Foot and heel pain tends to arise in more severe cases of ankylosing spondylitis, according to Tara Perry, an occupational therapist at Keck Hospital of the University of Southern California in Los Angeles. “The foot and heel pain presents like very severe arthritis,” she explains. “It can feel like walking on daggers with every step.” If you experience foot pain, one of the most important things you can do is choose the right shoes. In consultations with people who have ankylosing spondylitis, “Footwear is definitely something that comes up frequently,” says Perry.
Why Footwear Matters
There are a number of common foot problems in people with ankylosing spondylitis, including plantar fasciitis and Achilles tendinitis, according to the National Axial Spondyloarthritis Society in the United Kingdom. Minimizing foot pain is probably the most important consideration when choosing shoes. But the right choice of shoes is important even if you’re not experiencing foot pain, because what you wear on your feet can directly affect your spine. “Any sort of footwear that’s going to help decrease pressure across the spine — something that’s a little more padded in the heel like sneakers — is where you want to start out,” says Charla R. Fischer, MD, an orthopedic surgeon at New York University Langone’s Spine Center in New York City. You should also consider any difficulty you may have bending down to put on your shoes. Because this can be a challenge for many who have ankylosing spondylitis, a slip-on shoe like a loafer may be a good choice. For people with ankylosing spondylitis, “Those are becoming more and more popular,” says Dr. Fischer. Alternatives include shoes with straps fastened by Velcro or buckles, says Perry, but some people don’t like the look of Velcro. It’s important to find a shoe that fits your personality, lifestyle, and culture, as well as your condition, she says. You should also choose footwear that encourages mobility. “If every step you take is painful, [you] pull back from mobility,” says Perry. You want to avoid this, she says, because, “A certain level of movement is needed to reduce the pain.”.
What to Look For
There are a number of features to consider in the shoes you wear, in addition to type or style. Any shoe that constricts your toes is probably a bad choice, says Fischer. “As you get older, the soft tissues in your toes calcify and get a little bit stiffer,” she explains, so they’re less likely to tolerate pressure from the sides without causing discomfort. Having enough cushioning in your heels — to reduce pressure on your spine — and good arch support are also necessary to facilitate comfortable walking, Fischer notes. Some types of shoes are more likely to be a good fit for people who have ankylosing spondylitis, but even within a shoe type, there are better and worse choices, as explained below. Sneakers: These are the natural choice for many people with ankylosing spondylitis, since they tend to have good heel and arch support. They also usually have plenty of room inside for store-bought inserts or custom orthotics, should you decide that you need even more cushioning or support. “Anytime someone has foot pain, it’s a good idea to evaluate whether or not they need some orthotics,” notes Fischer. Loafers: While slip-on styles, such as clogs and loafers, can be easier to put on and take off than sneakers Fischer recommends that you buy ones with a closed back. “There needs to be a heel component,” she says, to reduce the risk of stumbling or tripping. Avoiding falls, Fischer notes, is especially important if you have ankylosing spondylitis, because your bones are more likely to fracture with even a relatively minor impact, putting you at increased risk for neck fractures in particular. Sandals: Flip-flops are always a bad choice, says Perry, due to their lack of support and stability. But other types of sandals may be okay, she adds. “You want a sandal that holds onto the whole foot, something with an ankle strap,” Perry notes. More rugged styles of sandals tend to have better heel cushioning and arch support and more adjustable straps than traditional sandals. Dress shoes: It’s unlikely anyone would choose a dress shoe purely for function or comfort, but many people have good reasons to choose them, says Perry. “I’ve had patients — male and female — who will only wear dress shoes, because it’s a part of their culture,” she says. Men’s dress shoes tend to offer more options for comfort and support than those for women, she notes, since orthotics “don’t fit into a ballet flat for a woman,” and many inserts may also be a tight fit in women’s dress shoes. Even so, some women’s dress shoes have more cushioning — or room for added cushioning — than others. High heels: “Heels are really not recommended,” says Fischer. Wearing them changes the position of your pelvis in a way that increases pressure on your sacroiliac joint, which ups the chances of pain in the area, she notes. On top of this, you’re more likely to stumble or fall when wearing high heels, raising the risk of fractures. If you’re unsure what type of shoe is best for you, don’t hesitate to ask your doctor or occupational therapist for advice. If you’re experiencing significant foot pain, both Perry and Fischer note that the best option may be a referral to a podiatrist who can evaluate whether orthotics may help or your condition requires further treatment.
