Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Psoriatic arthritis near Farmington Hills produces one foot finding that’s almost unique to it — and podiatrists often identify it before rheumatologists do. That finding, combined with nail changes most people ignore, frequently leads to a systemic diagnosis that changes the entire treatment course. Call (810) 206-1402 — psoriatic arthritis foot care in Farmington Hills.
Medically Reviewed by: Dr. Tom Biernacki DPM · Board-Certified Podiatrist · Balance Foot & Ankle PLLC · Updated 2026
Psoriatic Arthritis Foot Care Near Farmington Hills, MI
Psoriatic arthritis foot care near Farmington Hills, MI is available at Balance Foot & Ankle in Bloomfield Township. Dr. Biernacki DPM treats the podiatric manifestations of psoriatic arthritis — dactylitis, enthesitis, Achilles insertional disease, plantar fasciitis, and nail changes — coordinating with rheumatology for optimal outcomes. Call (810) 206-1402.
Psoriatic Arthritis and Your Feet
Psoriatic arthritis (PsA) produces a distinctive set of foot manifestations that differ from other inflammatory arthritides. The key features include: Dactylitis (“sausage toe”) — uniform swelling of an entire toe from combined tendon sheath and joint inflammation, pathognomonic for PsA. Enthesitis — inflammation at tendon insertions, particularly the Achilles and plantar fascia origin at the heel. Psoriatic nail disease — pitting, onycholysis, and subungual hyperkeratosis, frequently mistaken for toenail fungus. Asymmetric joint arthritis affecting toe and ankle joints. In our Farmington Hills-area patients, the foot is the presenting site for PsA in up to 30% of cases — we regularly identify suspected new diagnoses through these characteristic foot patterns and refer to rheumatology.
Key Takeaway: Psoriatic nail changes are NOT simply toenail fungus — proper nail clipping and culture before antifungal treatment. Heel pain or dactylitis that responds poorly to standard treatment in a psoriasis patient warrants urgent rheumatology referral.
Podiatric Treatment of PsA Foot Disease
Heel pain / enthesitis: Custom orthotics with heel cushioning and plantar fascia offloading. Corticosteroid injection at the plantar fascia origin or retrocalcaneal bursa. Bilateral involvement, prolonged morning stiffness, and poor response to stretching = prompt rheumatology referral. Dactylitis: Corticosteroid injection into the flexor tendon sheath. Biologic therapy (TNF inhibitors, IL-17 inhibitors) is initiated by rheumatology — highly effective for active dactylitis. Nail disease: Nail culture to rule out concurrent fungal infection. Nail avulsion for severely symptomatic nails. Joint management: Corticosteroid injections into affected joints; surgical arthroplasty for advanced joint destruction.
⚠️ See a Podiatrist If You Have Psoriasis And:
- Heel or Achilles pain that doesn’t respond to standard plantar fasciitis treatment
- A whole toe that is swollen and sausage-like — this is dactylitis, not a sprain
- Nail pitting, nail separation, or thickening without prior fungal diagnosis
- Asymmetric toe joint swelling or pain
- Foot symptoms appearing around the same time as psoriasis onset or flare
American Academy of Dermatology: Psoriatic Arthritis
Getting to Our Office From Farmington Hills
Our Bloomfield Township office at 43494 Woodward Ave #208 is about 15–20 minutes from Farmington Hills via I-696 E to Woodward Ave. We accept most major insurance. Call (810) 206-1402 or book online.
PsA Foot Problems? We Recognize Them
Balance Foot & Ankle · Serving Farmington Hills & Michigan
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Psoriatic arthritis in the feet near Farmington Hills commonly causes enthesitis (inflammation at tendon and ligament insertion sites), dactylitis (sausage toes), nail changes, and joint pain. Our podiatrist serving Farmington Hills works in coordination with rheumatologists to manage the foot and ankle manifestations of this systemic condition. Treatment focuses on reducing inflammation through topical and oral medications, protecting affected joints with custom orthotics and appropriate footwear, and maintaining function through physical therapy. Corticosteroid injections can target specific inflamed joints or tendons. During flares, offloading with accommodative devices reduces stress on painful areas. Nail involvement — including onycholysis and subungual hyperkeratosis — is managed to prevent secondary infection. Patients near Farmington Hills benefit from early podiatric involvement to prevent permanent joint damage and preserve long-term mobility.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
How does psoriatic arthritis affect the feet and toes?
Psoriatic arthritis commonly causes dactylitis — swelling of an entire toe, giving it the 'sausage toe' appearance — which is nearly pathognomonic for psoriatic arthritis. It also causes enthesitis (inflammation where tendons and ligaments attach to bone), particularly at the Achilles tendon and plantar fascia insertions. Nail changes including pitting, onycholysis (nail separation), and nail thickening frequently accompany foot involvement. These foot findings often precede systemic diagnosis, making podiatrists important in early identification.
What podiatric treatments help psoriatic arthritis foot symptoms?
Podiatric management focuses on reducing mechanical stress on inflamed joints and entheses. Custom orthotics offload painful insertions and protect deforming toe joints. Accommodative padding helps manage dactylitis-related pressure. For nail psoriasis causing pain or infection, podiatrists provide careful nail care. Corticosteroid injections into affected joints or entheses can provide significant relief during flares. Coordination with the patient's rheumatologist ensures systemic biologic or DMARD therapy is optimized alongside local podiatric care.
Can psoriatic arthritis permanently damage foot joints?
Yes — untreated or inadequately controlled psoriatic arthritis can cause erosive joint damage, particularly to the small joints of the toes, leading to permanent deformity. Arthritis mutilans — a severe destructive form — can cause 'opera glass' or 'pencil-in-cup' deformities visible on X-ray. Modern biologic therapies have dramatically reduced the risk of these outcomes when started early. Regular podiatric evaluation allows early detection of joint changes before irreversible structural damage occurs.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.