Coping with... ENTHESITIS

Plantar fasciitis is one of the most common types of enthesitis – inflammation of the connection points where tendons or ligaments join the bone

- Dr Gill Jenkins

Tendons attach muscles to bones, ligaments attach bones to one another, and where a tendon or ligament meets the bone is an enthesis. Enthesitis occurs when they become inflamed and painful because of injury, overuse or disease.

There are many different types of enthesopathies, the conditions leading to enthesitis. Some are systemic illnesses, some types just defined by the area they affect, such as plantar fasciitis, Achilles tendinitis, rotator cuff syndrome, bursitis of the hip, enthesopathy of the knee and so on.

Enthesitis isn’t always linked to osteoarthritis or adult rheumatoid arthritis (RA), but people with those conditions can have it. It’s more common in certain forms of autoimmune arthritis, including psoriatic arthritis and ankylosing spondylitis, and in some children with juvenile idiopathic arthritis.

The inflammation usually affects the heel, knee, hip, backbone and the bottom of your foot, leading to pain and stiffness. Swelling may occur and fatigue is common. The pain makes running or climbing stairs difficult. Slowly, prolonged inflammation leads to changes including calcification or ossification, where new bone tissue forms, affecting normal movement and function, for example a bony spur on your heel. Thickening called fibrosis causes soft tissues to become thick, ropey and tender.

Ways to help

•Weight management is important to reduce the pressure on tendons and joints if you are overweight. See the practice nurse for support and advice.

•Regular gentle stretching exercises, warming up before you do any activity and to help cool down after, will help protect the entheses.