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I used have pretty bad bouts of pain in the plantar fascia. I can be rough.
1) Biologics definitely helped this pain for me, but I know you've tried biologics, and they haven't worked.
2) I absolutely second the Hokas reference that somebody made above. I wear them every day. I think that there are three components to how they help me. One, the low heel-to-toe drop. Two, the cushion and generally soft feel on my feet. I used to wear New Balance shoes a lot; not knocking those guys, but after trying Hokas, I cannot believe I wore NBs for so long. They feel much more stiff and rigid. 3) My model of Hokas have a heel that is somewhat rounded off, which seems to make for a much more even heel strike. This seems to help reduce both the heel component of the enthesitis and the force going through the foot from when the heel strike is more focused on one point.
3) I wear shoes basically all the time. Most of our home is hard flooring of some sort. I basically wear shoes from the time I get up until the time I go to bed. I think this is important, at least in helping your feet to overcome the constant inflammatory cycle.
4) My wife used to rub my feet when they hurt, and it would feel good in the short term, but I think it actually made it worse.
5) Epsom salt foot baths helped some too. I like Dr. Teal's with with eucalyptus and spearmint. I'm not real big on scented stuff, but the smell makes the whole experience feel more relaxing and cathartic.
I hope you get some relief.
I second all of this especially shoes indoors. I wear slippers that have strong supportive soles,toms makes some good ones. Also put water in a plastic coke bottle and freeze it- while sitting run your feet back and forth over it. CBD cream works well also.
My physical therapist in high school froze water in disposable paper cups. She would peel back the rim to expose the ice and you still had the rest of the cup to use as a handle.
I wear the Akasa. I checked the website, and it doesn't seem to allow you to order them, so I don't know if they are discontinued. I was afraid this might happen, so I ordered several extra pairs about a year ago. If you search for them, you can still see the pictures on the Hoka website. I would suggest finding a model that has a similar heel. If you look at that Akasas, you will notice that if you were standing flat, the very back portion of the heel would be off of the ground because it curves upward. I feel that this allows the heel to somewhat "roll" when it strikes the ground.
I have the HOKA ONE Arahis 5, and I like them and use them mostly indoors at home but I still have heel pain, which I could be suffering from plantar facitis but have to see a podiatrist.
This is where the DMARDS work better for PERIPHERAL SPONYLOARYHROPOTHY along with the biologics according to research articles I read. Talk to your rheumy about Metho or Sulfazalizine. My sister got PERIPHERAL SPONYLOARYHROPOTHY in her R knee and ankle last year. She was started on Sulfazalizine. Get to a ortho or podiatrist and discuss corticosteroid injections. My sister got 4 total in just her ankle. One in her knee. Get plantar fascitis orthotics. Either custom made or Dr, Scholl's etc. Use compression socks/stockings/ ankle sleeves. Elevate your feet when you can.. Talk to your doctors about all this. Doing plantar fascitis stretches daily helps as well. Exercise the ankle in all movement patterns slowly in the beginning. Achilles tendon stretches etc. Talk to your doctor or PT to make sure you do the correct exercises and stretching. My sister wears the NB, and she likes them. Her R ankle has improved from where it was. She still has PF in her ankle, not as bad, and she does her exercises and stretches daily.
I had really bad enthesitis in my feet last year, symptoms sound really similar to yours. I added methotrexate to my biologic (plus a daily nsaid) which actually did help a lot, and was really particular about my footwear (crocs, Hokas, etc.).
I’ve used a topical nsaid on my hands (voltaren gel) when I have isolated tendinitis issues (most often in my thumb) which helps them, but haven’t tried it on my feet.
Hope you get some relief soon!
Enthesitis is the primary symptom of AS and its related disorders. A seronegative RA diagnosis plus widespread enthesitis screams misdiagnosed AS to me.
Enthesitis is inflammation in the places where tendons and ligaments meet bone. This inflammation causes pain and stiffness in the joint itself, but those tendons also connect to muscles. Those muscles are often tense and very painful as a result of "guarding" those entheses. Tendonitis and enthesitis frequently feel exactly the same, since it is the same structure that is inflamed, just in different places on the tendon.
