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Heel Pain

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

You may take it for granted that your feet will do what you want when you want them to. But when you have pain in your feet, the story changes.

If you have axial spondyloarthritis (axSpA), foot or heel pain may be one of your symptoms. When your feet hurt, walking or standing can be unbearable. Learning the causes of your pain and ways to manage it can help you get back on your feet with less impact on your daily life.1

What causes foot and heel pain with axial spondyloarthritis?

AxSpA can cause inflammation in different areas of the body. One area is where the ligaments and tendons attach to the bone. These points are called the entheses. When one or more of these points become inflamed, it is called enthesitis.2,3

Inflammation can also cause new bone to form where the ligament or tendon attaches to the bone. This new bone growth is often called "bone spurs." In some cases, the new bone grows into the joint, fusing it. This leads to pain and loss of movement in the joint.2,3

Enthesitis is an early and common symptom of axSpA. Any area of the body where the ligaments and tendons attach to the bone can be affected. But some areas are affected more often, including:2,3

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  • Heels and soles of the feet
  • Tops of the feet
  • Knees, elbows, and shoulders
  • Fingers and toes
  • Ribs or chest wall

Types of foot pain in axSpA

There are several types of foot and heel pain linked to axSpA.1

Plantar fasciitis

The plantar fascia is the soft tissue under your foot that attaches to your heel. When this area is inflamed, the condition is called plantar fasciitis.1

The symptoms of plantar fasciitis vary from person to person. The most common symptom is pain in the heel or bottom of the foot. This pain is usually the worst first thing in the morning or after sitting or standing for a long time. The pain may improve when you walk around, but it will usually come back after sitting or standing for a while.1

Other symptoms include stiffness, swelling, and redness on the sole of your foot.1

Insertional Achilles tendonitis

Another complication of axSpA that affects the feet is insertional Achilles tendonitis. In this condition, there is inflammation where the Achilles tendon attaches to your heel bone. This can cause pain and stiffness in the heel, which may make it difficult to walk.1

Like plantar fasciitis, insertional Achilles tendonitis can cause stiffness, swelling, and redness. But these symptoms are at the back of the heel.1

How are foot conditions diagnosed?

Your doctor will ask you about your symptoms to learn the cause of your foot pain. A full exam will include touching your feet and heels. It might include watching you walk or bend over. X-rays of your feet might be needed to see the amount of inflammation.2

How are they treated?

Your primary doctor, rheumatologist, or foot doctor (podiatrist) will work with you to make a treatment plan for your foot problems. Supportive treatment might include:1

  • Calf stretches
  • Insoles or orthotics
  • Supportive footwear
  • Night splints
  • Taping of the foot

When supportive treatment does not ease your pain, you might need medical options. Steroid injections into your foot or heel may reduce inflammation and help ease your pain. Like other treatments, this is not for everyone. Your doctor will let you know all the risks and benefits of this type of therapy.1

Treating your underlying axSpA condition can also help ease your foot pain. Stretching and physical therapy are a good first step. But you may need other options to reduce pain and inflammation. Some drugs used to manage axSpA pain and inflammation include:3,4

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
  • Drugs called disease-modifying antirheumatic drugs (DMARDs), which slow the progression of axSpA
  • Drugs called biologics that work on specific parts of your immune system

Other things to know

Being overweight can put extra strain on your feet and heels. If you have extra weight to lose, losing that weight might help ease some discomfort. Talk to your doctor about weight loss strategies that may be best for you.1

When your feet hurt, it can be hard to stay active. This can lead to weight gain and a decrease in your overall fitness level. If you have axSpA, find ways to stay active despite the pain. Exercise can help reduce inflammation and improve your overall health. Good options to try include:1

  • Walking
  • Swimming
  • Biking
  • Other low-impact activities

While foot pain is common in people with axSpA, treatment is available. If you are experiencing foot pain, talk to your doctor. With the proper treatment, you can manage your pain and stay active.