Focussing on the foot in psoriatic arthritis: pathology and management options

Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory arthritis characterised by a range of musculoskeletal conditions including enthesitis, dactylitis and synovitis as well as skin and nail manifestations. The foot is a complex mixture of tissues, all of which can be involved in this disease and is frequently the presenting feature. Areas covered: In this under-researched area, articles were reviewed from the authors' publications as well as from other known authors. This review will discuss how PsA affects the foot and ankle with a particular focus on synovitis, tenosynovitis, enthesitis, dactylitis, bone erosion and psoriatic skin and nail disease. The use of imaging is discussed. Conventional radiography is consistently used, however magnetic resonance imaging and ultrasound should be used routinely to diagnose, assess and monitor the disease appropriately. The complex nature of PsA in the foot and ankle should be considered when managing the condition and treatment should be individualized to relieve pain, maintain mobility and improve quality of life. Expert commentary: The foot and ankle remains a neglected area in PsA. Problems with the foot and ankle should be prioritised as they can significantly impact on patients' quality of life. Focussing treatment on the foot and ankle can significantly improve outcome.