Caring for the feet
What forms of psoriasis can affect the feet?
Different types of psoriasis affect different parts of the foot. Psoriasis can involve the toes, sole and dorsal (upper) surface of the foot.
Why are the feet particularly vulnerable to psoriasis?
The tough skin of the sole of the foot protects arteries, nerves and muscles. The sole must support the weight of the body, which is distributed between the toes and the heel; the arch of the foot provides the necessary strength and flexibility. When the skin on the toes and heels is inflamed, it produces a poor quality, thick layer of dead skin, resulting in painful, cracked skin. These cracks make it easy for bacteria to penetrate the skin and so inflammation spreads. The problem is exacerbated when patients are tall or overweight, have flat feet or have a job which requires prolonged periods of standing. Activities such as jogging and aerobics can also make inflammation worse.
When veins in the leg are swollen, the blood vessels in the ball of the foot also swell. This stretches the skin and increases the likelihood that psoriasis will appear at this site.
Apart from using medication, how can I protect my feet?
During flares, you should soak your feet in salt water for 10 minutes three times a day. Spread your toes so that the whole foot comes into contact with the water. Dry your feet carefully afterwards, paying attention to the area in between the toes. A footbath is recommended every day in summer. Any prescription cream should be applied sparingly, and you should wipe off excess cream which has not been absorbed by the skin after 10 minutes.
Skin on the heels often becomes dry and cracked. If this is the case, you can use an airtight polythene bag for a few hours every evening to moisturise the skin and soothe cracks. In winter, feet should be kept warm, particularly if you have poor circulation in the legs and if your feet tend to be cold.
What shoes are suitable if I have psoriasis of the foot?
Footwear should be light and comfortable. Pointed toes can damage both the skin and bones, especially in children. Choose leather rather than synthetic materials as it absorbs moisture better.
You can buy foam, cork or water-filled insoles which will relieve pressure on the skin. You can also use inner soles made from polymers which will act as shock-absorbers and protect healing skin. These can be worn with good quality trainers, which should be soft and made from breathable material.
Avoid socks, tights or stockings which are made from predominantly synthetic fibres.
Do allergies have a role in psoriasis of the foot?
The metal buckle of a shoe may trigger an allergic reaction, as can the rubber or chromium salts used in leather shoes. Chemicals contained in synthetic shoes can also cause a reaction. You need to find out for yourself which type of shoe is best tolerated by your skin during flares.
What should I do when I have lesions on my toes?
Psoriasis of the foot needs to be specially treated. When the skin between the toes is constantly moist, this creates a microclimate that encourages fungal and bacterial growth. Infection can then develop around the toes and toenails.
Toenails should be cut very regularly, and you should carefully cut the edges to make sure they do not pierce the skin. Use nail clippers or the base of a pair of scissors (where the two blades meet) to cut the nails straight across.
What should I do when the skin begins to heal?
When inflammation has subsided, the skin of the sole stops producing scale. Skin remains red, but is not particularly thick. It takes some time to recover its resilience. To protect it, you should make sure your skin is neither too dry nor too moist, a difficult balance to maintain.
Good everyday hygiene is essential when psoriasis affects your feet.
- Painful, cracked skin on the feet can cause great discomfort. It is best to try to be patient and leave your skin to heal on its own between washings, in order to make sure that a vicious circle of inflammation and infection is not created.