Many people think that Ankylosing Spondylitis, or AS for short, is a condition that only affects the spine, causing pain and stiffness. That's true, the main effect of this disease is on the spine. But did you know that about one in three AS patients can also have problems in other parts of the body, especially in the feet? Yes, this condition can cause stiffness and pain in places like your ankles, heels, toes, or the soles of your feet. Sometimes this pain is minor, but for some people it can be so severe that they can't even walk. So today, let's talk about the effects of AS on the feet.
What problems can AS cause in the feet?
Ankylosing spondylitis (AS) can affect your feet in a variety of ways. The main cause is inflammation in the joints and where tendons and ligaments attach to bones (called `entheses`). Simply put, the body's immune system attacks these areas. Here are some of the main problems that can result from this inflammation.
| Foot condition | Simply put, this is what happens. |
|---|---|
| Plantar Fasciitis | Plantar fasciitis is a swelling of the thick band of tissue on the bottom of your foot that connects your heel bone to the base of your toes. This causes severe pain in the bottom of your foot and heel when you step on the ground or put weight on it. Some people experience pain so severe that they can't even take the first step out of bed in the morning. The pain usually subsides within 5-10 minutes. |
| Achilles Tendonitis | The Achilles tendon, the largest tendon in the back of the leg, above the heel bone, is swollen. This is what helps us lift our heels when we walk and run. When this becomes swollen, the back of the heel and the heel area become painful and stiff. Sometimes, you can even see swelling and lumps in that area. |
| Toe Dactylitis | When AS affects the toes, the toes become swollen and red. The condition is also called "sausage digits" because the swollen toes look like sausages. This can be very painful. Sometimes the pain goes away, but the swelling may persist. |
| Change in walking posture | Due to pain and stiffness in the back and various parts of the body, we unconsciously change the way we walk, sit, and stand to avoid the pain. This puts extra strain on the leg muscles, which can lead to pain and lameness in the legs. |
The most important thing is, if you have AS and start experiencing new pain in your feet, don't ignore it. Be sure to tell your doctor about it.
How to control leg pain caused by AS?
The best ways to reduce foot pain and stiffness are to do the same things you do to manage your AS. The treatment your doctor recommends will depend on many factors, including the severity of your symptoms and your overall health. A typical treatment plan may include:
Exercise, Physical Therapy, and Posture Training
These can help reduce pain and stiffness, prevent joint damage, and improve your posture. Your exercise plan will likely include low-impact workouts that don't put too much strain on your joints. Mind-body exercises like tai chi and yoga can also help you relax and reduce pain.
Most importantly: Before starting any exercise program, be sure to talk to your doctor for advice. He or she will tell you what exercises are best for you.
Medications
Your doctor may prescribe medications such as these to reduce swelling and control pain and stiffness:
- Non-steroidal anti-inflammatory drugs (NSAIDs): Examples of these include drugs like ibuprofen and naproxen.
- Glucocorticoid injections: These are steroid injections given directly into the painful joint.
- Disease-modifying anti-rheumatic drugs (DMARDs): Drugs such as sulfasalazine and methotrexate.
- Biologic drugs: These are newer drugs that target specific parts of the immune system. Examples include drugs in the classes of anti-TNF, anti-interleukin 17, and JAK inhibitors (such as `infliximab`, `adalimumab`, `secukinumab`, `tofacitinib`).
- Painkillers (Opioids): Can be given for a very short period of time for severe pain.
Sometimes your doctor may refer you to a podiatrist , who can advise you on shoes, taping, and orthotics that are specific to your foot problem.
What things can you do at home?
Along with the treatment provided by your doctor, you can greatly reduce this foot pain with a few simple things you can do at home.
- Apply ice: Apply an ice pack to the painful area about four times a day, for about 20 minutes at a time. This will reduce swelling and pain.
- Give it a break: Give your legs a break whenever possible. It's even better if you can keep them elevated.
- Balance your exercise: Limit high-impact exercises like running and jumping as much as possible. However, that doesn't mean sitting in one place all day. Doing so can increase stiffness and pain. Something like brisk walking is good.
- Do stretches: Do simple stretches that are good for your hips, ankles, and toes.
- For plantar fasciitis: Place a tennis ball under the sole of your foot, sit in a chair, and roll it.
- For Achilles Tendonitis: Stand facing a wall, bend one leg at the knee, and place the painful leg straight behind you, with your heel on the floor. Now push your hips toward the wall. Hold until you feel a stretch in your hamstring area, then stop. Do this, and stop if the pain increases.
- Wear proper shoes: Avoid walking barefoot and wearing sandals as much as possible. It is important to wear shoes with good arch support and cushioned soles , especially good athletic shoes.
Take-Home Message
- Ankylosing spondylitis (AS) is not just a disease of the spine. It can also cause pain and other problems in your feet.
- If you have new pain, swelling, or stiffness in your feet, heels, or toes, don't ignore it. It could be part of AS.
- Be sure to talk to your doctor about this. He or she will provide you with the right treatment and advice.
- This pain can be largely controlled by exercising as directed by your doctor, using simple home treatments (icing, stretching), and wearing appropriate shoes.
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