Heel Pain

Reviewed by: HU Medical Review Board | Last reviewed: February 2019 | Last updated: November 2021

One of the areas of the body that can be affected by ankylosing spondylitis (AS) is the heel, causing significant pain and tenderness that can impact a person's ability to walk.

Foot pain from AS

In addition to the joints, 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. Both the Achilles tendon (at the back of the heel) and the plantar fascia (at the base of the heel and sole of the foot) can become inflamed, causing sharp pain and difficulty walking.1

Insertional achilles tendonitis

Inflammation in the Achilles heel is called insertional Achilles tendonitis. Symptoms of insertional Achilles tendonitis include pain at the back of the heel, redness, swelling at the back of the heel, pain during weight-bearing activities (like walking), and/or a bony bump at the back of the heel. Treatment for inflammation of the Achilles tendon may include2:

  • Gentle calf stretches
  • Insoles or orthotics
  • Corticosteroid injection
  • Supportive footwear that doesn't irritate the tendon
  • Treatment of the underlying AS condition with medications such as corticosteroids, DMARD's or biologics

Plantar fasciitis

Inflammation in the plantar fascia is called plantar fasciitis. Inflammation of this thick band of connective tissue is a common complaint among people with different types of inflammatory arthritis and can cause symptoms such as pain in the arch of the foot, pain under the heel, pain which is worse in the morning and during the first few steps after inactivity, and pain that worsens with long periods of standing or walking. The sensation of plantar fasciitis can range from mild discomfort to excruciating pain.2,3

Treatment for plantar fasciitis may include2,3:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Ice
  • Stretching the foot by pulling up on the toes or doing gentle ankle rolls
  • Taping of the foot
  • Night splints
  • Insoles or orthotics
  • Corticosteroid injection

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