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Living with Psoriatic Arthritis (PsA)

Feet feet FEET!

#1

There. Got your attention, didn’t I? Oh yes, mention feet here and there’s a shower of clicks. Punch “feet” into the search bar up there, and you get over 100 “hits”. Doesn’t that just tell you how many people here cope with foot problems?

My feet got damaged during the twenty years that I spent symptomatic but undiagnosed. In fact, the discovery of joint damage in my feet was what finally got me a diagnosis, and at that point it was already too late. Then they got worse before someone decided that I really needed aggressive therapy. The bottom line is that the damage in my mid-feet makes walking, wearing shoes, going barefoot and even rolling over in bed painful. Those feet of mine make a lot of aspects of my life very difficult, and the fact that they are a problem affects many – no, ALL – parts of my life. But when I say that, I feel a bit like a drama queen. Then I give myself a swift kick in the butt (a mean and painful feat, pardon my pun) and move on.

And then today I received this piece of research from a rather special acquaintance, and I feel validated. It’s a good read.

You can read the article here.

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#2

You got my attention, Seenie! I just read several pages of the article and will finish reading it tomorrow. Something very interesting was that a lot of the people with foot pain have psoriasis on their lower legs and/or feet. Well, that figures I’ve had psoriasis on my lower legs (mostly my right) which probably showed up around the same time my feet started hurting so bad a few years ago. And I have the same (or similar) mid-foot damage like you. Bone on bone (absence of cartilage), inflammation in the tendons, neuropathy (which is pretty well controlled), and now a painful spur in my right heel.
I had no idea the neuropathy I suffered with prior to starting Enbrel was causing irreversible damage to my feet. After we got the neuropathy under control, my feet were fine for a couple of years. I walked normally with no mid-foot pain or weakness. Then one morning following a day of running up and down our basement stairs storing Christmas decorations, I woke up with unusually sore, painful feet. X-rays and an MRI explained the damage.
My foot doctor told me surgery is a last choice and usually it doesn’t help and can make matters worse. Most recently I was told the cartilage at my ankles is very thin and I will need ankle replacements—a
not-so-common surgery.
I wanted to share my “feet” story to help those of you who are dealing with the same kind of symptoms. You need to get treatment ASAP to hopefully prevent permanent damage accompanied by chronic severe pain!

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#3

Same here, GrandmaJ!

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#4

Hi Seenie
I have found that talking to the Docs about crook feet is liking talking to a wall. It would seem there is no real treatment to specifically help the feet except for the normal drugs for PsA. I use anti inflam cream every day which I think helps a bit. Perhaps now Ive had knees and shoulders replaced I need the feet replaced with those spring thingys the disabled athletes use.
Happy new year to you
Allan

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#5

For what it’s worth, I also experienced acute pain in my right foot starting right after I retired (2010). The pain was in the top middle portion of my foot. It showed itself in two ways: one was that my arch pretty much collapsed; like having fallen arches. Secondly, when that happened the bones in the top of my foot shifted position, causing lots of sharp pain as they touched other bones. I need to mention that I carry too much weight, and I know this was a factor.

My first podiatrist had a custom made inner sole for my shoe prepared. It’s purpose was to try to hold the arch up and keep the bones more stable. I don’t remember exactly, but I seem to recall hearing there are 10-12 different bones in the top center of the foot. This treatment did offer some help, but did not solve the problem. Shortly after this, my wife and I moved to a medium sized city in North Carolina and I contacted a new Podiatrist who had been recommended. This guy was quite a character. His first comment to me after viewing the x-rays was something like “you really have a messed up foot.” I have cleaned up his sentence for the benefit of all. Interestingly, there was no damage of any kind in the left foot, only the right. He went on to tell me (and show me on the x-rays) that the edges of many of these bones had essentially been destroyed by the arthritis. His background included some time on the medical staff of the Philadelphia Eagles football team and he seemed to have a real grasp of how the foot functioned, how it was supposed to function, and cause/effect of why it was not functioning correctly. Essentially what he told me was that our feet were the load bearing parts of our body. Nothing earth shattering there. He then explained that because these bones and joints in my mid-foot were so corroded, they could no longer support the body as they had previously done, without touching each other.

He offered me two courses of treatment: (1) surgery and (2) a weight shifting foot brace which is worn inside the shoe. He went on to say that the damage was so significant he personally would not attempt the surgery. He said the only place he would send me was to Duke University Hospital if I wanted surgery. He mentioned that other docs in town would offer assurances that they could correct the problem with surgery. He urged caution. He explained very clearly that this was not a simple surgery. He said that the surgical repair would have to be perfect; if not the result might end up being worse than the current condition. It also would require a long rehab, with no foot movement for months, followed by extensive PT.