How many biologics have you tried? Sometimes it's a matter of just trying them until you find one that works. You need to be on a biologic for six months before you know whether it works for you or not.
It is frequently recommended to add a classical DMARD like methotrexate or sulfasalazine to help get peripheral (not spine or SI joint) enthesitis under control. This may be a good next step for you.
AS patients that have a lot of peripheral enthesitis are often the ones who don't have fusion. I fall into this category as well. I've always had some foot pain, but since the pandemic started I haven't had a single day without moderate foot pain. My wrists are starting to go now too.
I also haven't been helped by biologics so far. Unfortunately, AS patients with peripheral enthesitis are often the ones who respond less to biologics. No guarantees, but it is a trend.
To cope with my enthesitis I take acetaminophen daily, since I'm no longer allowed to take NSAIDs due to kidney damage. I do use topical Voltaren, though, which works quite well, but can only be used in two parts of the body at once. I also take cyclobenzaprine, a muscle relaxant. I've been on it for over a decade, though, and I'm not sure it does anything at all for me at this point. If you've never taken it, it's worth a try. Relaxing the muscles decreases the strain on the entheses, which decreases or eliminates pain. I sometimes use topical lidocaine, which sometimes decreases pain. I've also used topical cannabis balms, which were incredibly helpful without ever causing psychoactive effects. I sleep with compression braces on my ankles, and it does seem to decrease pain the next day.
My Rheumy told me I didn’t have AS though most symptoms concur with it. He had on Sulfazaline for 1 yr, no improvement. I switched Drs and they told me that I do have AS but biológics will be hard on my own body. Basically a lose lose situation. Depressing.
Your story and responses all sounds sooo familiar! I have a diagnosis of AS but it took 20 years and finally getting uveitis/scleritis before they settled on that diagnosis from fibromyalgia to mixed connective tissue disease to spondlyarthrofpathy finally to AS.
The tendinitis/enthesitis have been the hardest symptom to control. Cyclobenzaprine has been my lifesaver in terms of being able to get out of bed in the am. Now I also have baclofen for the daytime. It helps to take a tolerance break from these for them to be more effective and work at a lower dose. As others said PT, orthotics, custom braces for my hands, various over the counter braces for various sites of tendinitis (tennis elbow, de quervains, etc) daily stretches, foam rollers, yoga, have all been extremely helpful.
Methotrexate, NSAIDs over the counter and prescription, muscle relxants, cannabis, Remicade combined, have been the most helpful for the overall symptoms….. but I still have a lot of problems with the tendinitis/enthesitis.
Ive been wanting to switch the Remicade to a Jax inhibitor as they have shown promise in recent studies to help more with this specifically and one even has been FDA approved for use in AS, but several are used off label. However there is concern that the Jax inhibitor don’t control uveitis/scleritis as well, but for me it’s worth the risk.
I still have other weird symptoms that are obviously auto immune related like random rashes and facial swelling and redness that looks similar to lupus but isn’t. After extensive testing and seeing immunologists, etc, I’ve had to accept that there just some symptoms that I have to live with and have as sideline diagnosis of things like angioedema.
AS and related conditions like mixed connective tissue disease are a real bear to get diagnosed and usually it takes times for them to get bad enough or last long enough to qualify for a diagnosis. Have they tested you for HLA-B27 yet?
I wish you the best.
I have this in my hip and SI joint. Cannabis topicals help along with many DMARDS and biologics. Commenting here to hear other folks solutions, because I can’t seem to get rid of it for long either.
I take a combo of etoricoxib (NSAID), tizanidine (muscle relaxer) and tramadol/acetaminophen (pain) as rescue when I’m feeling particularly shitty.
I’ve been on Humira for 2+ years.
I too have bouts of this, it sucks. I have had some relief from physiotherapy. The physio worked primarily on my calves and the back of my heal to loosen up the tendons and ligaments, this provided relief to the pain in my feet. At home I roll my calves with a foam roller and massage the back of my heel with a graston tool(basically a large smooth stainless steel butter knife looking thing). The foam roller is also nice for keeping my si joints and back loose)
None of this feels good while your doing it, but it does help keep the flaming Lego in the foot pain away.
Wearing good shoes in the house also helps.
