Heel pain, another painful pain of ankylosing spondylitis

When it comes to ankylosing spondylitis, most people tend to think of low back pain
.
However, ankylosing spondylitis is a disease with complex etiology and symptoms, in addition to the common sacroiliac joint, spinal joint pain, seemingly unrelated heel pain, is also one of the manifestations of ankylosing spondylitis, and many patients with ankylosing spondylitis also have heel pain as the first symptom
.
Heel pain caused by ankylosing spondylitis is unexplained pain in the heel area, with or without swelling, can be unilateral or bilateral, no redness and swelling on the surface, skin temperature, skin color is mostly normal, often have multiple repeated attacks or long periods of no relief
.

After repeated attacks, the heel enlarges, the touch is harder, there is a sense of "tendons", often manifested as pain and swelling at the tendon attachment point, the heel is the attachment point of the gastrocnemius muscle tendon (ie Achilles tendon) on the back of the calf, the gastrocnemius muscle is the main muscle of the body, the Achilles tendon is also the toughest and thickest tendon in the human body, and the pathological change of ankylosing spondylitis is inflammation around the tendon end, so the thick Achilles tendon is easily affected
.

Although ankylosing spondylitis is a rheumatism that mainly invades axial joints such as sacroiliac joints and spine, tendon end enthesitis is its basic pathological change, and tendon end attachment point is often the first site
of ankylosing spondylitis.

Human tendon end attachment points are widely distributed, not only limited to sacroiliitis, but also tendon end enthesitis in the limbs, such as the biceps tendon of the upper limbs, the triceps tendon, the scapular spinatus tendon, the quadriceps tendon of the lower limb, the foot Achilles tendon, etc
.

Some scholars have conducted pathological research on the occurrence and development of tendinitis, and found that the early manifestation is inflammation of the tendon end dominated by lymphocyte and plasma cell infiltration, and then erosion of the tendon end, inflammation and edema of the bone marrow nearby, and then granulation tissue hyperplasia, destruction of bone cancellous, granulation tissue fibrosis
.
Due to inflammatory stimulation, excessive bone production occurs, and the new bone tissue not only fills the bone defect, but also extends to nearby ligaments, tendons, and joint capsules, forming osteophytes
.
When osteophytes exist for a long time, and the root bone with osteophytes bears too much weight for a long time, it causes local congestion and aseptic inflammation, which stimulates the nerves in the lesion site and produces pain
.
There are many causes of heel pain, such as rapid and slow injury caused by exercise, postpartum, bone hyperplasia in the elderly, fasciitis, infection, etc.
, so it is necessary to determine whether heel pain is caused by tendinitis of ankylosing spondylitis
.
For patients with a family history of ankylosing spondylitis and frequent symptoms such as heel pain, it is necessary to see a doctor as soon as possible to improve HLA-B27, sacroiliac joint and spinal joint CT or MRI to diagnose
as soon as possible.

Wear heeled shoes: Rigid patients are not suitable for wearing high heels, but patients with heel pain symptoms cannot wear flat shoes, and it is recommended to wear flat shoes
with 3 to 5 cm high heels.

Reduce weight loading: Try not to walk long distances and take short breaks for a while
.

Soak feet with hot water: When rigid patients have symptoms of heel pain, they can soak their feet with hot water, and hot water foot soaking has the effect
of relieving pain.
After soaking your feet in hot water, you can massage the heels with your thumbs and fingertips, which can also relieve pain
.

Active treatment: Heel pain can be treated with physiotherapy and pharmacotherapy, physical therapy can be combined with massage and adjuvancing, and pharmacotherapy with nonsteroidal anti-inflammatory drugs can also have the effect
of controlling heel pain.