Valgus heel?

Hello everyone,

I just realized that my feet flattening and right heel starting to drift outwards may be linked to PsA. Actually I got diagnosed with the feet flattening problem this summer, and had realized my feet was changing for a year before that. I had numbness, pain and the pins and needles sensation at the middle of my feet. Now I have arch support plates for my shoes made spesifically for me. And I read somewhere that the valgus heel problem may manifest itself before the arthritis. I was wondering if any of you have this problem?

Also, I realized that I began walking without moving my ankle much. I'm not limping, but I'm also not walking naturally. And I CAN move my ankle. But not when I'm walking. It's kind of weird.

Hi ladylazarus! Hopefully the arch support plates will help with the pain. IDK if the pins and needles feeling is like neuropathy--I had the burning sensation which felt like I was walking on a bed of burning spikes. The pain would build up during the day and by evening I was in excrutiating pain. Ice packs helped temporarily. I finally got a prescription for "nortriptyline", which almost cured this (I still have a little neuropathy, but nothing like it was).

I wish I could help you with some advice about valgus heel problems, but I never had that kind of pain.

Hi Grandma J,

The valgus heel problem was actually diagnosed when we thought my problem was fibromyalgia and my scoliosis was causing me trouble so I went to physical therapy this summer in my hometown. My pt thought it would be beneficial for me to wear arch support plates where the left is 0.8 mm higher, to support my uneven hips due to the scoliosis, so when the pt she referred me to make the measurements etc he realized that I also had feet flattening and valgus heel problem. I just thought my feet were getting bigger than they already were, haha :D And he said he pain and numbness was caused by my bones in the middle of my feet pressuring the nerves. I don't know if it can be called neuropathy?

I will definitely ask them if it can be PsA related when I see them again this month. But arch support plates definitely helped!

LL, I am totally impressed with your pt. Without getting into the whole long story, after years of being undiagnosed, developing foot problems (pain, and neuropathy), I was finally diagnosed with PsA when they found erosions in my feet. At that point, I went to a neurologist, who explained my neuropathy-like symptoms exactly the way your pt did. It was swelling in my mid feet pressing on the nerves. (There was no problem with the nerves themselves.) By the time they realized that my disease was severe and they found the right treatment for me, my feet were irreparably damaged. My damage is all mid-foot, although most people with PsA tend to have toe problems first. The longer story is here:

I don’t know if your mid-foot problems are PsA related, but I sure would be asking my rheumatologist to do an investigation to see whether you have inflammation in those joints of your mid-foot. An x-ray will only show damage that is already done, but an MRI will show inflammation. I believe there are certain kinds of ultrasound which will also show inflammation.

The last time I saw my rheumatologist, I witnessed a teaching moment with a student. He impressed on the student that foot issues should never be taken lightly, and should always be thoroughly investigated. “Otherwise,” he said, “you can get this.” And he pointed at my foot x-rays and shook his head.

The last time I saw my foot surgeon, we discussed reconstructive surgery, which in my case would be extremely difficult because there are ten joint surfaces with severe damag in each midfoot. Given the risks and the uncertainty that I’d be better after the surgery than before, I’ve decided to leave well enough alone, and live with the pain and disability. I commented to him about how unusual my case is, that my toes and ankles are perfectly fine. His comment was that it’s not at all unusual for a disease like PsA to do damage such as what I have.

Knowing what I know now (and living with what I have) I wish that I had been more insistent that my foot issues be thoroughly investigated, particularly after I was diagnosed with PsA. I was too trusting of the professionals who seemed to think that new orthotics were the answer, and another who saw no urgency despite the fact that I already had midfoot damage. Hindsight is wonderful, isn’t it?

Many joints in the body can be successfully replaced and repaired. But foot damage is very difficult to set right once it has happened. For what it’s worth, I’d suggest having your feet thoroughly investigated, and also accepting the most aggressive therapy that your rheumatologist is prepared to give you. Feet are that important.

Here’s another discussion about feet –

Hi Seenie,

Yes, this feet stuff has been bothering me since I realized it might be PsA related, because I figured it must be the hardest to repair the feet. The problem is, I was in such a shock when I was diagnosed with PsA, I didn't even think about telling my rheumy about the problems with my feet. I only realized that it could be PsA related when I took my sock off, and there was this bump just above my heel (caused by friction against the shoe) that was not where it was supposed to be! It was way to the right, and that's when I remembered my feet were not only flattening, my heel was drifting sideways as well. And with a flashback I remembered I read about it when I was researching PsA. So next time I see my Pt and my rheumy I will have lots of questions for them both :)

I don't mind the pain but I am terrified about the damage that can be done! So I will ask for x-rays of my hip, SI and feet. I wish there was a way to look inside for ourselves and see what was going on.

