Ankylosing Spondylitis is primarily a problem of the spine, but the arthritis there can also cause arthritis in the foot and pain in the heel. The involvement of the spine also means the feet are going to be difficult to reach to provide self care for foot problems.
Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that primarily affects the spine and sacroiliac joints. It falls under the broader category of spondyloarthropathies, which are conditions characterized by inflammation of the joints and entheses (the areas where tendons and ligaments attach to bone). The hallmark feature of AS is inflammation of the axial skeleton, leading to back pain and stiffness, which often begins in late adolescence or early adulthood. Over time, persistent inflammation can cause the vertebrae to fuse, resulting in reduced flexibility and a rigid spine.
The exact cause of ankylosing spondylitis is not fully understood, but genetic factors play a major role. A strong association exists with the HLA-B27 gene, which is found in the majority of patients, although not everyone with this gene develops the condition. Environmental triggers, such as infections, may also contribute by activating the immune system in genetically predisposed individuals. Men are more commonly affected than women, and symptoms often present gradually rather than suddenly, which can delay diagnosis.
Clinically, the main symptoms include chronic lower back pain, stiffness that improves with exercise but not with rest, and reduced range of motion in the spine. Extra-articular manifestations are also common, such as inflammation in the eyes (uveitis), cardiovascular complications, and, less frequently, lung and gastrointestinal involvement. As the disease progresses, spinal fusion can lead to a characteristic stooped posture, sometimes referred to as a “bamboo spine” on imaging studies.
Treatment for ankylosing spondylitis focuses on controlling inflammation, relieving symptoms, and preserving mobility. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line therapy, while more severe or refractory cases may require biologic agents such as tumor necrosis factor (TNF) inhibitors or interleukin-17 (IL-17) inhibitors. Physical therapy and regular exercise are critical in maintaining posture and spinal flexibility. While there is no cure, early diagnosis and appropriate management can significantly improve quality of life and slow the progression of structural damage.
Most Useful Resources:
Ankylosing Spondylitis (PodiaPaedia)
Ankylosing spondylitis (Foot Health Forum)
Heel Pain and Ankylosing Spondilitis ? (Podiatry Experts)
Impaired Gait in Ankylosing Spondylitis (Podiatry Arena)
Tarsal involvement in ankylosing spondylitis (Podiatry Arena)
Ankylosing spondylitis (Podiatry Arena)