How a Small Change in My Fingernails Revealed a Major Health Diagnosis

Captain Kerry Titheradge never anticipated that a wheelchair would become part of his life story.

As he celebrated his 29th birthday, Titheradge, now 50 and a familiar face on Bravo’s Below Deck, was in his prime—energetic, fit, and thriving as a boat captain in Florida.

However, his world quickly changed when a sharp, stabbing pain began plaguing his feet, eventually creeping up through his body and altering his life forever.

Although the exact sequence of events is somewhat blurred in his memory, Titheradge recalls that the pain first surfaced in 2005. In the months that followed, he experienced a peculiar pattern: he would wake up feeling fine, but the moment he attempted to stand, an excruciating pain would shoot through his feet.

“I got up and found I couldn’t walk,” Titheradge recounted to the Daily Mail. “I’d get up to go to the bathroom… and have to get down on hands and knees.”

Doctors initially dismissed his condition as plantar fasciitis, a common condition causing pain in the sole of the foot. They sent him home with special boots to wear at night and instructions to roll a frozen water bottle on the soles of his feet.

But the pain only worsened.

Within months, he said, the backs of his feet became red and inflamed, making each step feel like a nail was being driven into his foot. He told the Daily Mail that scans showed the tendon had started to come away from his heel bone.

Eventually, as the pain persisted, his heel bones fractured, and Titheradge – who is known for his active lifestyle and muscular frame – was confined to a wheelchair.

Captain Kerry Titheradge, who stars on Below Deck, revealed to the Daily Mail that he spent six months in a wheelchair after living with a type of arthritis in his 30s

‘I didn’t know what was going on with me, and doctors had no clue,’ Titheradge told the Daily Mail. ‘My body was reacting like I was 300lbs, like I was an old man.

‘I walk fast, and each morning I used to walk past all these old people with [walkers]. But pretty quickly, the old people were walking past me.’

Titheradge said the beginning part of his illness is still a blur to him. 

He remembered that doctors tried to treat him by recommending he shift his weight from one foot to another when he walked.

After about a year of pain, in August 2006, doctors put his right foot – which was faring worse than his left – into a plaster cast to try to help it heal. They asked him to get around using crutches.

By September, the plaster cast was switched to his left foot, which was deteriorating quickly.

Then, in December 2006, and with no answers as to what was happening, Titheradge started using a wheelchair and was no longer able to work.

‘It was a scary time,’ he told the Daily Mail. ‘I was like, I am the person that is here to provide for my family. My son was just born. My wife, she quit work to be home with our kid – and I was home, too, and I couldn’t… even hold him in my arms [because it was so painful]. That just destroyed me. 

‘I am the breadwinner, that was my job. I was a strong guy physically, [but] I just didn’t know whether I was going to be able to provide for my family.’

A few weeks after being confined to a wheelchair, Titheradge saw a rheumatologist.

The doctor – who specialized in conditions that affect muscles, bones and joints – noticed something about his fingernails. They were pitted, which means they had tiny, shallow or deep depressions in their surface, which can be caused by inflammation that affects the growing nail.

He told Titheradge that the condition was a warning sign of autoimmune disease psoriatic arthritis. 

He then completed a thorough examination and considered the sea captain’s past medical history – during which the physician also noted that Titheradge had suffered from psoriasis since childhood – before giving him a diagnosis.

Psoriasis – an immune system-linked skin disease that causes red, itchy and scaly patches – is known to raise the risk of psoriatic arthritis.

Doctors put Titheradge’s right foot in a plaster cast before one finally diagnosed him with psoriatic arthritis

The sea captain revealed that his symptoms began as morning stiffness in his feet that made it difficult to walk

With psoriatic arthritis, the immune system misfires and mistakenly attacks healthy joints and tendons, causing pain, redness and swelling.

Up to 2.4 million Americans suffer from the condition every year, which typically emerges among those aged 30 to 50 years and begins in the foot, heel or lower back.

About one in three people who have psoriasis go on to develop psoriatic arthritis. Doctors say, however, that it can also emerge in patients who do have not had the skin condition.

Family history of the disease also puts people at higher risk.

It isn’t clear why those in the 30-50 age group are more at risk, but scientists say it may be because the condition normally emerges seven to ten years after the onset of psoriasis, which tends to be diagnosed between ages 15 and 35.

Titheradge told the Daily Mail he believes a golf cart crash in 2004 led to his diagnosis. He said injuries from the crash required facial reconstruction surgery and two operations on his rotator cuff. Trauma can trigger joint inflammation, which raises the risk of the immune system misfiring.

Doctors often struggle to diagnose psoriatic arthritis because it does not have a definitive test and often mimics other conditions. A 2021 study found that patients waited about two years on average to find out the cause of their ailments.

There is no cure, but patients may be able to manage symptoms using several medications.

After his diagnosis, Titheradge was put on sulfasalazine, an anti-inflammatory drug that works by suppressing inflammation-causing blood cells.

He remained on the drug for six months – confined to the wheelchair for the duration – but said it had no effect.

That was when doctors switched him to Enbrel, which contains the active drug etanercept.

It is used to treat moderate to severe autoimmune conditions and works by reducing inflammation markers in the blood – which doctors say can prompt healing to start and help symptoms to resolve. The medication is administered via at-home injections into the thighs once a week.

Titheradge said it took six months for him to notice any improvement, but found that, gradually, his feet began to heal.

Within months of the symptoms improving, the captain said he was finally able to ditch the wheelchair, and, within a year, he was back at work.

Today, Titheradge – who recently split from long-term girlfriend Gönül Bihan – monitors his health and has continued with an injection treatment

Titheradge has largely recovered, and has since moved on to more common lifecycle issues – like his recent split from long-term girlfriend Gönül Bihan. However, he still takes Enbrel to manage his symptoms, though his dosage has been reduced from once a week to once or twice a month.

Titheradge also bears a few physical marks from his experience. He told the Daily Mail that his right big toe remains much larger than his left, after it swelled during the worst of the condition.

He also said that, at times, he still gets flare-ups of pain in his feet, although the symptoms are nowhere near as severe as when he first felt them all those years ago.

‘People see the version of me I’m becoming, and people think the success is given, and that I didn’t have hardships along the way,’ he told the Daily Mail.

‘I want people to know, wherever they are, that there is a way out.’