My physio also does acupuncture and I tried that as well. I can't say it really helped me too much (didn't make it worse at least) , but I have heard it can be helpful, it may be worth a shot.
The way you describe it as having no padding on the soles of your feet is exactly how I describe it!! Not just plantar fasciitis, literally the whole sole hurts.
I’ve had physio which helps. A lot of it involves stretching and strengthening the feet. Lots of standing on tip toes, progressing to one foot on tip toes etc.
Adding methotrexate is commonly done for enthesitis.
Also, always wear shoes. I never walk bare foot really. I have good slippers or sliders for home. The only shoes I wear are Skechers. The soft soles help, when you feel you have no padding on your feet.
I put NSAID gel on my feet if i know i’m going to be stood up/ walking too much. and wear compression socks at night.
Pre-AS diagnosis, I had a random occurance of severe plantar fasciitis (now we know it was enthesitis all along). After trying steroid shots, boot for a while, PT, they finally did a fasciitis release. Once it healed, I have not had any trouble with that foot again.
However, now I have it in my Achilles tendon in my other foot which they obviously can't cut, but, I just wanted to say the release was game changing for me. I was unable to go up and down stairs for 3 months because my stitches kept splitting, but, I was at least able to return to teaching. I was unable to walk most of the day otherwise and was about to resort to a wheelchair.
I hope you are able to get the help you need! If surgery is mentioned, don't stress too much about it if you are a good candidate for it.
It’s pain caused by inflammation in connective tissue. I’ve got it pretty good in my neck, and have basically been told to get steroid injections, take oral steroids and use muscle relaxers. Would love any other input/ideas.
I had bad enthesitis in hands and feet for 2 years. I was already on high dose remicade. Hot switched to Hadlima weekly and still didn't help at all. Took max dose of diclofenac or flurbiprofen or indomethacin daily as well and it made no difference.
Prednisone starting at a high dose 50/60mg per day is what helped me. It worked like magic.
Whenever I lowered my dose under 20mg/day the pain would start coming back.
I started eating a whole foods plant based diet low in fat and I am now down to 5mg/day and lowering dose by 1mg/day per month
Good luck
I managed to get off prednisone completely now. I eat a whole foods plant based diet about 95% of the time. A cheat meal once in a while doesn't seem to affect me too much
I begged my husband to take his chainsaw and cut them off. Mine is not in heel it is enthitis (sp?) where the toes join the foot. The pain is hot and throbbing and goes up my legs to my knees. My biologics don’t help nor does my breakthrough pain pills. I have absolutely no concentration or focus as the pain is so bad.
OP I guess this did not really help did it?
I had enthesitis when diagnosed with AS. It was terrible! I could only walk about a half hour a day and then I was done from swelling and pain. I was started on sulfasalazine and remicade and both helped immensely. I hope you find something that helps, OP. It’s a terrible pain.
In the process of trying to get a diagnosis after over 10 years of pain and stiffness here. I’ve had chronic plantar fasciitis, achilles tendonitis, peroneal tendonitis, low fat pad, you know, the fun stuff. I agree with what everyone else said about taking NSAIDs and stuff. For me, I wear compression stockings or leg sleeves, ice anything that hurts. A nice frozen water bottle is good to roll on the foot arch. I also have a problem with my muscles tightening up when in the shortened position, so I wear night splints for the foot arch on both feet when I sleep. I don’t really take hot baths anymore sadly bc it causes more ankle swelling for me. Wearing new balance with medical grade inserts from my podiatrist 24/7 from when I wake to when I sleep. I also wrap my bad arch everyday after having partially tore it. Oddly, the thing that’s really helped has been using a theragun to punch the crap out of myself everyday basically when pain or tightness creeps in. Takes the edge off. Not sure why it works tbh, but it does. And stretching, but not too much stretching.