The alternative, which I selected, is called a Ritchie Brace. This brace works by slightly altering the way the body’s weight is supported by the foot. His explanation was that it moved the foot towards the rear of the shoe, which allowed the larger leg bones coming into the top of the foot and ankle to handle more of the load, freeing pressure on the mid-foot. I may not have it exactly as he explained it, but it has worked for me since 2013.

This damned disease has cause me to have too many surgeries, and I do not wish to have any others unless there is no other choice. This has worked so far for me. If you or anyone else is considering surgery of the mid-foot (fusing all of those bones and joints), this Ritchie Brace may be something you want to talk to your Podiatrist about.

I hope this helps. Good luck.

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#6

Weeeeeellll…I saw the best foot surgeon on this side of Canada, and he basically said there was no point in even trying surgery, because I was likely to end up worse off. Then he started talking about cadaver bones and steel plates and I stopped him right there. I said that I’d rather have bladerunner feet. (That was just after the Oscar Pistorius murder trial in South Africa.) The surgeon, without missing a beat said “No, I wouldn’t consider doing that cuz I’d be too afraid that you’d shoot your lover through the bathroom door.” (What a wit!) But I wasn’t that far off being serious.

The key to preventing foot (or any other) damage is what should be every rheumatologist’s approach to PsA: early and aggressive treatment. My PsA specialist in Toronto once told a resident in the room, “THIS is what happens when you underestimate this disease. (Points at my feet.) Don’t ever let this happen to one of your patients.”

Happy New Year to you too, Allan. So nice to hear from you again!

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#7

Wow schoonerbird, your foot sounds like mine. That is exactly it: I have nine joints where both surfaces are corroded. The surgeon said the one or two joints can be fused successfully, but more than that is next to impossible. And yes, any surgery (talking cadaver bone grafts and metal pieces now) would involve six months on non-weight bearing, and then gradual rehab lasting up to a year. I decided the same as you.

Orthotics simply increased my pain, but a brace like that was never mentioned. That is interesting. My best solution (and I had to find it myself) is an ankle boot that fits the foot snugly and minimizes all movement of those joints. I’m just lucky that I was able to find a boot that happens to fit my feet almost perfectly. I have two pairs which I rotate and I wear these boots three seasons. In the summer I resort to a couple of pairs of sandals with footbeds that I’ve found fit me, unless I have to walk a significant distance and then it’s black boots again.

And I used to LOVE shoes. Especially red ones. Boo hoo.

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#8

The Ritchie Brace sounds interesting. The only thing I’d be concerned about for myself is that my podiatrist told me the cartilage at my ankles is very thin and I will eventually be a candidate for ankle replacements. I’d be worried that the way the foot is altered so the pressure from the legs is more on the rear of the foot, my ankles would wear out even faster. Hmmmm…wouldn’t hurt to check this out with my podiatrist.

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#9

Do a google search for “Ritchie brace”. There are several informative sites that will appear; some with interesting videos and pictures.

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#10

As soon as I posted, I googled, Schoonerbird. Very interesting info. The Ritchie brace is usually used for people with drop foot, but it makes sense for us, with midfoot damage, to use it to transfer weight and pressure to the rear of the foot. And I now see why those boots of mine help: they immobilize my mid foot and have a rigidity/stability a bit like the back of the brace: they probably shift some of the pressure on the back of my foot as well. The things we learn from each other. (And yes, @Allan, I’ve found doctors pretty clueless – and nonchalant – about foot problems too.)

It’s odd, isn’t it, how one part gets devastated by PsA while another remains untouched. Schoonerbird’s one foot got clobbered and the other one’s escaped damage. In my case, both feet are more or less wrecked, but my ankles are (in the words of Fred, the radiologist) “like a twenty year old’s”. Very funny, Fred! (The only part of me that’s like that, I assure you.)

Seeing the Ritchie brace makes me wonder what kind of an improvement it might offer over my big black equestrian boots. Might work better in the summer too. At least my toes could get some fresh air.

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#11

At least your boots are smart looking, Seenie. I wear my hiking boots literally everywhere, because they’re the only ones that are comfortable and minimise pain. hiking boots Problem is, they only do their job if I lace them tight, and that hurts my fingers… Oh, well. Ten minutes of finger pain for a day of being able to walk isn’t too bad.

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#12

Yes, took me a long time to find those! But those are seriously nice hikers, and they do the same job as my boots and schoonerbirds brace: immobilize and align.

I know what you mean about fingers! I sometimes have to re-lace once or twice to get the tension just right. And that hurts.

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#13

Seenie,

You’re no drama queen! The pain in my feet is the worse in my entire body! I get tendon foot pain that makes it difficult to walk long distances some days and short distances other days. I’m often icing my burning feet and swollen toes at night with ice packs or an ice/water bath.

I’m sorry you are having so much pain in your feet - it makes it difficult to do anything.

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#14

My feet are THE worst. THE WORST. They wake me up at night screaming at me! I walk like a crippled old fart. But my ankles are miserable! They are stiff and sore so much of the time!

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