Objective. The aim of this study was to identify independent predictors of pain at the MTP joints inpatients with PsA. Methods. Thirty-four consecutive patients with PsA (mean age 45.3 years, 65% female, mean diseaseduration 9.9 years) and 22 control participants (mean age 37.9 years, 64% female) underwent clinical andUS examination to determine the presence of pain, swelling, synovitis, erosions, effusions and submetatarsal bursae at the MTP joints. Mean barefoot peak plantar pressures were determined at each MTP joint.Levels of pain, US-determined pathology and peak pressures were compared between groups. Binarylogistic regression was used to identify demographic, clinical examination-derived, US-derived and plantarpressure predictors of pain at the MTP joints in the PsA group.Results. The presence of pain, deformity, synovitis, erosions (P<0.001) and submetatarsal bursae andpeak plantar pressure at MTP 3 (P<0.05) were significantly higher in the PsA group. MTP joint pain in PsAwas independently predicted by high BMI, female gender and the presence of joint subluxation, synovitisand erosion.Conclusion. These results suggest local inflammatory and structural factors, together with systemic factors(gender, BMI), are predominantly responsible for painful MTP joints in PsA, with no clear role forplantar pressure characteristics.Key words: psoriatic arthritis, metatarsophalangeal joints, pain, ultrasound, plantar pressure.