What does a podiatrist treat?

Podiatrists specialize in the foot, ankle, and lower leg. They diagnose and treat heel pain, bunions and hammertoes, tendon injuries, nerve conditions (Morton's neuroma, neuropathy), toenail disorders, skin conditions (warts, calluses, ulcers), fractures, sports injuries, diabetic foot complications, ankle instability, and perform foot and ankle surgery. At Balance Foot & Ankle, Dr. Tom Biernacki DPM, Dr. Carl Jay DPM, and Dr. Daria Gutkin DPM AACFAS serve Howell, Bloomfield Hills, and surrounding Michigan communities.

How often should a healthy person see a podiatrist?

Annual foot exams are beneficial if you are over 60, are an active runner or athlete, have diabetes, have a family history of foot problems, or notice any changes in foot shape, nail appearance, or skin texture. Preventive visits catch problems early — before bunions require surgery or a small nail issue becomes an infection.

Can foot problems cause knee, hip, or back pain?

Yes — the foot is the foundation of the kinetic chain. Overpronation causes the tibia to internally rotate, increasing stress on the knee and altering hip alignment. High arches transmit shock poorly, overloading the ankle and knee. Custom orthotics that correct foot mechanics frequently improve knee, hip, and back symptoms — one of the most underappreciated benefits of podiatric care.

When should I see a podiatrist versus an orthopedic surgeon?

Podiatrists specialize exclusively in the foot, ankle, and lower leg — making them the most experienced providers for most foot and ankle conditions. For foot and ankle surgery, a DPM with high case volume is appropriate. Dr. Tom Biernacki at Balance Foot & Ankle has performed over 3,000 foot and ankle procedures. Call (810) 206-1402.

Psoriatic Arthritis Foot Symptoms 2026

Medically reviewed by Dr. Tom Biernacki, DPM

Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026

Psoriatic Arthritis Foot Symptoms Treatment - Michigan podiatrist, Balance Foot & Ankle — Psoriatic Arthritis Foot Symptoms Treatment treatment | Balance Foot & Ankle, Michigan

Foot Manifestation	Prevalence	Clinical Features	Podiatric Management
Enthesitis (Achilles, plantar fascia)	Most common foot finding; 30-50%	Tender insertion sites; morning stiffness; Achilles or heel pain	Orthotics; ESWT; rheumatology for biologics
Dactylitis (sausage toe)	30-40% of PsA patients	Diffuse swelling of entire toe; skin stretch	Rheumatology biologics (IL-17, TNF inhibitors); padding
MTP / IP Joint Arthritis	60-80% have foot joint involvement	Pain, swelling, morning stiffness in toe joints	Custom orthotics; wide shoes; joint protection splints
Nail Changes (subungual hyperkeratosis, pitting)	80% of PsA have nail involvement	Thickening, discoloration, pitting, nail lifting	Distinguish from fungus (culture); biologics most effective
Skin Psoriasis (plantar plaques)	Variable; may precede or follow arthritis	Thick scaly plaques on sole; fissuring; pain with walking	Topical steroids; emollients; specialist referral

Treatment Category	Agent / Approach	Target Manifestation	Evidence
NSAIDs	Naproxen, ibuprofen, celecoxib	Mild joint and enthesis pain	Level I; first-line for mild PsA
TNF Inhibitors	Adalimumab, etanercept, infliximab	Dactylitis, enthesitis, joint arthritis	Level I; gold standard for moderate-severe PsA
IL-17 Inhibitors	Secukinumab, ixekizumab	Skin + joint disease; enthesitis	Level I; superior for skin involvement
Custom Orthotics	Accommodative + redistributive	MTP joint arthritis; plantar enthesitis	Level III; significant functional improvement
ESWT	Extracorporeal shockwave	Plantar fascia and Achilles enthesitis	Level II; adjunct when NSAIDs fail

Quick answer: Treatment for psoriatic arthritis foot symptoms treatment follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan

https://www.youtube.com/watch?v=8opvH3qxkW4

Dr. Tom Biernacki explains psoriatic arthritis in the foot — the different patterns of PsA foot involvement and how podiatric care helps.

psoriatic arthritis foot dactylitis enthesopathy Achilles treatment

Watch: How to Regrow Cartilage & Reverse OsteoArthritis? [Can We Do It?] — MichiganFootDoctors YouTube

Psoriatic arthritis (PsA) is an inflammatory arthritis occurring in 20-30% of patients with psoriasis. The foot is one of the most commonly affected areas — and PsA foot presentations are distinct from rheumatoid arthritis, requiring a different diagnostic and treatment approach.

Watch: Foot & ankle health tips from Dr. Biernacki

MICHIGAN PODIATRIST INSIGHT

The most important clinical decision with Psoriatic Arthritis Foot Symptoms Treatment isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.

MICHIGAN PODIATRIST INSIGHT

Dactylitis: The Sausage Toe

One of the most characteristic PsA findings is dactylitis — diffuse swelling of an entire digit, giving the “sausage digit” appearance. In the foot, any toe may be affected. It results from inflammation of the flexor tendon sheath combined with MTP and IP joint arthritis. Dactylitis is so characteristic of PsA (and reactive arthritis) that it effectively rules out RA when present. Treatment is systemic — biologics, particularly TNF inhibitors and IL-17 inhibitors, are highly effective for dactylitis.

