I've been wondering if I'm alone in having finger and toe joints that are beginning to look deformed (PIP joints in fingers and toes and sesamoid (?) on ball of foot) but my X-rays don't show any unusual deterioration.
How can my hands and feet look so utterly gnarly and feel pretty crappy at times and for my films to look OK? Anyone? Anyone? Bueller?
No, Jane, you're not alone but I dunno the answer that's for sure!
Seems to me also to depend on who is looking. My knees are butt ugly these days but according to the knee surgeon there is very little (nothing!) wrong with them and he won't go in for a root about ... yet he commented on my finger joints, position of two fingers on my right hand and the general swelling that not even my rheumy has made any observation about. Go figure!!!!
Good to know, Jules. I know at least three of my fingers are turning at the PIP and the ball joint of my big toe now has such a huge lump on the side that it is hard to fit into some shoes. But the x-rays "look fine". Although they did spot two bone spurs growing on my heels.
I've had x-rays of hands and feet and had an MRI of my hands about 18mos ago.
That sounds about right. The good news is that it means that your treatment plan is working overall. I think that the type of damage that you are talking about is soft tissue damage, and it can definitely make hands and fingers look weird. I’ve got a few fingers that have rotated at the dip joint. Add to that some ulnar deviation, some bumps,etc, my hands have clear damage but no erosions on films.
My rheumy describes my entire feet as damaged just by looking at them. My toes have been a mess since I was in my 20s and it wasn't down to wearing crazy shoes as a teenager, my mum wouldn't let me and anyway I was a clog-toting hippie. I suspect an early episode of PsA having had a very swollen knee at 16. I've had my feet x-rayed once which showed damage to big toe joints but no discernible damage to other toes. Yet they are deformed. Tendons??
If the lump you're describing is a bunion, I've had bunion surgery, the surgeon said he'd been hoping to do something creative with the main tendon but had to chuck it in the bin. I've heard that bunions, common as they are due to pronation and so on, can also result from PsA. My bunion surgery was genius if that's any consolation .... that one fixed big toe complete with big old metal implant is probably the best bit of my entire body.
It's so weird that the digits look so odd but the joints are in tact. That turning of the joints is just so odd to look at!
Stoney said:
That sounds about right. The good news is that it means that your treatment plan is working overall. I think that the type of damage that you are talking about is soft tissue damage, and it can definitely make hands and fingers look weird. I've got a few fingers that have rotated at the dip joint. Add to that some ulnar deviation, some bumps,etc, my hands have clear damage but no erosions on films.
Hi Sybil,
The doc ruled out bunions as my toes haven't shifted and the "growth" on the side of my foot doesn't look bunion-like. I suspect that most of the deformities are, as you said, related to soft tissue not bone so wouldn't show up on x-ray. I'll have to take a photo of my feet and post a 2 years ago/now before and after shot. But I'd best paint my toenails first. Gag!
Sybil said:
My rheumy describes my entire feet as damaged just by looking at them. My toes have been a mess since I was in my 20s and it wasn't down to wearing crazy shoes as a teenager, my mum wouldn't let me and anyway I was a clog-toting hippie. I suspect an early episode of PsA having had a very swollen knee at 16. I've had my feet x-rayed once which showed damage to big toe joints but no discernible damage to other toes. Yet they are deformed. Tendons??
If the lump you're describing is a bunion, I've had bunion surgery, the surgeon said he'd been hoping to do something creative with the main tendon but had to chuck it in the bin. I've heard that bunions, common as they are due to pronation and so on, can also result from PsA. My bunion surgery was genius if that's any consolation .... that one fixed big toe complete with big old metal implant is probably the best bit of my entire body.
Well, talking out of my backside a bit here, for a change, but before the joint becomes sub-luxed (dislocated) the bursa will swell. That's what I think happens. I seem to recall it was a while before the toe shifted inwards but I had a swollen bursa for about 10 years beforehand. So maybe there's such a thing as a pre-bunion??
I'd have to have a stiff drink before posting pics of my feet and that's not allowed. But yes, I've often pondered the state of my poor toes just as you are doing. If you post a pic I'll know if we're similarly afflicted.
Did not know about the whole "pre-bunion" thing. I'll find the courage for a before/after shot in a while. It's been a slow day at work--or rather I've been completely unmotivated--so perhaps this will give me some purpose!
Sybil said:
Well, talking out of my backside a bit here, for a change, but before the joint becomes sub-luxed (dislocated) the bursa will swell. That's what I think happens. I seem to recall it was a while before the toe shifted inwards but I had a swollen bursa for about 10 years beforehand. So maybe there's such a thing as a pre-bunion??
