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Ankylosing Spondylitis

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Icon not found What is ankylosing spondylitis?
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What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a form of inflammatory arthritis that affects the spine and sacroiliac joints, which link your pelvis with the lower spine. ‘Ankylosing’ translates to joints becoming stiff or fusing, while ‘spondylitis’ refers to the spine.

What Are The Symptoms Of Ankylosing Spondylitis?

The symptoms of ankylosing spondylitis typically appear between the ages of 20-45 years. For women, many of the first signs of ankylosing spondylitis develop during pregnancy. Symptoms can include: 

• Ongoing back pain, which may be worse in the morning and the middle of the night
  
• Back stiffness, that may improve with exercise
  
• Inflammation
  
• As the condition progresses and worsens, the spine may also curve
  

Interestingly, ankylosing spondylitis can also cause inflammation, pain and stiffness in other areas of the body too, ranging from the shoulders to the hips to the feet. Specifically in the feet, we may notice:

• Plantar heel pain or Achilles tendonitis symptoms in up to one-third of those with ankylosing spondylitis
  
• Enthesitis: inflammation of the site where tendon attaches to bone
  
• Synovitis at the metatarsophalangeal joints
  
• Deviation of the lesser digits of the foot (like in rheumatoid arthritis, but less severe)
  
• Small foot joint stiffness or fusion
  
• Reduced stride length
  
• Decreased knee and hip flexion
  

What Causes Ankylosing Spondylitis?

The exact cause of ankylosing spondylitis is not well understood, but the involvement of genetic (hereditary) factors has been linked in studies. Specifically, it has been linked to having a gene called HLA-B27, even though the gene is also present in those without this condition too. Ankylosing spondylitis has also been linked to Crohn’s disease and bowel inflammation.

Ankylosing Spondylitis Diagnosis

Diagnosing ankylosing spondylitis involves a comprehensive assessment, a review of family history, and medical imaging to assess the integrity of the spine. This is done by your GP or rheumatologist. If ankylosing spondylitis is confirmed, it’s important to further study other pains or problems you may be experiencing, including that of the feet. This is where our podiatrists will evaluate your lower limb pain and symptoms in light of your diagnosis.

Ankylosing Spondylitis Treatment Options

Treatment focuses on improving your comfort, reducing your pain levels, and optimising your quality of life so you can continue to perform daily activities as comfortably as possible. 

The first step is to get a formal diagnosis - being diagnosed early and starting care can help slow the progression of the disease, control your inflammation, and reduce the damage to your spine. Treatment options for ankylosing spondylitis include:

• Medications: ranging from pain relievers and anti-inflammatories to disease-modifying drugs to manage your symptoms
  
• Exercise: controlled, regular exercise is essential to maintain movement of the spine and strengthen back and neck muscles. A good option if you’re first starting exercise is swimming as the water supports your weight. Stretching exercises can also help reduce stiffness and increase flexibility
  
• Physical therapy: targeted physical therapy can help alleviate pain, increase spinal mobility and functional capacity, reduce morning stiffness, correct postural deformities, increase mobility and improve the psychosocial status of those affected
  
• Postural support: as there is a tendency for spinal curvature with ankylosing spondylitis, it’s important to focus on your posture, keeping your bodyweight balance between both feet and your neck straight and long. If working at a desk job, ensure you take stretching and movement breaks at least hourly.
  

Podiatry Treatment For Ankylosing Spondylitis

Our podiatry team is experienced in working with those with ankylosing spondylitis to manage the effects of the condition on the feet and lower limbs. This includes providing appropriate and timely management for conditions including plantar fasciitis, insertional Achilles tendonitis, toe clawing, and more. To do this, we may use:

• MLS laser to help reduce your pain and promote healthy function
  
• Custom prescribed foot orthotics to best support your feet and heels, reducing the strain on the plantar fascia and allowing it to heal
  
• Lower limb strengthening and stretching exercises to help support good function and mobility
  
• Dry needling of surrounding soft tissue structures to release tension in the muscles, by targeting trigger points
  
• Foot mobilisation to mobilise the joints and bones of the foot and ankle, address any stiff and dysfunctional joints and help to restore support movement and flexibility
  
• Footwear recommendations and modifications: your footwear can play an important role in helping keep you comfortable on your feet, and we’ll help you find the best shoes for your foot type and symptoms. We also offer custom footwear modifications such as a rocker bottom sole to overcome gait-related challenges and support an efficient gait style.
  

Living With Ankylosing Spondylitis

While there is no cure for ankylosing spondylitis, there is a lot that can be done with conservative (non-surgical) management to support your comfort, movement and quality of life. The earlier you are diagnosed, the better.

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