Foot pain is a common symptom of ankylosing spondylitis. It may affect the ankles, feet, or heel. But it doesn’t have to limit your mobility.
AS can cause heel and foot pain due to a problem called enthesitis, which is inflammation where tendons and ligaments attach to bones. It can also lead to foot deformities.
Physical therapy
Ankylosing spondylitis can cause pain and stiffness in the pelvis, spine and other joints. Over time, the stiffness can lead to a hunched-forward posture. It can also make it difficult to move and walk easily. Physical therapy can help manage the pain and improve mobility.
There are many types of physical therapy, but some are more effective than others. Supervised exercise is more effective than home-based exercises, and group physical therapy is more effective than individual exercises or no physical therapy at all. A combination of exercise and supervised massage (balneotherapy) is more effective than a single type of treatment.
Exercise can strengthen muscles that support the spine and hips and help prevent or relieve back pain from ankylosing spondylitis. Exercise can also help improve posture. People with ankylosing spondylitis can try some simple exercises to help improve their posture, such as lying on their stomach and gently pushing themselves up with their arms. Aerobic exercise can also help improve heart and lung function and mood, and reduce disease activity, pain, fatigue and stiffness.
Anti-inflammatories
NSAIDs are the medicines health care providers most often use to treat inflammation stiffness and pain in ankylosing spondylitis. These medicines can ease pain and may help prevent or delay structural damage to the spine. They can also decrease the likelihood of complications such as gastrointestinal bleeding or kidney disease.
Most people with ankylosing spondylitis can live normal lives, even though it’s a chronic condition with a variable course that may include painful flare-ups and periods of less pain. You can manage your ankylosing spondylitis with medication, exercise and lifestyle changes.
DMARDs slow the progression of disease by blocking substances that cause inflammation. NSAIDs, and other anti-inflammatory medicines such as meloxicam or tofacitinib, are effective in treating ankylosing spondylitis. Alternatively, doctors may prescribe an anti-tumor necrosis factor (anti-TNF) drug such as infliximab or adalimumab to reduce inflammation and prevent joint damage and disability. A newer type of biologic, which blocks a specific inflammatory molecule called interleukin-17, has been found to be especially useful for ankylosing spondylitis. Two such drugs, secukinumab and ixekizumab, are now available.
Insoles
Ankylosing spondylitis mainly affects the spine, but it can cause pain and stiffness in other parts of your body, including your feet. Your doctor may recommend that you wear insoles to help alleviate your foot and ankle pain.
Insoles are shoe inserts that provide support, correction and comfort. They are designed to reduce pressure on specific areas of your foot, which can relieve pain and prevent sore spots or ulceration. There are several different types of insoles that you can choose from, depending on your needs.
Insoles can be made from soft materials such as foam or fabric, or from hard materials like plastic and gel. You can also get specialized insoles for plantar fasciitis (pain and tenderness in the heel area), arthritic joints such as your knee or hip, or bunions, which are bumps that develop at the base of your big toe. Your rheumatologist can explain the various options and help you find the right treatment plan for your foot and ankle problems. It’s important to try different things and find what works best for you.
Orthotics
Inflammation in the joints where tendons and ligaments attach to bones is a common feature of ankylosing spondylitis (AS), which can also affect other joints in the lower body. Heel pain is particularly common, and is often caused by enthesitis, inflammation in the areas where tendons and ligaments connect to bones in the heel, ankles and feet.
As well as medication, including NSAIDs and disease-modifying antirheumatic drugs (DMARDs), podiatry can help manage foot problems in AS by providing orthotics. These can be designed to address skeletal imbalances in the feet, which are often linked to instability and poor posture.
For example, people with hyperpronation (flat feet) or overpronation (high arches) tend to have poor shock absorption in the feet and knees which can cause problems in the hips, back and ankles. Orthotics can help improve posture and balance, which reduces foot fatigue and improves function and quality of life. They can also be used to improve gait and prevent injuries. In more severe cases, biologic therapies can be used to slow the progression of ankylosing spondylitis and improve foot function.
Rest
The goal of treatment for ankylosing spondylitis is to reduce pain and stiffness and prevent damage to the spine. This can be done with medications, exercise and lifestyle changes. Treatment is most successful when started before the disease causes irreversible spine damage. Treatment options for AS include nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). These medicines can relieve inflammation, pain and stiffness, but may cause gastrointestinal bleeding in some people.
Symptoms of ankylosing spondylitis usually start in the lower back and hips. They can also involve other joints in the body, such as those in the knees, ankles and shoulders. The disease can cause pain, swelling and stiffness in the sacroiliac joints (where the spine connects to the pelvis).
The most common symptoms are low back or neck pain, especially first thing in the morning, and stiffness that gets worse after exercise or prolonged periods of rest. Some people develop a tight feeling in their chest that makes it hard to breathe deeply. It’s important to see your health care provider if you have these symptoms.