Achilles Tendon Pain: Is It Ankylosing Spondylitis or Posture Issues?

There is soreness in the Achilles tendon?

Hello, doctor.
When I was about 23 years old, I started experiencing soreness in my Achilles tendon when I first got up in the morning or after sitting for long periods (around 30 minutes).
The soreness occurs at the beginning of walking but does not involve any pain.
After walking for a while, the soreness disappears, and this issue occurs daily, regardless of whether I exercise or not.
I found some research online suggesting it might be ankylosing spondylitis, but I do not experience any soreness in my back, even though I have a hunchback issue.
Could this be ankylosing spondylitis, or is it related to my walking and sitting posture? If I need to consult a specialist, would you recommend seeing an orthopedic doctor or a rheumatologist? Thank you.

XIAO, 20~29 year old female. Ask Date: 2016/09/07

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Regarding your inquiry, it is quite difficult to provide an immediate diagnosis without a physician examining your heel, assessing your spinal mobility, and inquiring about your clinical symptoms.
I recommend that you consult with a specialist in Allergy, Immunology, and Rheumatology.
The Changhua Hospital of the Ministry of Health and Welfare has a department for Allergy, Immunology, and Rheumatology that can assist you.
Take care.

Reply Date: 2016/09/07

More Info

Achilles tendon pain can be a complex issue, and your symptoms raise important considerations regarding potential underlying conditions such as ankylosing spondylitis (AS) or posture-related problems.
Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints in the pelvis. It can lead to chronic pain and stiffness in the back, particularly in the morning or after periods of inactivity. While AS typically presents with back pain, it can also manifest in other areas, including the Achilles tendon. The pain you experience in your Achilles tendon upon waking or after prolonged sitting could be related to inflammatory processes associated with AS, especially if you have a family history of autoimmune diseases or other symptoms such as eye inflammation (uveitis) or inflammatory bowel disease.

On the other hand, your symptoms may also be attributed to postural issues or mechanical stress on the Achilles tendon. Poor posture, such as slouching or having a forward head position, can lead to muscle imbalances and increased strain on the tendons. If you have a history of slouching or kyphosis (hunchback), this could contribute to the discomfort you feel in your Achilles tendon, particularly after sitting for long periods. The fact that the pain subsides after walking suggests that it may not be purely inflammatory but could also be related to how your body is positioned during rest.

To determine the exact cause of your Achilles tendon pain, it would be advisable to consult a healthcare professional. Given your symptoms, you might consider visiting a rheumatologist, especially if you suspect ankylosing spondylitis. A rheumatologist specializes in autoimmune and inflammatory conditions and can perform the necessary evaluations, including blood tests for inflammatory markers (such as HLA-B27) and imaging studies to assess your spine and joints.

Alternatively, an orthopedic specialist can evaluate your Achilles tendon and assess for any mechanical issues or injuries. They can provide insights into whether your pain is related to tendonitis, tendinopathy, or other musculoskeletal issues.
In summary, both ankylosing spondylitis and postural issues could be contributing to your Achilles tendon pain. A thorough evaluation by a rheumatologist or orthopedic specialist will help clarify the diagnosis and guide appropriate treatment. Treatment options may include physical therapy to improve posture and strengthen the muscles around the Achilles tendon, anti-inflammatory medications, or specific exercises to enhance flexibility and reduce strain on the tendon.
In the meantime, consider incorporating gentle stretching and strengthening exercises for your calves and Achilles tendon, as well as paying attention to your posture while sitting and standing. Using supportive footwear and avoiding prolonged periods of inactivity may also help alleviate your symptoms.

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