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Rheumatoid Arthritis and Heel Pain: What Is Enthesitis?

Updated on March 09, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Anastasia Climan

If you have heel pain with rheumatoid arthritis (RA), you may be dealing with a condition called enthesitis (inflammation of the entheses). Entheses are the locations where tendons and ligaments, which are responsible for keeping our bones and muscles attached, insert and connect to bone. There are more than 100 entheses in the human body. When the entheses are under chronic stress, they can become inflamed.

Members of myRAteam have described their heel pain in different ways. One said, “My feet and ankles have been hurting so badly today with pain shooting in my Achilles tendon.” Another shared, “I had a great jog and walk today, but now I can’t walk on my foot.” Put simply: “My heel feels broken.”

Here’s a deeper look at enthesitis and how others are coping with heel pain.

Enthesitis Causes

Scientists have various theories about what causes enthesitis, but the specific cause remains a bit of a mystery. A combination of lifestyle and biological factors likely contribute to the development of enthesitis.

Enthesitis is not typically a symptom of rheumatoid arthritis. Enthesitis may occur in people with other autoimmune diseases, particularly spondyloarthropathies. This group of conditions includes:

  • Psoriatic arthritis
  • Reactive arthritis
  • Ankylosing spondylitis
  • Enteropathic arthritis (linked to inflammatory bowel disease)

Research suggests that the prevalence of enthesitis may be similar in people with rheumatoid arthritis compared to those with spondyloarthritis, affecting at least one area detected by ultrasound in 46 percent to 48 percent of people.

Enthesitis may also occur due to mechanical stress, or overuse. Repetitive motion through work or sports can trigger inflammation that resolves when the activity is discontinued. For instance, problems like “tennis elbow” usually go away when the individual takes a break from playing.

Diagnosing Enthesitis

Imaging technology like magnetic resonance imaging and ultrasound can shed some light on the severity and progression of enthesitis. Identifying the problem early can help prevent more severe joint damage. Rheumatologists may use ultrasound to scan the Achilles tendon, interphalangeal joint, and metacarpophalangeal joint to look for changes in the foot that can cause pain and a reduced range of motion.

When entheses are exposed to prolonged biomechanical stressors, the immune system responds by boosting local cytokine production and possibly tumor necrosis factor. Specific genes may also be upregulated in people who are prone to enthesitis. As diagnostic tools continue to improve, early detection of enthesitis may give doctors the upper hand in treating inflammatory arthritis.

Managing Enthesitis Pain

You can take steps to avoid the pain that comes with enthesitis from RA:

  • Proper footwear and rest
  • Specialist care
  • Medication
  • Home remedies

Proper Footwear and Rest

Sometimes, avoiding activity that triggers inflammation may help you avoid symptoms of enthesitis. For people with arthritis who work or spend a lot of time on their feet, it can be tough to find a realistic solution for inflammatory entheses pain in the feet and heels.

Finding the right footwear and avoiding overuse by taking breaks to put your feet up may help. A member said, “Every day starts off with pain in both feet, especially my heel on the left foot. The pain is worse in shoes. But if there’s no weight on my feet, there’s no pain.” Another recommended, “Wear good shoes. Any time we have problems with our feet because of RA, it is hard to deal with. I also wear slippers with adjustable straps.”

Specialist Care

One member wrote, “Does anyone have pain and stiffness in your heels and from the back of your heel? Mine are swollen and it hurts to walk.” Another said that their heel pain meant that they can’t walk very far because their balance is off. In cases like these, you may want to consider seeing an occupational therapist or a podiatrist if heel pain is affecting your overall quality of life or your ability to work, exercise, or perform daily functions.

Medication

Medications and treatments that help with joint pain are likely to also help with enthesitis. Following the medical advice of your health care provider for the effective use of nonsteroidal anti-inflammatory drugs, biologics, and disease-modifying antirheumatic drugs may help improve your symptoms.

Finding the right treatment may take some time and collaboration between you and your health care providers. “I have pain in my feet also, and it seems like it’s taken forever to get the right medication. I’m on leflunomide, which helps somewhat, and I’ve changed doctors. This is my third!” said one member. They continued, “I would stay on top of the doctors, and if you're not feeling better, let them know. It’s a constant battle to find what helps or what to do, but don’t give up. Your health and getting taken care of is the most important thing!”

Home Remedies

With a little trial and error, myRAteam members have been able to find ways to cope at home. One shared, “A hot water and Epsom salt foot soak will help those feet. The soaks are great. Rub in coconut oil afterwards. Vicks salve does wonders also. Be sure to put on some good cotton socks.”

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis, more than 181,00 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you experienced enthesitis from rheumatoid arthritis? Share your story in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anastasia Climan is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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