Ankylosing spondylitis is a type of chronic inflammatory arthritis. This condition occurs when the immune system mistakenly attacks healthy tissues — especially the joints — causing pain and stiffness. The inflammation often affects the lower body, and the heel of the foot is one of the most common problem areas.

“I’ve been dealing with heel pain since my early 20s,” a MySpondylitisTeam member said. “It turns out heel pain and Achilles enthesitis were early symptoms of my ankylosing spondylitis.”

The points where tendons and ligaments attach to bone are called the entheses. When these areas become inflamed, it’s called enthesitis. If you have ankylosing spondylitis, ongoing heel and foot pain can affect your quality of life. Learning how to manage this symptom can minimize further damage and help you feel your best.

1. Avoid High-Impact Movements

Studies show that repetitive movements on commonly affected joints can cause damage in people with ankylosing spondylitis. Staying off your feet isn’t always realistic — or healthy — but choosing low-impact exercises can help protect your joints. Instead of running or jumping, try gentler activities such as water aerobics, swimming, or biking.

“Swimming or water therapy is excellent for AS,” shared one MySpondylitisTeam member. “Floating in the water takes the stress off joints. It is important that the water is not cold — that just increases discomfort! Years ago, I used to use two empty bleach bottles as flotation devices and just gently kick myself around the pool or tread water. I have also had professional water therapy.”

2. Meet With a Physical Therapist

Most people with ankylosing spondylitis can benefit from physical therapy. A trained physical therapist can teach you safe ways to stay active and avoid movements that might worsen symptoms. They can also show you how to tape your foot for extra support or suggest gentle stretches for the plantar fascia (the tissue along the bottom of the foot) to help ease pain. Ask your doctor for a referral to a physical therapist who can help you build a personalized routine.

3. Take Medication That Works for You

International spondylitis groups recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as an important part of managing ankylosing spondylitis. These drugs help reduce pain and inflammation in the short term and may also slow ankylosing spondylitis-related bone changes over time. NSAIDs can cause gastrointestinal side effects in some people, so your doctor might also recommend other medications to protect your stomach.

However, NSAIDs don’t work well for some people with ankylosing spondylitis. For these people, known as nonresponders, targeted therapies that block specific immune system pathways are more effective. New biologics and disease-modifying drugs (DMARDs) are being developed to help manage autoimmune conditions like ankylosing spondylitis.

4. Get Custom Orthotics

Foot pain from ankylosing spondylitis may feel worse if you also have issues with your foot structure or the way you walk. A podiatrist can design custom inserts that make your shoes more comfortable and help spread pressure more evenly across your foot.

“I saw a foot doctor once, and he gave a prescription to the person who makes custom shoe inserts,” one member said. “I always bring a new pair of New Balance shoes, and he makes a custom insert. I walk around for 30 minutes, he checks my shoes, and I’m released. I can put shoe inserts in other shoes. I also have one insert for dress shoes.”

5. Rest During Flare-Ups

If you’re in the midst of an ankylosing spondylitis flare, your doctor may encourage you to rest your foot so it can heal. Using crutches or a cane can remove pressure and give your foot a break from additional stress. Applying ice may ease swelling. If rest and ice aren’t enough, your doctor might recommend a stronger treatment, like a corticosteroid injection directly into the affected area.

Tips From MySpondylitisTeam Members

Not every treatment works for everyone with spondylitis, and you should always check with your doctor before trying something new. Still, it can be helpful to hear how others manage ankylosing spondylitis symptoms. Just knowing you’re not alone can be encouraging.

One member of MySpondylitisTeam follows a soothing bath routine to help with joint pain: “Soaking in a hot bath with 1 cup of Epsom salt and 1 cup of vinegar helps more than you would expect. I add a little bath oil to my water as the others are drying on my skin, and I feel like the oil helps my joints. Adding essential oils such as lavender, chamomile, peppermint, and eucalyptus helps, too.”

You have choices when it comes to managing foot pain and other ankylosing spondylitis symptoms. If your current treatment isn’t working, talk with your rheumatologist (a specialist in diseases that affect the joints, muscles, bones, and immune system). They might suggest options such as:

• Participation in a clinical trial
• A new medication
• A surgical procedure
• Therapeutic injections

It can take some trial and error to find the best way to keep your condition under control. Even if your plan works for a while, it may need to be adjusted if your ankylosing spondylitis progresses. By working with your doctor, you’ll find the care and relief you deserve.

Talk With Others Who Understand

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

How does joint pain affect your daily life? Have you found effective ways to reduce disease activity in the back of the heel or Achilles tendon? Share your experience in the comments below, or start a conversation by posting on your Activities page.