where I've walked with all this gunk oozing out of my bags/socks etc (note to self: book carpet cleaning man!).

It helped. Over the course of around four months I got something like a 70% improvement in the original areas of plaques. But the moment I missed a night of soaking/slathering/covering or I spent too long on my feet during the day then the plaques would flare and deteriorate almost before my eyes. One step forward, two steps back.

Just this last week or so I have noticed that the plaques and underlying skin along the ball/MTP's of both feet is finally showing signs of healing. The plaques are disappearing, the splitting has stopped and the skin looks pink and healthy not red and inflammed. There are a few 'new' patches where these previous plaques have crept towards and between my toes -- these are sore.

My heels are hard to quantify. Improvement in some places and still spreading in others but so long as I keep them as soft as possible it stops the deep, deep fissues which makes it slightly more bearable. I'm back to see my GP on 25th ... to see whether he thinks it's time for a dermy review. I probably should have pushed for this sooner but to be truthful I've been alot more concerned and busy getting myself better rheumatology care.

I did see a PsA expert for a second opinion a while back and I did ask why my biologic (Simponi) wasn't helping my skin when it seems to be suiting me quite well for my joints. It should be, there was no explanation for why it isn't. And it's not just my feet, my hands are quite patchy and I'm getting intermittent inverse in all the "usual" places as well as being driven nuts by my ear canals and the folds behind my ears.

So I have three of my own theories based on events of 2014 when it flared: (i) it is a side-effect of Simponi ... this is, I think, the least likely albeit not impossible cause, (ii) it is a response to the doubling of my beta-blocker (atenolol) dose, (iii) stress.

My money is on a combination of (ii) and (iii). Worsening pre-existing psoriasis is a known side-effect of atenolol. Stress? Yes, I reckon my PsA merry-go-round and treatment battle, being unable to run my business/work any more because of my health, losing my sister-in-law in tragic circumstances overseas, my husband jacking his job in (without any consultation!) followed by seven months of having him home unemployed and then losing my dearest childhood friend to cancer, all in the space of a year qualifies as stress. In fact now I look at all that in black and white I don't know why I'm even questioning why my skin is a mess. The only way is UP!