Enthesopathy: Where Tendons Meet Bone

PsA is an enthesopathic disease — it preferentially inflames the entheses, the sites where tendons and ligaments attach to bone. In the foot, this produces:

Insertional Achilles tendinopathy: Inflammation at the Achilles-calcaneus insertion that is more intense and more resistant to mechanical treatment than typical insertional Achilles tendinopathy. May be bilateral. X-ray often shows erosion at the Achilles insertion and irregular bone formation.

Plantar fasciitis: PsA plantar fasciitis is enthesopathic — driven by inflammation at the plantar fascial origin rather than mechanical overload. It may occur in patients with no biomechanical risk factors and may be bilateral. Responds to systemic disease control and mechanical treatment (orthotics, heel pads) but not as reliably to typical physical therapy alone.

Nail Changes and DIP Joint Involvement

Psoriatic nail changes — onycholysis (nail separation), pitting, subungual hyperkeratosis — are present in approximately 80-90% of PsA patients and are associated with DIP (distal interphalangeal) joint arthritis. Nail psoriasis can be mistaken for onychomycosis (toenail fungus). Podiatric nail care addresses symptomatic dystrophic nails; systemic therapy controls the psoriatic process.

Podiatric Management of PsA Foot Disease

Systemic disease control through rheumatology is the foundation. Podiatric contributions: mechanical management of enthesopathy (heel lifts, orthotics, appropriate footwear for Achilles and plantar fascia issues), nail care for dystrophic PsA nails, dactylitis evaluation and coordination with rheumatology, and selective corticosteroid injection — used more cautiously in PsA than in RA due to risk of local skin reaction and systemic flare with certain biologics.

Dr. Tom's Product Recommendations

Recommended Products for PsA Foot Management

Tuli’s Heavy Duty Gel Heel Cup

⭐ Highly Rated

Maximum-cushion gel heel cup for insertional Achilles and plantar fascia enthesopathy pain relief.

Dr. Tom says: “Heel cups provide cushioning and slight heel lift — reducing the tension at the Achilles insertion and plantar fascia origin that worsens enthesopathy pain. Tuli’s Heavy Duty is a thicker, firmer option better suited for significant enthesopathy than standard cushion cups.”

✅ Best for
Insertional Achilles enthesopathy, PsA plantar fasciitis, heel cushioning

⚠️ Not ideal for
Haglund’s deformity requiring posterior heel offloading (different geometry needed)

View on Amazon →

Disclosure: We earn a commission at no extra cost to you.

✅ Pros / Benefits

S
y
s
t
e
m
i
c
b
i
o
l
o
g
i
c
s
h
i
g
h
l
y
e
f
f
e
c
t
i
v
e
f
o
r
d
a
c
t
y
l
i
t
i
s
a
n
d
e
n
t
h
e
s
o
p
a
t
h
y
i
n
P
s
A
;
m
e
c
h
a
n
i
c
a
l
t
r
e
a
t
m
e
n
t
p
r
o
v
i
d
e
s
m
e
a
n
i
n
g
f
u
l
s
y
m
p
t
o
m
a
t
i
c
r
e
l
i
e
f
;
p
o
d
i
a
t
r
i
c
n
a
i
l
c
a
r
e
m
a
n
a
g
e
s
d
y
s
t
r
o
p
h
i
c
P
s
A
n
a
i
l
s

❌ Cons / Risks

P
s
A
e
n
t
h
e
s
o
p
a
t
h
y
c
a
n
b
e
r
e
s
i
s
t
a
n
t
t
o
m
e
c
h
a
n
i
c
a
l
t
r
e
a
t
m
e
n
t
w
i
t
h
o
u
t
s
y
s
t
e
m
i
c
d
i
s
e
a
s
e
c
o
n
t
r
o
l
;
c
o
r
t
i
c
o
s
t
e
r
o
i
d
i
n
j
e
c
t
i
o
n
s
c
a
r
r
y
a
d
d
i
t
i
o
n
a
l
r
i
s
k
i
n
p
a
t
i
e
n
t
s
o
n
b
i
o
l
o
g
i
c
s
;
s
k
i
n
c
h
a
n
g
e
s
f
r
o
m
P
s
A
c
a
n
a
f
f
e
c
t
w
o
u
n
d
h
e
a
l
i
n
g

Dr. Tom Biernacki’s Recommendation

PsA foot disease is something I see regularly, often before the patient has a formal PsA diagnosis. Bilateral Achilles enthesopathy in a patient with nail pitting and a sausage toe should always prompt rheumatology referral. Getting systemic disease under control is essential to foot treatment working.

— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle

Frequently Asked Questions

q

Michigan Foot Pain? See Dr. Biernacki In Person

4.9★ rated | 1,123 Reviews | 3,000+ Surgeries

Same-week appointments · Howell & Bloomfield Hills

📞 (810) 206-1402 Book Online →

⚕ Doctor Recommended

Doctor Hoy’s Natural Pain Relief

Topical relief for foot & ankle pain

View Product →

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your foot or ankle condition, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

American Academy of Dermatology: Psoriatic Arthritis

Ready to Get Relief?

Same-day appointments available in Howell & Bloomfield Hills, MI

4.9★ | 1,123 Reviews | 3,000+ Surgeries

Book Your Appointment →

Or call: (810) 206-1402

Dr. Tom Biernacki, DPM

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.