FEET and PSORIATIC ARTHRITIS. Louise Skipp Podiatrist, Sirona Care and Health, Bath

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1 FEET and PSORIATIC ARTHRITIS Louise Skipp Podiatrist, Sirona Care and Health, Bath

2 What would you like to know? Common problems Practical tips What you can do to help yourself When to seek help and from whom?

3 Psoriatic nails Pitting Thickening and crumbling Lifting(onycholysis) Sometimes discoloured Not to be confused with fungal nail infection

4 Psoriatic nails (continued) Pitting Thickening and crumbling

5 Psoriatic nails (continued) Onycholysis Discolouring

6 What can you do? Continue to cut nails straight across Use an appropriate foot file to smooth off edges and to reduce the thickness by filing over the top Files available from various sources including RUH pharmacy, some available at end of session

7 Foot files

8 Mechanical Foot Problems Pain in the entheses (where bone and tendon/ligaments meet. In the foot most common areas are: - Plantar Fascia -plantar fasciitis The insertion of the Achillies Insertioanl Achillies tendinopathy.

9 Plantar fasciitis

10 Plantar fasciitis (continued) Pain under central region of heel Usually worse on initial weight-bearing Often eases with gentle walking but can worsen with prolonged standing or walking

11 Why does it happen? Prone due to inflammatory nature of psoriatic arthritis Can be purely mechanical ie poor foot mechanics, weight, occupation, footwear, injury Often a mix of both

12 What can you do? Calf stretching Plantar fascia stretching Ice/frozen plastic bottle/frozen tennis ball Insoles/orthotics to control adverse foot posture and/or to cushion and absorb shock Footwear supportive, not too flat, firm upper Taping Cortisone injection Night splints See podiatrist

13 Insertional Achilles Tendinitis

14 Insertional Achilles Tendinitis (continued) Pain at back of heel bone Can be red and swollen Can feel better in small heeled shoes Worse with weightbearing Tender to touch

15 Why does it happen? Similar to plantar fasciitis Susceptible due to inflammatory nature of Psoriatic arthritis Mechanical ie foot posture, occupation, weight, footwear, Often a mix of the two

16 What can you do? If acute, ice and rest Ensure footwear doesn t cause irritation Gentle calf stretching Small heeled shoes (stable heel) and /or heel raise in shoe to offload achilles Look at mechanics of feet See podiatrist

17 Joint changes Joints themselves can become affected by arthritis itself for example ankle or ball of foot Can lead to muscle fatigue and pain and/or overloaded joints Calluses and corns Instability of ankles Change in general posture

18 What can you do? Ensure good footwear Keep up with reviews with rheumatologist or GP to ensure medication is suitable See podiatrist for advice and treatment

19 Dactylitis Dactylitis or sausage digit is inflammation of an entire digit (a finger or toe), This is can occur in seronegative arthopathies, such as psoriatic arthritis

20 Insoles and orthotics what are they? Devices which sit in your shoe Can help with pain, instability, foot function and gait Many different properties ie shock absorbing, supportive, hard, soft Can be shop bought Sorbothane good example Often premade Can be bespoke impression taken

21 Orthotics.

22 Role of the Podiatrist To assess problem referred for, having taken a comprehensive medical history To offer advice, exercise plans, insoles/orthotics where needed, routine care Refer onwards such as Xray, physiotherapy, consultant, GP

23 How to access a podiatrist On NHS self refer? Via GP? Via other health professional? Private HCPC registered the online register is available at To see a degree qualified podiatrist they will have a BSc in podiatry and usually be registered with the society of chiropodist and podiatrists (MChS) The society website has a podiatrist register. Other foot care people are available.

24 Footwear eek! Good, bad and ugly Can be difficult Once achieved, helps with foot problem and to allow other treatments to work Wide enough, deep enough, stable cushioned sole and a fixing i.e. lace, strap etc.

25 Good Footwear Images!!

26 Bad footwear

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