A leg with an ankle bandaged up and an ice pack sitting on the Achilles tendon area of the ankle.

Treating RA-Related Ankle Tendonitis

Last updated: August 2022

I’ve had ankle pain for years. Perhaps I should have taken specific action about it sooner, but if you have severe rheumatoid arthritis in every bone of your body, it can be difficult to prioritize.

When you have a lot of physical challenges, you tend to live with what you can and work through the issues like a checklist. At least, that has been my approach. I feel like I can only handle so much at a time. If I take on too many projects, something gets dropped or goes sideways.

Throbbing pain in my ankle

My right ankle developed into a particular problem when I had my knee revision a few years ago and was working on my walking in recovery. I re-learned that the limit to my walking was limited not by my knee, but by my right ankle. At first, I am OK. But after a certain number of steps, my ankle starts throbbing and increases until I can rest again.

In the last couple years, my ankle pain has worsened so that it occurs even when I am just sitting or have my foot on my wheelchair footrest for a long time. I’ve started positioning my foot off the pedal or dangling it when I am sitting at my desk for a while. And then a few weeks ago, it became nearly unbearable a lot of the day — from waking to trying to sleep at night with the throbbing in the background.

Talking to my podiatrist

So, the right ankle was promoted to the top of the list! I went and visited my podiatrist, explaining my usual ankle pain had worsened along with swelling around my heel and back, outside area of the foot. We had a good conversation about the challenges I have with rheumatoid arthritis in my feet and steps I could take to see if I could alleviate my pain. (Steps! Har har! I can still be funny while dealing with ankle pain!)

RA-related foot problems

The American Academy of Orthopaedic Surgeons has a good summary of the issues that can occur in RA patients’ feet. (I did find it humorous that they identify these regions as common problem areas: hindfoot/heel, midfoot/top, forefoot/ball, and toes. Am I missing something? What is left?!) If you’re experiencing possible RA-related foot symptoms, this is a good place to start with an overview, what tests to expect, and possible treatment.

In my case, I have had RA foot involvement for a long time. I wore braces as a child to help prevent damage, but it gradually occurred. I have crazy, dislocated toes. I have largely fused foot and ankle bones. And I wear orthotics (without which I cannot safely stand and balance) in my shoes to better support my feet. I usually see my podiatrist a couple of times a year to keep an eye on things.

An ankle tendonitis diagnosis

While my ankle pain is bothersome, I didn’t feel like it really interfered until recently when I had a lot more pain, swelling, and felt limited in my activities. My podiatrist thought I was having tendon inflammation or tendonitis related to my RA in the heel of my ankle. Literally, my Achilles tendon had become my Achilles heel.

He thought more supportive shoes could help better support my ankle and foot, taking the strain off this tendon. And he referred me to physical therapy for treatment in the hope that it would ease the inflammation and pain.

Common issues with RA

I shouldn’t have been surprised, but a search online revealed that achilles tendon issues are common with RA patients. Probably because we have other joint and related soft tissue issues, it may not always be identified and treated.

I have to admit: I wondered how a person who uses a wheelchair could get ankle tendonitis. It probably resulted as a combination from my long-active RA and the stress of my exercise routine because in recent months I have been using a seated stepper machine almost daily to keep up my strength due to not having access to a pool for my usual exercise activity. The RA brings the inflammation and my repetitive exercise aggravated the Achilles tendon.

Immediate relief with physical therapy

Thankfully, physical therapy brought nearly immediate relief. I learned a band exercise to strengthen the tendon by going against the resistance to turn out my foot. Additionally, I bought new shoes to provide more foot and ankle support. While I tried compression socks, I couldn’t manage to put them on so I use regular socks instead to help with my foot swelling.

Using heat and cold

When I need to soothe my ankle, I use heat or cold (or a combination) and also try to spend some time with my feet up in the middle of the day. I’ve been able to gradually work my exercise back up while being attentive and backing off when I need to if my ankle feels worse or gets too tired.

Why did I take so long to address this?

The huge improvement is much less pain. I’m almost pain-free in my ankle and am scared to admit it! Why did I wait so long to give it the attention it needed? No matter; it’s on the mend now and I’ll keep at it until I have a solid recovery.

It’s been a good reminder that sometimes the ‘little problems’ deserve attention before they turn into bigger or more painful issues. Additionally, I always learn good new things in physical therapy that I can carry on at home. While I was afraid for (and of) my ankle for quite a while, I now feel like I’m getting a handle on it and hopefully will have one less item worrying me on the RA list.

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