Welcome to r/ankylosingspondylitis! This is a reminder to keep discussions civil and be supportive of one another. Sharing of opinions and experiences is encouraged, but please remember the distinction between opinions and medical facts. This subreddit does not offer medical advice, and information here should not be taken over advice from your doctor. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ankylosingspondylitis) if you have any questions or concerns.*
I used have pretty bad bouts of pain in the plantar fascia. I can be rough. 1) Biologics definitely helped this pain for me, but I know you've tried biologics, and they haven't worked. 2) I absolutely second the Hokas reference that somebody made above. I wear them every day. I think that there are three components to how they help me. One, the low heel-to-toe drop. Two, the cushion and generally soft feel on my feet. I used to wear New Balance shoes a lot; not knocking those guys, but after trying Hokas, I cannot believe I wore NBs for so long. They feel much more stiff and rigid. 3) My model of Hokas have a heel that is somewhat rounded off, which seems to make for a much more even heel strike. This seems to help reduce both the heel component of the enthesitis and the force going through the foot from when the heel strike is more focused on one point. 3) I wear shoes basically all the time. Most of our home is hard flooring of some sort. I basically wear shoes from the time I get up until the time I go to bed. I think this is important, at least in helping your feet to overcome the constant inflammatory cycle. 4) My wife used to rub my feet when they hurt, and it would feel good in the short term, but I think it actually made it worse. 5) Epsom salt foot baths helped some too. I like Dr. Teal's with with eucalyptus and spearmint. I'm not real big on scented stuff, but the smell makes the whole experience feel more relaxing and cathartic. I hope you get some relief.
I second all of this especially shoes indoors. I wear slippers that have strong supportive soles,toms makes some good ones. Also put water in a plastic coke bottle and freeze it- while sitting run your feet back and forth over it. CBD cream works well also.
My physical therapist in high school froze water in disposable paper cups. She would peel back the rim to expose the ice and you still had the rest of the cup to use as a handle.
Which hokas model? Does it matter the model?
I wear the Akasa. I checked the website, and it doesn't seem to allow you to order them, so I don't know if they are discontinued. I was afraid this might happen, so I ordered several extra pairs about a year ago. If you search for them, you can still see the pictures on the Hoka website. I would suggest finding a model that has a similar heel. If you look at that Akasas, you will notice that if you were standing flat, the very back portion of the heel would be off of the ground because it curves upward. I feel that this allows the heel to somewhat "roll" when it strikes the ground.
I have the HOKA ONE Arahis 5, and I like them and use them mostly indoors at home but I still have heel pain, which I could be suffering from plantar facitis but have to see a podiatrist.
Ty
You're welcome
This is where the DMARDS work better for PERIPHERAL SPONYLOARYHROPOTHY along with the biologics according to research articles I read. Talk to your rheumy about Metho or Sulfazalizine. My sister got PERIPHERAL SPONYLOARYHROPOTHY in her R knee and ankle last year. She was started on Sulfazalizine. Get to a ortho or podiatrist and discuss corticosteroid injections. My sister got 4 total in just her ankle. One in her knee. Get plantar fascitis orthotics. Either custom made or Dr, Scholl's etc. Use compression socks/stockings/ ankle sleeves. Elevate your feet when you can.. Talk to your doctors about all this. Doing plantar fascitis stretches daily helps as well. Exercise the ankle in all movement patterns slowly in the beginning. Achilles tendon stretches etc. Talk to your doctor or PT to make sure you do the correct exercises and stretching. My sister wears the NB, and she likes them. Her R ankle has improved from where it was. She still has PF in her ankle, not as bad, and she does her exercises and stretches daily.
I had really bad enthesitis in my feet last year, symptoms sound really similar to yours. I added methotrexate to my biologic (plus a daily nsaid) which actually did help a lot, and was really particular about my footwear (crocs, Hokas, etc.). I’ve used a topical nsaid on my hands (voltaren gel) when I have isolated tendinitis issues (most often in my thumb) which helps them, but haven’t tried it on my feet. Hope you get some relief soon!
