The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis.

Abstract

SUMMARY This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus.

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

“…11,40 Further, patients who suffer from systemic inflammatory arthritis (eg, rheumatoid arthritis, psoriatic arthritis, and reactive arthritis) may exhibit signs and symptoms consistent with Achilles tendinopathy. 39 However, symptoms and signs in these cohorts are typically confined to the insertion. 104 …”

Does Painful Heels in Ankylosing Spondylitis Demonstrate Distinctive Features on Plain Radiographs: A Study of 104 Cases

“…In those studies, it was noted that 17% to 58% of patients with AS had radiographic changes in their heels [1,9] and some radiographic alterations were seen in the absence of local symptoms [8,11]. However, there is no information about the incidence and pattern of abnormal findings in symptomatic heels in AS patients.…”

“…Plain radiography is primarily and commonly used to evaluate chronic inflammatory and degenerative joint diseases [7]. There are, however, few examples of radiographic studies of the heel in AS [1,4,8,9]. Previous studies employing plain radiography of the heel in AS have used conventional film radiography and involved mostly asymptomatic heels so that comparable findings for painful heels are, to the best of our knowledge, not available [4,8,9].…”

“…Enthesitis is defined as inflammation at the bony interfaces of ligaments, tendons, aponeurosis, annulus fibrosus and joint capsules [3]. Because many of such structures originate from, are inserted in, and also pass alongside the calcaneus, heel pain is frequent peripheral symptom in AS patients from enthesitis of inferior and posterior calcaneus [1,4,5].…”

“…Heel pain is a common symptom in the foot and ankle region, with many different causes that need to be distinguished by differential diagnosis [1]. Among them is ankylosing spondylitis (AS), in which enthesitis of the heel is common and occasionally is responsible for their initial symptom to seek clinics [2].…”