In short, our feet are the foundation for a healthy and active life. So when psoriasis involves the feet, it’s a serious problem.
When Psoriasis Affects the Feet
Psoriasis is a condition caused by an overactive immune system that triggers abnormal skin cell growth. Normally, skin cells grow and shed in a monthly cycle. With psoriasis, the skin cells grow and build up on the surface of the skin, forming plaques and scales. Foot psoriasis — or palmoplantar psoriasis, which means psoriasis of the hands and feet — is a less common type of psoriasis. It causes painful, itchy, red, dry patches of skin on the bottom or soles of your feet. A more rare form of the condition, called pustulosis, involves small, pus-filled blisters in the same area. In both cases, the psoriasis can crack and bleed, which can make everyday tasks like standing or walking difficult. Forty percent of people who have psoriasis experience palmoplantar psoriasis, according to the National Psoriasis Foundation (NPF). In a study published in the August 2020 issue of the Journal of the American Academy of Dermatology, people with palmoplantar psoriasis were six times as likely to have mood disorders — likely due to problems with mobility — than those with psoriasis affecting other parts of the body. “In some cases, people with foot psoriasis can’t even walk,” says Abby S. Van Vorhees, MD, chair of dermatology at Eastern Virginia Medical School and emeritus chair of the NPF Medical Board. “But the good news is that there are treatments available and there’s a lot that can be done to make patients feel better.”
How to Find Relief for Foot Psoriasis
Between treatments and lifestyle changes, there are plenty of steps you can take to help control your symptoms. Start with these strategies to help you manage foot psoriasis and get back on your feet.
1. Try Topical Medication
The first line of defense against psoriasis symptoms is medication, according to Mark Lebwohl, MD, professor and chair of the department of dermatology at Mount Sinai Hospital in New York City. For mild cases, topical steroids could be enough to abate flare-ups, Dr. Lebwohl says. Over-the-counter and prescription lotions, ointments, creams, sprays, and foams reduce swelling and itching and can help make you more comfortable, Lebwohl notes. Besides topical steroids, there are topical vitamin D analogues and topical retinoids, according to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA). Since psoriasis is also characterized by thick scaly plaques, using topical medications to effectively remove the scale is helpful. Ask your doctor if over the counter treatments with salicylic acid or lactic acid are right for you.
2. Seek Phototherapy
If topical medications don’t work, Lebwohl recommends moving to phototherapy treatment. Phototherapy, or light therapy, is usually prescribed by a dermatologist, according to the NPF. It involves treating affected areas of the skin, such as the bottom of the feet, with ultraviolet (UV) light on a regular basis. These treatments can be done under medical supervision in your dermatologist’s office or at home with a personal phototherapy unit. Light therapy has been shown to slow the growth of skin cells on the feet that are affected by psoriaris, Lebwohl says.
3. Pursue Other Treatment Options
If symptoms persist, it may be time to consider biologic therapy. Injectable biologics, which target specific parts of the immune system, block cells or proteins that play a role in the development of psoriasis, or oral systemic medications are used to calm down underlying inflammation in the body.
4. Avoid Foot Trauma
Any kind of trauma to the feet can trigger psoriasis, notes Dr. Van Vorhees. Psoriasis can flare up in a previously unaffected part of the skin following even a minor bump or bruise, which is known as the Koebner phenomenon, according to the National Institutes of Health. So protecting your feet from injury is critical for people with psoriasis. The NPF recommends avoiding tight shoes and high heels because of the pressure they place on the toes. The type of material the shoe is made of is less important than the fit, Van Vorhees explains. In general, the front of the shoe should be round, rather than triangular, and loose shoes that cause friction or rubbing on the heel should also be avoided, says Van Vorhees. Flip-flops or other open-toe sandals should be worn with caution as they expose your toes to possible injury, she adds.
5. Focus on Diet and Exercise
There are no studies showing that a particular food can exacerbate or benefit psoriasis, says Lebwohl. However, a general healthy diet, combined with exercise, can have great benefits, he says. That’s because there’s a strong correlation between obesity and psoriasis. Often, those who are obese experience more severe psoriasis symptoms. Conversely, weight loss can have a dramatically positive impact on people with psoriasis. “Exercise and diet that specifically lead to weight loss can help,” Lebwohl notes. “There are many studies that have shown that weight loss in combination with therapy improves psoriasis.” In addition, psoriasis medications have been shown to be more effective for those who have lost weight, he says. A review of clinical trial data published in October 2018 in the journal Cureus found that weight reduction through diet and exercise is an “accessible, inexpensive, empowering method” that gives people with psoriasis more control over their symptoms. In this review, researchers used a Psoriasis Area and Severity Index (PASI) score to measure the severity of psoriasis based on how much of the body is covered and the appearance of the plaques. Results found that exercise improved PASI scores in people with foot psoriasis.
When to Call Your Dermatologist
Above all, seeing your dermatologist is essential for managing symptoms that affect your feet. That’s because foot psoriasis can sometimes be mistaken for something else, such as a fungal infection like athlete’s foot. The wrong treatment for the wrong condition can worsen symptoms and lengthen their duration. “Each person has a unique situation,” Lebwohl says. “Their dermatologist is the best trained to help.”
