Enthesitis, Heel Pain, and Ankylosing Spondylitis
Last updated: January 2023
Did you know that foot pain may be associated with having ankylosing spondylitis (AS)? Yeah, no kidding. Most of us know that AS is far more than a back condition. It often impacts several body parts. But when our feet hurt, could it be AS? It turns out it pays to think about AS being a potential cause.
My right foot is a mess. I have everything from ingrown nails (a genetic problem) to something called Diabetes-Charcot-Marie-Tooth disease. I have had Plantar Fasciitis. And just for fun, I have something called Insertional Achilles Tendinosis. Ugh, those are the only issues I can remember. That is a lot for one foot.
The result has been four surgeries: screws inserted that had to come out, nails removed, toes repositioned, blah blah blah. Once, a podiatrist told me he could retire off the procedures needed for my right foot. He said he could have a new life in West Palm Beach, Florida, if I let him correct all the issues. (Note: he is still working and waiting for me to return).
So as I start to write an article for this site, it is not easy to separate what is attributable to AS and what is just other stuff. As you can see, I have a lot of other things. But one thing I know that is attributable to AS is my heel pain.
Heel pain and AS
The first thing I learned is that AS can cause nerve pain in our heels. For me, the Achilles tendon in my right foot aches all the time. It tingles, and sometimes it has minor swelling. Unfortunately, I have not found a single great treatment.
What causes the pain?
According to the editors of AnkylosingSpondylitis.net (these seem like reputable folks):
"AS can cause inflammation in the entheses, the points where the ligaments and tendons attach to the bones. This inflammation is called Enthesitis, and these tender spots are often called 'hot spots.' A common location of enthesitis in people with AS is the heel." You can read more from this article here.
Enthesitis and the feet
Enthesitis can impact one heel or both as well as other body parts. It can occur in most places we hurt, but common locations for people with ankylosing spondylitis include1:
- The Achilles tendon
- The arch of the heel
- In the knee
- In the bones of the feet
- In the spine
- The elbows
- The ribs
- The back of the head
Here is a great graphic supplied by our very own graphics team at AnkylosingSpondylitis.net that shows the elements of enthesitis:
In part 2, I will discuss treatments for foot pain and my routine. But before we get to that, do you have foot pain caused by ankylosing spondylitis? Tell us about it.
Do you notice worsening flares in colder weather?