I'd have to have a stiff drink before posting pics of my feet and that's not allowed. But yes, I've often pondered the state of my poor toes just as you are doing. If you post a pic I'll know if we're similarly afflicted.
WARNING! FEET!!!
I guess the difference in appearance is not huge but still perceptible.
summer 2012
November 2015
This is a great discussion. I couldn't understand why my middle and ring fingers had snuggled up together on my right hand. The ring MCP now actually looks like its dropping but it makes sense that its tendons ... would also explain why the area is generally very tender but the actual joint not so much except on the palmar aspect. Been a while (nearly 4 years) since I had hand x-rays.
Do you have pain from the heel bone spurs, Jane? When I had my June x-rays the report didn't mention anything but when I looked at the images in relation to where I get pain I zeroed straight in to these funny little flick things. My right heel is now pretty damn painful all the time. There is a new and seemingly successful non-invasive treatment (sound wave zapping ... same as is used for kidney stones) coming to a clinic near me in the New Year so I'll be looking into this.
Jules--I get pain from the heel spurs when I'm lying down or if I prop my feet up. But they are still relatively small right now and don't hurt when walking. I assume that there's some zapping in my future, too. Not now, but soon. Glad there's a non-invasive procedure.
Jules G said:
This is a great discussion. I couldn't understand why my middle and ring fingers had snuggled up together on my right hand. The ring MCP now actually looks like its dropping but it makes sense that its tendons ... would also explain why the area is generally very tender but the actual joint not so much except on the palmar aspect. Been a while (nearly 4 years) since I had hand x-rays.
Do you have pain from the heel bone spurs, Jane? When I had my June x-rays the report didn't mention anything but when I looked at the images in relation to where I get pain I zeroed straight in to these funny little flick things. My right heel is now pretty damn painful all the time. There is a new and seemingly successful non-invasive treatment (sound wave zapping ... same as is used for kidney stones) coming to a clinic near me in the New Year so I'll be looking into this.
Well, I would say that those big toe joints look like they are on their way to becoming bunions. Looks to me as if the big toes are turning inwards in a suspiciously bunion-like way but I'd hate to argue with a doctor about it. All my toes look like your little toes except the ones on my left foot which have recently become hammer toes as well. I've gone bunion mad now, but I reckon you might have the start of a tailor's bunion on your right foot i.e. one on the outside.
I suppose the best case scenario is that your feet are showing signs of maturity rather than PsA damage. However, I thought mine were just plain showing signs of ugliness .... an ugliness that did not appear until I was 20 something. They have been amazingly tough things, my feet, considering the mess they're in. In general, I get the impression that my joints hang on in there very well despite bits and pieces of damage and that has been one big obstacle to realising the onset or full impact of PsA. It's only full-on, in yer face joint inflammation that has made me or anyone else think about what's going on.
It's a smack-down in a couple of weeks when I go back to the rheumy. Oh, it's on now! Sybil sent me...
Sybil said:
Well, I would say that those big toe joints look like they are on their way to becoming bunions. Looks to me as if the big toes are turning inwards in a suspiciously bunion-like way but I'd hate to argue with a doctor about it.
Unfortunately, I have both visible damage and damage seen on x-rays.
Jane: those 2015 feets look like mine! The hump on the big toe of both of my feet is more bulbous, if that makes sense. Never been told I have a bunion. I'm adding that question to the list for my December visit to Dr. Abbas.
Well it is reassuring to know that other people can see what I see in the outward appearance of my feet. I'm pleased that my x-rays show no damage but it is weird to see my body shift and move on the outside and experience pain and swelling but on the inside things look fine.It's one of those events that gets me questioning my sanity! I will certainly press my doc on the lumps at the ball joint (that may/may not be bunions).
sixcatlawyer said:
Unfortunately, I have both visible damage and damage seen on x-rays.
Jane: those 2015 feets look like mine! The hump on the big toe of both of my feet is more bulbous, if that makes sense. Never been told I have a bunion. I'm adding that question to the list for my December visit to Dr. Abbas.
Yes on 2 fingers and toes
Ur not alone
Your feet look nice compared to mine.....but, yes, there are some changes. I took a pic of mine, but not sure if you'd want to see them....they are ugly!
I remember my first rheumy (about 10 years ago) saying she could see and feel arthritis in my fingers but it didn't show up on the xrays at that time. That was back in the day when I wasn't having the PsA pain yet.
janeatiu said:
I had my bone spurs removed and i don have any problems with them now. As for the toes, my docs says all is well so I jus go with that.
