Psoriasis is often misperceived as a cosmetic disease. psoriasis as being equal or greater to heart disease or cancer in its impact on a patient's life. It is a chronic and serious condition that must be monitored and managed continuously. Psoriasis involving the hands and feet affects only about 30% of patients with plaque psoriasis, but is a uniquely problematic form of the disease . The impact of hand and foot psoriasis on patients' quality of life is extremely high. While these individuals may have a relatively small BSA ( body surface area ) involved, the location of the lesions often prevents patients from participating in everyday activities and the visibility of the disease weighs heavily on emotions and self-image. Unlike many other forms of this disease, hand and foot psoriasis is difficult to treat and often refractory to multiple therapies, even those that are effective in generalized psoriasis. Patients with hand and foot involvement are affected to a greater degree by physical aspects of the disease (such as pain, discomfort, cracking and bleeding of the skin) than patients without lesions on the hands and feet .
In addition to the enormous emotional burden, the disease also impairs a patient's basic day-to-day activities. Many patients are unable to wear shoes comfortably or use their hands. One male patient recently lost his job because he could not perform his job responsibilities due to the psoriasis on his hands. A female patient in her 20s lost her mid-level position because she had to wear flip-flops to work. Her feet were cracked and bleeding due to psoriasis on her feet, which made wearing shoes difficult. Psoriasis also impacts other activities of daily living. Simple daily activities such as sewing, using a computer, or walking in the park can be difficult for individuals suffering from the pain and discomfort that accompany hand and foot psoriasis.
Socially, the disease can take an enormous toll, causing dysfunction in relationships and sexuality. A female patient stated that her young children were reluctant to hold her hands because of the condition, while a male patient with hand psoriasis told us he had not touched his wife in months.
Hand and foot psoriasis may also be a causative factor in co-morbidities. For example, hyperkeratotic fissured plaque psoriasis on the feet can limit a patient's ability to take part in physical activity, which in turn may contribute to weight gain. A recent study found that 71% of patients with psoriasis became overweight or obese after onset of the disease .
Psoriatic Arthritis of the Foot
When you have psoriatic arthritis of the foot, the pain and discomfort it causes can make daily activities difficult and take a toll on your quality of life. Depending on your psoriatic arthritis symptoms, there are a number of foot care and footwear options to ease your discomfort and get you -- comfortably -- back on your feet again.
Psoriatic arthritis may affect any of the joints in your body. But it is very common for the disease to strike some of the thirty-odd joints in the feet, especially the toe joints closest to the nail. When this occurs, toes often become red and swell into a sausage shape that is characteristic of psoriatic arthritis of the foot. Inflammation in the toe joints may also damage the nail bed, causing nails to be pitted or ridged or peel away from the nail bed.
In some instances, psoriatic arthritis symptoms include soreness at the points where tendons and ligaments meet bones, a condition known as enthesopathy. With psoriatic arthritis of the foot, this may result in soreness in your sole or heel (Achilles tendon) that makes every step a painful proposition. In rare instances, psoriatic arthritis manifests itself as arthritis mutilans, a disfiguring form of arthritis that usually targets the hands and feet and leads to significant bone damage.
Whether your psoriatic arthritis of the foot is mild or severe, it's important to do everything you can to minimize inflammation. Left untreated, it may cause permanent joint damage or deformity. You can help reduce your symptoms by making sure you wear shoes that fit properly, and by keeping your feet in good shape.
Shoes and Psoriatic Arthritis of the Foot
When you have swollen toes caused by psoriatic arthritis of the foot, it may be painful or impossible to wear traditional shoes. If that is the case, look for shoes with extra room in the toe box to accommodate your toes.
Think sturdy and supportive. With psoriatic arthritis of the foot, it's essential to give your feet all the help they can get, and that includes a shoe that will support your heels, arches, and the balls of your feet.
Cover up. When your toes are swollen and sore, you want to protect them from any additional injury. Sandals that cradle your foot in a deep footbed or full-coverage shoes will provide a barrier between your toes and anything that might hit them.
Get the proper cushioning. Try to strike a balance between cushioning for comfort and rigidity for support. Shoes with shock-absorbing rubber soles are a good bet for psoriatic arthritis of the foot.
Not too tight. There should be wiggle room for your toes and about a half-inch worth of space behind your heel.
Stay grounded. High heels may look attractive, but the effect they have on your feet isn't nearly as pretty. Three-inch heels subject your poor, aching feet to seven times more stress than a more reasonable one-inch heel.
Stretches for Psoriatic Arthritis of the Foot
Though it can be difficult to move around when you have psoriatic arthritis of the foot, exercising is one of the best ways to reduce your symptoms and improve the range of motion in your joints.Doing certain stretches on a regular basis may also help increase flexibility and lessen pain:
Achilles tendon stretch. Stand with your back and one foot against a wall, with your other foot slightly in front of you. Keeping both heels on the floor, lean into your front foot to stretch the Achilles tendon of your rear foot. Repeat three times, holding for 10 seconds each time, and then switch feet.
Big toe stretch. Hook a large rubber band around your big toes. Using the muscles of your feet (not your legs), pull your big toes as far away from each other (in the direction of your other toes). Repeat 10 times, holding for five seconds each time.
Five toe stretch. Put a rubber band around all the toes on each foot and stretch the toes apart as wide as you can. Repeat 10 times, holding for five seconds each time.
If you don't see any improvement in your psoriatic arthritis of the foot after doing at-home exercise and stretching, ask your doctor about a referral to a physical therapist. A physical therapist can work with you to improve your flexibility and comfort.
You may also find that using cold packs on your feet reduces swelling and helps maintain and improve flexibility and range of motion.
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