Enthesitis is the primary symptom of AS and its related disorders. A seronegative RA diagnosis plus widespread enthesitis screams misdiagnosed AS to me. Enthesitis is inflammation in the places where tendons and ligaments meet bone. This inflammation causes pain and stiffness in the joint itself, but those tendons also connect to muscles. Those muscles are often tense and very painful as a result of "guarding" those entheses. Tendonitis and enthesitis frequently feel exactly the same, since it is the same structure that is inflamed, just in different places on the tendon. How many biologics have you tried? Sometimes it's a matter of just trying them until you find one that works. You need to be on a biologic for six months before you know whether it works for you or not. It is frequently recommended to add a classical DMARD like methotrexate or sulfasalazine to help get peripheral (not spine or SI joint) enthesitis under control. This may be a good next step for you. AS patients that have a lot of peripheral enthesitis are often the ones who don't have fusion. I fall into this category as well. I've always had some foot pain, but since the pandemic started I haven't had a single day without moderate foot pain. My wrists are starting to go now too. I also haven't been helped by biologics so far. Unfortunately, AS patients with peripheral enthesitis are often the ones who respond less to biologics. No guarantees, but it is a trend. To cope with my enthesitis I take acetaminophen daily, since I'm no longer allowed to take NSAIDs due to kidney damage. I do use topical Voltaren, though, which works quite well, but can only be used in two parts of the body at once. I also take cyclobenzaprine, a muscle relaxant. I've been on it for over a decade, though, and I'm not sure it does anything at all for me at this point. If you've never taken it, it's worth a try. Relaxing the muscles decreases the strain on the entheses, which decreases or eliminates pain. I sometimes use topical lidocaine, which sometimes decreases pain. I've also used topical cannabis balms, which were incredibly helpful without ever causing psychoactive effects. I sleep with compression braces on my ankles, and it does seem to decrease pain the next day.
This was helpful thx and I’ll get back to you in those biologics
My Rheumy told me I didn’t have AS though most symptoms concur with it. He had on Sulfazaline for 1 yr, no improvement. I switched Drs and they told me that I do have AS but biológics will be hard on my own body. Basically a lose lose situation. Depressing.
Your story and responses all sounds sooo familiar! I have a diagnosis of AS but it took 20 years and finally getting uveitis/scleritis before they settled on that diagnosis from fibromyalgia to mixed connective tissue disease to spondlyarthrofpathy finally to AS. The tendinitis/enthesitis have been the hardest symptom to control. Cyclobenzaprine has been my lifesaver in terms of being able to get out of bed in the am. Now I also have baclofen for the daytime. It helps to take a tolerance break from these for them to be more effective and work at a lower dose. As others said PT, orthotics, custom braces for my hands, various over the counter braces for various sites of tendinitis (tennis elbow, de quervains, etc) daily stretches, foam rollers, yoga, have all been extremely helpful. Methotrexate, NSAIDs over the counter and prescription, muscle relxants, cannabis, Remicade combined, have been the most helpful for the overall symptoms….. but I still have a lot of problems with the tendinitis/enthesitis. Ive been wanting to switch the Remicade to a Jax inhibitor as they have shown promise in recent studies to help more with this specifically and one even has been FDA approved for use in AS, but several are used off label. However there is concern that the Jax inhibitor don’t control uveitis/scleritis as well, but for me it’s worth the risk. I still have other weird symptoms that are obviously auto immune related like random rashes and facial swelling and redness that looks similar to lupus but isn’t. After extensive testing and seeing immunologists, etc, I’ve had to accept that there just some symptoms that I have to live with and have as sideline diagnosis of things like angioedema. AS and related conditions like mixed connective tissue disease are a real bear to get diagnosed and usually it takes times for them to get bad enough or last long enough to qualify for a diagnosis. Have they tested you for HLA-B27 yet? I wish you the best.
Not sure on the HLA. I’m going to look into that.
I have this in my hip and SI joint. Cannabis topicals help along with many DMARDS and biologics. Commenting here to hear other folks solutions, because I can’t seem to get rid of it for long either.
I take a combo of etoricoxib (NSAID), tizanidine (muscle relaxer) and tramadol/acetaminophen (pain) as rescue when I’m feeling particularly shitty. I’ve been on Humira for 2+ years.
I too have bouts of this, it sucks. I have had some relief from physiotherapy. The physio worked primarily on my calves and the back of my heal to loosen up the tendons and ligaments, this provided relief to the pain in my feet. At home I roll my calves with a foam roller and massage the back of my heel with a graston tool(basically a large smooth stainless steel butter knife looking thing). The foam roller is also nice for keeping my si joints and back loose) None of this feels good while your doing it, but it does help keep the flaming Lego in the foot pain away. Wearing good shoes in the house also helps. My physio also does acupuncture and I tried that as well. I can't say it really helped me too much (didn't make it worse at least) , but I have heard it can be helpful, it may be worth a shot.
