Psoriatic Arthritis in Ankles

Medically Reviewed by David Zelman, MD on July 15, 2022
6 min read

With psoriatic arthritis (PsA), it’s common to have problems with your ankles. You may have joint inflammation, pain, swelling, and stiffness. It may go along with issues in your feet, knees, and hips.

Ankle pain is common with many types of arthritis, including PsA. About 50%-70% of people who have PsA have problems with their feet.

Your ankle is a hinge joint that connects your foot and leg bones. It helps you move your foot up and down.

Your ankle is lined with a synovial membrane. This membrane creates synovial fluid, which is an oil that lubricates the joint to help it move. Your tendons and connective tissue around your ankle also have synovial membranes.

PsA can make your synovial membranes thick and inflamed. When this happens, they may release more fluid than normal. This can make your joints and tendons tender and swollen.

Symptoms may vary, but common symptoms include:

  • Deformity
  • Joints that feel hot
  • Locked joints
  • Pain
  • Range of motion problems
  • Stiffness
  • Swelling
  • Tenderness
  • A hard time walking

You may feel these symptoms in just your ankle joint or in several joints. You may also have symptoms in your toes and feet.

With PsA, these symptoms tend to have an asymmetric pattern, which means they may not be the same on both sides of your body. Your symptoms may be mild or severe. Your symptoms may flare up at times, then ease up.

If PsA is affecting your ankles, you may notice things like:

  • Hot pain from the swelling of your Achilles tendon, which connects your calf muscle to your heel bone
  • Stiffness after you’ve been inactive, like when you wake up in the morning
  • Swelling of your ankles
  • Swelling of your toes that makes them look like sausages

Ankle and foot pain is often the first sign of PsA. If you haven’t been diagnosed with PsA and you have ankle pain, talk to your doctor.

Your doctor will ask about your symptoms, your overall health, and your medical history. Then they’ll look at your ankles and feet.

They may look for changes in the skin on your foot and take notice of its shape. They may apply gentle pressure to your ankle joint to see what’s sensitive and may be causing pain. They may ask you how the flexibility in your ankle area has changed.

If you have signs and symptoms of PsA in your ankle, your doctor may refer you to a rheumatologist. A rheumatologist may do blood tests and imagery like an MRI, ultrasound, and X-rays.

Ankle pain can get in the way of your day-to-day activities by making it harder to move comfortably.

If you have PsA in your ankles and feet, you may have other problems with these parts of your body as well.

Foot problems from PsA may include:

  • A hyperextended big toe
  • Corns, calluses, and ulcers
  • Flattening of your metatarsal arch
  • In-rolling of your ankle
  • Irreversible stiffness
  • Shortening or clawing of your toes

If you have inflammation and pain in your feet, it’s important to see your doctor. If you leave it untreated, you may have long-term problems, like toe joints that fuse together.

With PsA, it’s important to reduce inflammation and pain, as well as prevent long-term disability.

If your PsA is mild, your doctor may recommend first-line treatments for PsA, including:

  • Anti-inflammatory gels
  • Disease-modifying drugs like methotrexate
  • Oral corticosteroids or corticosteroid shots, depending on how severe you condition is
  • Over-the-counter anti-inflammatory pain relievers like ibuprofen
  • Prescription medication to treat inflammation and swelling

These drugs can ease pain and inflammation, but they won’t make your PsA progress more slowly.

The medications that doctors use most often for PsA are disease-modifying antirheumatic drugs, or DMARDs. These can slow down the progression of the disease and head off lasting damage.

The most commonly prescribed DMARD is methotrexate (Otrexup, Rasuvo, Trexall). Others in this class include leflunomide (Arava) and sulfasalazine (Azulfidine).

Another type of DMARD known as biologics affect your immune system differently. These include:

If conventional DMARDs and biologics don’t work for you, your doctor might try what’s called a targeted synthetic DMARD known as tofacitinib (Xeljanz).

If you can’t take DMARDs or biologics and your PsA is mild to moderate, apremilast (Otezla) is a drug that tamps down the body’s enzymes that control inflammation.

Both over-the-counter and prescription medications may have side effects. Talk with your doctor about which ones may be right for you.

Your doctor may recommend corrective footwear, or orthotics, to help with foot problems. Orthotics redistribute your weight to relieve pressure. They also correct your gait and structural issues. Splints that stabilize and immobilize your hindfoot and ankle may also help.

If you have mild or moderate pain in your ankle, your doctor may recommend a lace-up ankle brace for support.

If your ankle is very stiff or if you have severely flat feet, your doctor may recommend a stronger brace made of custom-molded plastic or leather.

If your ankle pain or deformity makes it hard for you to move around, or if you’ve tried other treatments that haven’t worked, you may need orthopedic surgery.

Ankle replacement surgery. Your doctor may recommend this if your PsA affects other joints around your heel or if you’ve had fusion on your foot or other leg. The surgery will replace your bones and joints with metal and plastic parts that together will mimic the action of a healthy joint.

Ankle fusion surgery. This surgery fuses your joint to stop pain caused by movement. It’s also called arthrodesis. It’s the most common surgery for ankle problems from PsA.

After ankle fusion, you may have less range of motion when you move your ankle up or down. To make up for this, your joints near your ankle and your foot will work together to create an up-and-down motion.

Synovectomy. Your doctor may recommend removing the thickened synovial membrane. This type of surgery is called a synovectomy.

Osteotomy. This is surgery that involves realigning your joint.

Excision arthroplasty. This is surgery to remove the end of a bone that’s painful.

With any kind of surgery, you’ll have a hospital stay and will need time to heal before you can go back to your normal activities. It’s likely that you’ll have at least some of the common side effects of surgery, including pain and swelling where the surgery cut you. Talk to your rheumatologist about what’s best for you.

Many home remedies can be used to treat ankle pain from PsA.

Heat. You may get relief from heat. Try applying warm towels or heat packs to your ankle. A hot bath may also ease pain and swelling.

Cold. You may also get relief from cold. Try applying an ice pack to ease inflammation.

Supportive shoes. Choose comfortable shoes with good foot and ankle support. Avoid high heels. Consider wearing shoe inserts that are custom-made for you to absorb shock and relieve pressure on your feet.

Taking good care of your health may help you manage ankle pain and inflammation.

Lose weight. If you’re overweight, you put more stress on your joints. By losing a few pounds and managing a healthy weight, your joints will have less pressure placed on them.

See your doctor. Getting treated for ankle pain is important to feel better, stay active, and avoid long-term problems. Talk to your doctor about your symptoms and how they impact your life and how well you get around. Your doctor can treat your pain and swelling so you can avoid bigger problems and permanent damage.