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Living with Psoriatic Arthritis (PsA)

Foot swelling - not just sausage toes


#1

Hi everyone, I am at the end of my rope with issues in my right foot. My foot went completely numb and cold on 8/6 - and it stayed that way for 12 hours. Then the swelling began. And the neuropathy. And the pain. I went to my rheumy on 8/14 and he gave me a cortisone shot. It did nothing. He didn’t seem to think my issues were anything unusual. Went to my PCP on 9/6 and he sent me for a doppler ultrasound to check my arteries. Turns out I DO have a popliteal artery compression behind my knee; the report says due to inflammation in my knee. (So not necessarily peripheral arterial disease.) Had a round of 14-day prednisone to see if it would help. It did not faze me. Then had an MRI this past Monday to see if there was a compressed nerve causing pain all the way to my foot. It showed my DDD and facet arthritis were unchanged from 2013, and no definitive evidence of nerve entrapment. This is all a very roundabout way of asking this…everything I read talks about the dactlytis/sausage toes with PsA. NOTHING I read speaks of the entire foot swelling. My PCP says PsA attacks one finger, one toe, etc. Which I do NOT agree with. Have any of you ever had long term swelling of your ENTIRE FOOT with neuropathy? The front of my foot and toes are the most affected, but the bottom of my foot feels like it is filled with fluid from front to back. I am trying to attach a picture (embarrassing) Not sure it will work. I don’t know where to go from here and I am so depressed! Using a walker now with no end in sight to this.


#2

I’ve had intermittent problems similar to yours. I also have periodic swelling in my knee which seems to be accompanied by the red tight skin and swelling of one foot. The rheumatologist usually puts me on a medrol dose pack which helps, but if you’ve had a cortisone injection and used prednisone, I don’t know if it would work for you. Sorry I’ve got nothing else to offer, but let’s hope other members have better input.


#3

Thank you for your input Glinda. I was very surprised that the Prednisone did not work. I am on a maintenance dose of 7.5mg per day. But dr upped it to 60mg tapering down. The last time I had to up the prednisone it started working in 2 days. I guess I need to think that it might not be PsA related. Really not wanting it to be an artery issue. Just adds insult to injury.


#4

Call your PCP. NOT your rheumy ASAP Both feet are showing signs of edema. There appears to swelling on your shins as well. If you press on your shins about 6 inches above the ankle and you can’t feel the “knobs” and it feels "spongy. it is emergent.

I’m concerned that you may be having some early signs of Congestive heart Failure (not as scary as it sounds) I would request an echo cardiogram and a complete metabolic blood test. Inflamatory diseases such as PsA are NOT respecters of anything including your organs - Heart and Kidneys are easily effected…


#5

My left foot has done this occasionally, and sometimes not obviously related to a pain flare-up. But as we all know, swelling doesn’t always equal pain - and pain doesn’t always mean your joints are going to be swollen. However, mine normally goes down after a couple of days - and I think mine is sometimes caused by the support I wear for my ankles “pushing” the ankle swelling down the foot towards the toes. Rather like a corset. While my ankles are swollen to some degree, I can’t say that the swelling has removed the definition of them in the way that has occurred with your right ankle in the pic. In other words, they still have “shape”.


#6

Thank you so much for this advice. Dear God I hope it isn’t CHF. My stepdad had this for many years and the pitting edema was awful. My outer right ankle stays swollen even when I don’t have pain in my foot…has been this way for at least five years. But the swelling/edema seems to be moving up my leg, which is worriesome. I can feel the knobs of my shin, at least for now. Heart disease runs in my family. My dad died at 65, mom at 71, but her heart attack was lupus related. I am due to see my PCP next week and will discuss this.


#7

I think that from the feedback I am getting so far, this issue is not necessarily a PsA flare but something else. May be that it is related. Sounds as if you feel the same with your own foot issues. Thank you for your input. At this point my PCP has said neurologist for nerve conduction study or vascular doc because of the popliteral artery issue. And now maybe I need to add a cardiologist into the mix.


#8

My swelling isn’t normally bad enough to determine whether it is pitting or not, to be honest. Very occasionally it can occur around the ankle, but normally it’s not severe enough to leave an indent as it’s not deep enough. The same is true of my hands and knees too. Feels worse than it looks,more often than not!


#9

Grrrrrrrrrrrrrrr! Gosh I hate that attitude! The redness isn’t normal with swelling! Your other foot is slightly swollen and IT isn’t red!
My daughter gets something in her finger–I just texted her to ask what it is. This is her reply:
Erythema Multiforme… it’s a drug reaction. It only happened to my ring finger anytime I took Aleve…


#10

This same daughter was a nurse for a dermatologist. I described your foot to her…she said it doesn’t sound like Erythema Multiforme…she said her first thought was cellulitis., and cellulitis is treated with antibiotics.
Now that she mentioned that, I’ve seen cellulitis before and it sure does resemble it!