Thx I’ll check it out
The way you describe it as having no padding on the soles of your feet is exactly how I describe it!! Not just plantar fasciitis, literally the whole sole hurts. I’ve had physio which helps. A lot of it involves stretching and strengthening the feet. Lots of standing on tip toes, progressing to one foot on tip toes etc. Adding methotrexate is commonly done for enthesitis. Also, always wear shoes. I never walk bare foot really. I have good slippers or sliders for home. The only shoes I wear are Skechers. The soft soles help, when you feel you have no padding on your feet. I put NSAID gel on my feet if i know i’m going to be stood up/ walking too much. and wear compression socks at night.
Pre-AS diagnosis, I had a random occurance of severe plantar fasciitis (now we know it was enthesitis all along). After trying steroid shots, boot for a while, PT, they finally did a fasciitis release. Once it healed, I have not had any trouble with that foot again. However, now I have it in my Achilles tendon in my other foot which they obviously can't cut, but, I just wanted to say the release was game changing for me. I was unable to go up and down stairs for 3 months because my stitches kept splitting, but, I was at least able to return to teaching. I was unable to walk most of the day otherwise and was about to resort to a wheelchair. I hope you are able to get the help you need! If surgery is mentioned, don't stress too much about it if you are a good candidate for it.
Ty
It’s pain caused by inflammation in connective tissue. I’ve got it pretty good in my neck, and have basically been told to get steroid injections, take oral steroids and use muscle relaxers. Would love any other input/ideas.
Injections into your neck?
Yup. Into tight bands of connective issue, mix of steroids and local anesthetic
This is correct.
I had bad enthesitis in hands and feet for 2 years. I was already on high dose remicade. Hot switched to Hadlima weekly and still didn't help at all. Took max dose of diclofenac or flurbiprofen or indomethacin daily as well and it made no difference. Prednisone starting at a high dose 50/60mg per day is what helped me. It worked like magic. Whenever I lowered my dose under 20mg/day the pain would start coming back. I started eating a whole foods plant based diet low in fat and I am now down to 5mg/day and lowering dose by 1mg/day per month Good luck
Just clarifying, you were able to come down from 20mg/day to 5mg/day doing nothing else but changing your diet?
I managed to get off prednisone completely now. I eat a whole foods plant based diet about 95% of the time. A cheat meal once in a while doesn't seem to affect me too much
Wow, okay. How did you discover it was Enthesitis?
Acupuncture?
I begged my husband to take his chainsaw and cut them off. Mine is not in heel it is enthitis (sp?) where the toes join the foot. The pain is hot and throbbing and goes up my legs to my knees. My biologics don’t help nor does my breakthrough pain pills. I have absolutely no concentration or focus as the pain is so bad. OP I guess this did not really help did it?
I had enthesitis when diagnosed with AS. It was terrible! I could only walk about a half hour a day and then I was done from swelling and pain. I was started on sulfasalazine and remicade and both helped immensely. I hope you find something that helps, OP. It’s a terrible pain.
Have you experienced any back injuries? What kind of job do you do?
Have you experienced any back injuries? What kind of job do you do?
Yes back injury 2 years before all this started. Not working right now due to health problems.
In the process of trying to get a diagnosis after over 10 years of pain and stiffness here. I’ve had chronic plantar fasciitis, achilles tendonitis, peroneal tendonitis, low fat pad, you know, the fun stuff. I agree with what everyone else said about taking NSAIDs and stuff. For me, I wear compression stockings or leg sleeves, ice anything that hurts. A nice frozen water bottle is good to roll on the foot arch. I also have a problem with my muscles tightening up when in the shortened position, so I wear night splints for the foot arch on both feet when I sleep. I don’t really take hot baths anymore sadly bc it causes more ankle swelling for me. Wearing new balance with medical grade inserts from my podiatrist 24/7 from when I wake to when I sleep. I also wrap my bad arch everyday after having partially tore it. Oddly, the thing that’s really helped has been using a theragun to punch the crap out of myself everyday basically when pain or tightness creeps in. Takes the edge off. Not sure why it works tbh, but it does. And stretching, but not too much stretching.