Category: Rheumatology

Fibromyalgia and the Foot

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Fibromyalgia is a miserable chronic pain condition that affects the whole body including the foot.

Fibromyalgia is a chronic condition characterized primarily by widespread musculoskeletal pain, accompanied by fatigue, sleep disturbances, memory issues, and mood disorders. It’s classified as a central sensitization syndrome, meaning that the brain and spinal cord process pain signals abnormally, often amplifying sensations that wouldn’t typically cause discomfort. This heightened sensitivity can make everyday activities feel painful or exhausting, even when there’s no obvious injury or inflammation present.

While the exact cause of fibromyalgia remains unclear, researchers believe it results from a complex interplay of genetic, environmental, and psychological factors. Many individuals report the onset of symptoms following a physical trauma, surgery, infection, or significant psychological stress. Genetics appear to play a role too — fibromyalgia tends to run in families, suggesting a hereditary predisposition. Neurotransmitter imbalances, especially involving serotonin, norepinephrine, and dopamine, are also suspected to contribute to the disorder’s impact on pain perception and emotional regulation.

Diagnosing fibromyalgia can be tricky, mainly because its symptoms mimic those of other conditions like chronic fatigue syndrome, rheumatoid arthritis, or lupus. There’s no definitive lab test for it; diagnosis usually hinges on clinical evaluation and ruling out other illnesses. The American College of Rheumatology’s criteria include a widespread pain index (WPI) and symptom severity (SS) scale, with symptoms persisting for at least three months. Patients often experience what’s referred to as “fibro fog” — a cognitive impairment that affects memory, focus, and mental clarity.

Managing fibromyalgia is a long-term, multidisciplinary effort. There’s no cure, but symptoms can be controlled through a combination of medication, lifestyle adjustments, physical therapy, and psychological support. Medications like duloxetine, pregabalin, and low-dose antidepressants are commonly used to manage pain and mood. Regular low-impact exercise, such as swimming or yoga, often helps improve function and reduce symptoms over time. Just as crucial are stress-reduction techniques like mindfulness, cognitive behavioral therapy (CBT), and good sleep hygiene — all of which can significantly improve quality of life for those living with fibromyalgia.

Most Useful Resources:
Fibromyalgia and the Foot (PodiaPaedia)
Fibromyalgia and Heel Pain (Podiatry Arena)
Fibromyalgia (Foot Health Forum)
Fibromyalgia (Podiatry TV)
Have you got fibromyalgia? (Miracle Cures)
Fibromyalgia Forums (Forum Finder)
A cure for fibromyalgia …. not (Sunday Soapbox)

Foot Problems in Ankylosing Spondylitis

Posted on by Staff

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)