#11

I think everyone is confirming that the redness isn’t normal with PsA. A sidenote: For years I have had episodes of what was diagnosed as gout…high uric acid and I just realized (reading a question in the People’s Pharmacy column) that my blood pressure med contains HCTZ, a diuretic, which will concentrate the uric acid even more. Rheumy says high uric acid is common with PsA and thinks these episodes were not true gout. I maintain one can have both PsA and gout. (Why not?) I asked my PCP last week if I could have phlebitis because the veins in my foot felt hard. He did not think so. (Veins are not hard this week.) This has gone on way too long. In reading about PAD ( which is suspected because of the popliteal artery issue in my knee) I see nothing about redness and inflammation of the foot in the symptoms list. I am beginning to think the foot issues may not be related to nerve or arterial issues. And I have suspected cellulitis as well, so thank you GrandmaJ for asking your daughter’s opinion. Sad that I am trying to figure this out myself. One conclusion I have come to is that I think I am going to find a new rheumy. I have had kidney issues since I was 16…blood and protein. No one seems to know why, including my nephrologist. But my kidneys continue to deteriorate. When I asked the rheumy about this (a connection with PsA and kidney problems) he just shrugged it off. Nephrologist fears undetected connective tissue diseases. I have always suspected negative ANA lupus, as my mother had SLE and it attacked her kidneys. She also had the foot issues I am having. Anyway, I am all over the place with this post…sorry for that. I will ask PCP to consider cellulitis.


#12

No problem! I just think obviously your doctor is on the wrong track since none of his “solutions” has worked! I agree–find a new rheumy. The Uric acid thing, too, and why couldn’t one have gout and PsA? Geez, some docs are stuck in their thinking and don’t think out of the box at all!!! That brings to mind my pulmonologist who figured out I had asthma and later, histoplasmosis. She told me some doctors are strictly textbook…she had an adult patient who had severe hoarseness most of her life and no doctor linked it with asthma, except her. She put the woman on asthma meds and the hoarseness was cured! She said most doctors won’t (or wouldn’t at that time anyway–about 20 years ago) diagnose asthma if there wasn’t wheezing, but she said some people don’t have the typical wheezing. When she diagnosed my histoplasmosis, my regular doctor had sent me to her, telling me to insist on a lung biopsy immediately. Well, she told me lung biopsies come with risk and she wanted to do some blood tests first. She did the right thing–the blood test confirmed what my lung scan was showing–she was nearly 100% sure it was histo and the med she prescribed cured it.
It’s always nice when you “run into” a doctor who is so smart and caring and figures things out quickly…it’s not fun being a guinea pig, and the trial and error method when it comes to your health and well-being sucks!
I hope you find someone who can help you, kris! Good luck!


#13

I have had weird symptoms and ailments for most of my life. So any time something new crops up I just dread it. Have spent $1000 out of pocket this month for an ultrasound and MRI. PCP is new, and I like him. But the foot is the reason I went to him in the first place, although I know I also was complaining of the sciatica issues. Most doctors just can’t handle multiple issues unless they are glaring. And I really don’t think the foot swelling is PsA related OR arterial related. It is inflamed, top and bottom, and has been for almost 2 months now. In reading about cellulitis I realized that at the onset of this mess I had (healing but still have) a heel crack - pretty painful. The PCP even asked me about it because I had a bandAid on my heel. I can’t help but think that staph or strep may have caused cellulitis. I will get to the bottom of it! Probably would not have thought of it if it weren’t for your daughter. Thank her for me, and I’ll report back! :slight_smile:


#14

OMG! I’m glad you’re looking further into this! I didn’t realize you had a crack on your heel, and definitely we could be on to something here! Keep us posted–you need to fix that foot–I can’t imagine how that must hurt! :cry:
I’ll tell my daughter maybe this will help you get some good medicine that’ll make it better!


#15

It hurts terribly. Wondering if oral antibiotics would even faze it at this point. My mother had systemic lupus and even a small wound would require IV antibiotics. I just have to figure out how to convince my PCP.


#16

My daughter said Keflex is the oral antibiotic they used for infections involving the skin. If it’s cellulitis, it can spread and she thought it could turn into an emergency…not to scare you or anything, but your doctor needs to listen to you!


#17

Thank you for this. Though I would think that after almost 2 months it would have already spread more? Maybe my immune system is stronger than I think. I am having more pain in the back of my knee, which is where the popliteal artery issue is. So an ischemic foot is still a strong contender. Either one is nothing to mess around with without quick attention.


#18

kris your immune system may well be stronger than you think … a lot of us find that we don’t get sick, apart from the PsA, due to our rather overactive immune systems perhaps, so seems to me it’s not beyond the bounds of possibility that infection wouldn’t spread too quickly. But it’s all speculation and something’s going on for sure, I do agree with you, get quick attention, that’s got to be the priority.


#19

Thank you! See my latest question to Grandma J. :slight_smile:


#20

One more question for you to relay to your daughter if you would be so kind. In researching both gout and cellulitis treatment, several articles maintain that a course of prednisone can accelerate healing. Since I have already done a 14-day course, with no positive reaction, I wonder if that rules out both. Perhaps your daughter could agree/disagree. The other question I struggle with is the suggestion of ischemic foot from arterial issues. An ischemic foot will pale when raised and is cold to the touch. My foot does not pale when raised and is warm, not hot. This then leads me back to nerve impingement issues since my doctor said that could also affect veins/arteries. I realize I am just throwing things out here, hoping for any feedback. But without health insurance any visit and any diagnostics just set me back further financially. In two months I have spent $2,000 on doctors and testing. Can’t even imagine the costs of vascular or nerve testing. Thank you, all of you, for bearing with me and trying to help!