Your Feet

This information is for anyone with axial spondyloarthritis (axial SpA), including people with ankylosing spondylitis (AS)

The average person walks about 70,000 miles in a lifetime – 4 times around the world

Most of the time we take for granted that this will happen without any trouble and that our feet will do exactly what we want, when we want them to. But this isn’t always the case. Throw into the mix pain in your feet or elsewhere in your body and things start to change.

Your body is very good at changing the way you move if a certain area becomes painful. A small but uncomfortable blister under your right foot becomes painful after a mile of walking. This leads you to spend more time on your left leg, resulting in pain in either your left knee or back. This is because your gait (walking) pattern has changed, and you are using muscles and joints in different ways.

Axial SpA and foot problems

Just because you have axial SpA doesn’t mean you will develop foot problems – but there are a few foot problems that seem to be more common.

Plantar fasciitis

Also known as ‘policeman’s heel’ it causes inflammation at the site where the plantar fascia (a soft tissue structure under the foot) attaches to the heel bone. The most common symptoms are:

• Pain under the heel – often towards the inside of the heel and/or the arch
• Worse first thing in the morning and during your first steps after sitting
• May be worse after long periods of standing or walking
• Pain can vary from mild discomfort to excruciating pain

There is a lot that can to help. A physiotherapist or podiatrist is the best source of help. One of the most important things to do is calf stretches as tight calves often cause or worsen this condition. Other treatments include:

• Plantar fascia stretching
• Taping of the foot
• Night splints
• Cortisone (steroid) injection
• Insoles or orthotics (bespoke insoles)
• Change of footwear – trainers are often a great choice.
• Being overweight can cause or worsen the condition so weight loss can help

Insertional Achilles tendinitis

This is inflammation where the Achilles tendon attaches to the back of the heel bone. The most common symptoms are:

• Pain at the back of the heel
• Back of the heel is red and swollen
• Painful when doing weight-bearing activity – such as walking
• Bony bump may develop at the back of the heel called a Haglund’s bump, as well as a bursa (fluid filled sac)

Tight calf muscles can worsen the condition so gentle calf stretches need to be carried out. Other treatments include:

• If the pain is very severe then a heel raise may be necessary at first to offload the tendon on the heel bone.
• Insoles or orthotics may be used to alter any foot function anomalies and sometimes more specific exercise plans can help
• If the bursa is the main problem then a cortisone injection can sometimes be useful
• Supportive footwear which doesn’t irritate the back of the heel

Cramping and toe clawing

Cramps and clawing of the toes can occur in people with axial SpA. If your posture has changed due to pain or fusion in the spine then the loading through your legs and feet will change. Muscles which are now being used more or just differently can be more prone to spasms.

If you have a forward curve of your spine then you may notice your toes clawing in an attempt to gain stability from falling over. If your spine is fused in this way (particularly your upper spine) then often your knees will be in a flexed position helping you to stand more upright. This can cause shortening of one of the calf muscles and sometimes knee pain.

Your GP can help with medication for cramps. It is also worth asking for a referral to a podiatrist or physiotherapist to check for any muscle imbalance and foot function problems which may be helped by exercise plans and insoles or orthotics.

Footwear

Ideally you need to be wearing footwear with good shock absorbency to reduce jarring through the joints, particularly the spine. Trainers are obviously great for this but they aren’t always a practical option. Insoles, such as those by Sorbothane, are excellent at shock absorbing and can be put into most good footwear. They can be bought from good sports shops, especially those that specialise in running, as they are often used for shin splints.

Help and support

Podiatrists can help with all of these conditions and give lots of advice. Podiatrists are trained to do vascular and neurological assessments, nail surgery, biomechanical assessments, provide orthotics, insoles and exercise plans and wound care.

The route to getting referred to a podiatrist varies across the UK. Some NHS podiatry departments have a self-referral system whereas others only accept referrals from other health care professionals such as your GP or physiotherapist. It is worth calling your local podiatry department or GP surgery to find out. If you decide to go privately, do ensure that your podiatrist is HPC (Health Professions Council) registered. You can find a list of private podiatrists and more advice at the Royal College of Podiatry website.

Learn more about how axial SpA can affect your feet

The Royal College of Podiatry have worked with patient organisations including NASS, other paprofessional bodies, leading clinical experts, and a team of international academics to produce a suite of five information resources for people living with arthritis.

With Dr Lindsey Cherry, Senior Clinical Academic Podiatrist at University of Southampton and Solent NHS Trust.

You can also read more on the Royal College of Podiatry information pages.

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