Ankylosing spondylitis (AS) is a type of chronic inflammatory arthritis. In ankylosing spondylitis, the body’s immune system attacks healthy tissues, like the joints, causing pain and stiffness. Inflammation commonly affects the lower body, and the heel of the foot is one of the most common problem areas.

“I’ve been dealing with heel pain since my early 20s,” said a MySpondylitisTeam member. “It turns out heel pain and Achilles enthesitis were early symptoms of my ankylosing spondylitis.”

The connecting points between bones with tendons and ligaments are called the entheses. Enthesitis is the condition that occurs when this area becomes inflamed. If you’re like most people with ankylosing spondylitis, foot pain is an ongoing issue that affects your quality of life. Learning strategies to manage it can minimize further damage and help you feel your best.

1. Avoid High-Impact Movements

Studies show that repetitive movements on commonly affected joints can cause damage in people with ankylosing spondylitis. It’s not always possible or desirable to stay off your feet, but you can choose to do lower-impact exercises rather than pound the pavement with running or jumping. Try water aerobics, swimming, bicycling, or other activities that aren’t as hard on your joints.

One MySpondylitisTeam member suggested, “Swimming or water therapy is excellent for AS. Floating in the water takes the stress off of joints. It is important that the water is not cold — that just increases discomfort! Years ago, I used to use two empty bleach bottles as flotation devices and just gently kick myself around the pool or tread water. I have also had professional water therapy.”

2. Meet With a Physical Therapist

Most people with ankylosing spondylitis can benefit from physical therapy, which can help them find safe and beneficial ways to stay physically active. It’s important to learn how to perform exercises in the correct way to avoid further harm. A physical therapist can also show you how to wrap your foot in athletic tape for support or how to gently stretch the plantar fascia (the tissue at the bottom of the foot) to help relieve some of the pain. Ask your doctor for a referral to a physical therapist who can help you learn new exercises to add to your routine.

3. Take Medication That Works for You

International spondylitis groups recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) as a fundamental component of condition management. These drugs help reduce pain and inflammation in the short term and also help prevent AS-related bone changes over time. NSAIDs frequently cause gastrointestinal side effects, so talk to your doctor about other medications to protect your stomach. Applying a cream with NSAIDs to the painful area can also help relieve discomfort.

However, besides causing side effects, NSAIDs don’t work well for some people with ankylosing spondylitis. For these people, known as nonresponders, targeted therapies that block specific immune system pathways are more effective. New biologics and disease-modifying drugs (DMARDs) are being developed to help people with autoimmune conditions like ankylosing spondylitis.

4. Get Custom Orthotics

Foot pain can feel worse if you also have an underlying problem with the structure of your foot or the way you walk. A podiatrist can design specialized inserts that make your shoes more comfortable and adjust the pressure on your foot.

“I saw a foot doctor once, and he gave a prescription to the person who makes custom shoe inserts,” one member said. “I always bring a new pair of New Balance shoes, and he makes a custom insert. I walk around for 30 minutes, he checks my shoes, and I’m released. I can put shoe inserts in other shoes. I also have one insert for dress shoes.”

5. Rest During Flare-Ups

If inflammation is particularly painful, your doctor may encourage you to try resting your foot first. Using crutches or a cane can remove pressure and give your foot a break from additional stress. You can also try applying ice to reduce inflammation. However, if this isn’t helping, you may need a stronger intervention, like a corticosteroid injection to the affected area.

Tips From MySpondylitisTeam Members

The same treatments don’t always work for everyone with spondylitis, and you should always talk to your doctor rather than follow medical advice from someone else. However, it’s helpful to hear how others with ankylosing spondylitis experience and manage symptoms. Even just knowing that someone else is dealing with the same problems can provide some comfort.

One member of MySpondylitisTeam adds ingredients to bathwater to help with joint pain. “Soaking in a hot bath with 1 cup of Epsom salt and 1 cup of vinegar helps more than you would expect,” they shared. “I add a little bath oil to my water as the others are drying on my skin, and I feel like the oil helps my joints. Adding essential oils such as lavender, chamomile, peppermint, and eucalyptus help too.”

It’s important to remember that you have options for managing foot pain and other AS symptoms. If your current treatment plan isn’t helping, talk to your rheumatologist. They may suggest participating in a clinical trial, trying a new medication, scheduling a surgical procedure, or getting therapeutic injections.

It can take some trial and error to find the best way to keep your condition under control. Even if one plan works for a while, you may need to change it if your ankylosing spondylitis progresses. You should never stop searching for solutions to the issues that interfere with your everyday life.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 97,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

How does joint pain affect your daily life? Have you found effective ways to reduce disease activity in the back of the heel or Achilles tendon? Share your experience in the comments below, or start a conversation by posting on your Activities page.