I was terrified too, LL, but felt that I had to trust the professionals. Well, those professionals won’t be spending a day in my shoes! I would be asking for advanced techniques for my feet (MRI or U/S).

The heel bump is pretty classic for PsA, I think, although I don’t have it. My arches have collapsed.

You are absolutely right Seenie!

And we have so many different symptoms I think it is our responsibility to inform our doctors about every little thing that's going on. My rheumy thought my only problem was my SI, because I hadn't told him about my feet. I believe the fault is mine on that one :)

Also, I didn't know about the heel bumps being classic for PsA. Gosh, what else should I be looking out for that I thought were normal because I had them for so long?!?!?!

I know … you start looking at everything through PsA lenses! Hey, maybe my chin hairs are PsA too. LOL

But seriously, have a look at the pictures on this page.—…

It makes me feel good that I'm not the only one who gets them! (Chin hairs!) I've instructed my daughters that when I'm laid out in a casket someday for viewing (the thought of which makes me cringe that people would be staring at me while I'm dead) they need to make sure my 3 chin hairs are plucked!

I should have my feet MRI'd too, but I agree with you, Seenie, about not having surgery anyway. It could very well just make matters worse. Ladylazarus, you're so young that you might need to take a different approach than us because you have a lot of years of needing strong feet ahead of you. I'm resigned to the fact that my feet are going to hurt when I first get up or out of a chair, and hurt when I walk any distance over a half block, and then usually just hurt for no reason. It's my mid-feet too-not my toes. I've found that rest and daily ice packs help the most.

Seenie said:

I know ... you start looking at everything through PsA lenses! Hey, maybe my chin hairs are PsA too. LOL

But seriously, have a look at the pictures on this page.

Yeah I had looked at them a little while ago but thanks :) The funny thing is, if I were to be diagnosed just by those 5-6 distinct signs like swollen digits or the problems with the nails, I think I would never be diagnosed at all. Because all my problems are with my larger joints. So I definitely feel the swelling, but it is not visible. (I look like a fool looking at the mirror at my buttock trying to see the swelling I feel so distinctly :D ). My one toenail looks a little funny all cracked and maybe a little thicker but that's all. And my fingernails feel ridged but very slightly. So nothing visible yet on my part :) Oh, and I think both my ankles are swollen and have been swollen for a long time. I had noticed it a while ago but I thought I was gaining weight or something (the things the mind can imagine just to find an explanation. Gaining weight? Really? Only on my ankles?!). And I had the pain in the feet for some time but I just ignored them (wrong shoes, I must have done something wrong, I walked too much etc). So now I have nothing to compare it to. I know my ankles were a lot thinner and that's the only evidence that I have :)

Yes of course, LL! There’s always an explanation for our many and variable symptoms: the wrong shoes, needing to lose weight, walked too much, being menopausal, doing too much, having a bad mattress, not exercising enough, needing to eat better, not getting enough sleep blah blah blah. (And I’ll add, easy to see most of those “reasons” as being our own fault.) Until you start connecting the dots and seeing the pattern. Interesting, isn’t it!

Yes, lately I am somewhere in between connecting the dots and becoming paranoid and making up the dots :) That's why I've been asking too many questions. To know what the real dots are and not make things up because they seem like they fit in the picture :) So thank you for all your help, really!

Yes, LL, I know exactly what you mean!
After I was diagnosed, I started to think back on about twenty years’ worth of strange things that nobody could figure out. Pretty much everything was explainable as Ps or PsA. Weird. But at the same time, validating. I hadn’t been imagining things after all.

I am still having a hard time believing that it wasn't all in my head or just caused by my psychological problems :) I had gotten so used to thinking that everything was my own fault somehow. That's why I ignored so many things :) It was kind of easier to think I was crazy, turns out I wasn't. How do I live now with knowing I'm a normal person with a physical condition?! :))))

Yup. I can completely relate to that. Totally.
Making the transition to “I’m a normal person with a physical condition” isn’t an easy task. There are still days that I give my head a shake and wonder if this is really happening.