RA, Achillies Tendonitis & Plantar Fasciitis - what should I ask at Rheumatology appointment?

Hi all

I'm preparing for a Rheumatology appointment next Tuesday. I have RA which seems to be causing achillies tendonitis and plantar fasciitis in both legs/feet. My joints and swelling in feet is starting to improve with Methotrexate, but the stiffness and pain in my achillies tendons is not (3.5 months now). I am unable to walk much and cannot get my heels down on the ground after resting for more than 15 mins.

Anyone else had the same? If so, what helped improve it? What should I be asking for at my appointment?

I haven't had foot X-rays for 3 years and they said I couldn't have one last year despite foot problems. I'm going to push for an X-ray this time as have had 2.5 months bad foot joint inflammation and still getting pains/stiffness on walking, but I'm wondering about an ultrasound or MRI to show inflammation and condition of my achillies tendons? Has anyone had that done? My hospital is reluctant to do monitoring X-rays etc, so I'll have to push, but don't know what is available via NHS Rheumatology.

I had the same achillies problem in one leg for 6 months last year and it improved with oral steroids, physio and starting Methotrexate. Unfortunately I had to move to the lowest dose MTX due to side effects at Christmas and during this time started a huge flare and both legs started playing up (plus all my joints, horrendous). I'm just getting under control again with my joints, having worked up to 15mg Mtx since then, but there's no improvement at all in my tendons.

I'm sleeping with a Dorsiwedge boot on each foot at night and doing as much of the physio exercises as I can, but still at the point that exercise is making them worse. Had a really bad time on steroids (40mg Prednisone) and coming off them after Christmas, so hoping to avoid going back on. I'm still awaiting a podiatry appointment at the hospital, so haven't found insoles that's help yet, other than gel heel raisers.

Anyone had the same problem? What diagnostic tests have you had and what treatment has helped you?

Many thanks

Fiona

20 Replies

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  • Oh poor you. I absolutely know how you feel!

    I had bilateral Achilles tendinitis for over a year. It was agonising. Both heals were hugely swollen. My flipping GP did nowt!

    I eventually saw a rheumatologist who ordered an ultra sound, which showed huge inflammation and bony spurs. What a surprise!

    It was virtually impossible at the time to do any of the calf stretches. My knees were also affected. Things improved drastically after IM steroid shots. The inflammation went right down.

    I do still have issues with right knee and toes, and the occasional twang in the Achilles. I also take leflunomide.

    Docs are still faffing about trying to decide if I have psoriatic arthritis. I'm pretty sure I do, as I have a skin complaint too.

    Oh yes, the most helpful thing I had done was having special souls to fit in my shoes made. They are quite thick, and I can only wear walking boots and shoes, but I don't give a stuff bout that. The gel things you buy are useless. Ask to be sent to orthotics. You will have a plaster cast of your foot done, which you take home. I've just ordered my second pair. Flipping brilliant! I can't really walk well without them.

  • Thank you for your reply Nettac. It gives me hope to hear that you have found treatment that has helped you (I was beginning to think I might be left like this permanently).

    I will definitely push for an ultrasound and I'll ask the Rheumatologist to push for my podiatry appointment, they've had the referral for 6 weeks and no appointment yet. I'm hoping podiatry is the same as orthotics in that they can make me insoles?

    My last IM steroid shot didn't do much to help, but I might ask for another at my appointment next week, worth a try.

    I have wondered whether I have psoriatic arthritis as I've always had lots of ligament inflammation, especially where the tendons join the muscles. I think the treatment regimes are the same as for RA. I did try Sulphursalazine a few years ago, but had to come off it. Methotrexate is working for my joints, just not for my tendons, or maybe I need to give it more time.

    Hope you continue to keep well, keep walking!

  • I think my rheumatologist referred specifically to orthotics. Was best thing I did, though it takes a few days to get used to them.

    The first IM shot didn't help as much as second and third. I think partly because I was allergic to the sulfasalazine.

    Good luck, and don't despair.

  • I will ask for an orthotics referral. Many thanks for all your help. 😀

  • Podiatrists are the people who supply the orthotics (or custom made inserts for shoes/boots etc). Important thing is to ask whether the podiatrist specialises in rheumatology patients.

    My first pair of orthotics was done with a plaster cast and produced a lovely neat leather lined insole. However the latest pair was done with 3D modelling - much easier as just had to stand on a platform. When I collected them they looked like a dogs dinner of stuck together bits of plastic, and I was very suspicious, but hugely better than the last pair and I can walk much, much further.

  • All your symptoms for RA are exactly the same as mine. The tendon/ligament thing has always. Even the worst. After 1 year, it's. It gone but it's improved. Still there though in arms and feet and Achilles.

  • Sorry to hear that Aloquifiqie. But I'm glad to hear that it's not just me, the last Rheumatologist I saw didn't seem to understand what I was telling her about my achillies etc and had a puzzled look on her face.

    Best wishes

  • Orthotics have helped me walk again without excruciating pain. Physio never worked for me, UNTIL I discovered a facility near where I live where I do physio in a pool. The underwater treadmill, and exercises that I do, have helped my legs get stronger and more stable. Because there is less pressure on my feet in the pool, there is also much less pain (during and afterwards). I have bone spurs in both heels and knees, tendonitis on one side, baker's cyst on the other, as well as plantar fasciitis, all linked to my PsA.

  • Thank you Snowglobe. I'm glad you've found orthotics have helped you, it is miserable not being able to walk. I will definitely ask for a referral.

    Very interested in physio exercises in the pool, I might give that a try, what a good idea!

  • I have had achillies tendinitis in both legs prior to being diagnosed with RA that fortunately resolved with 8 weeks of ankle classes at my local hospital physio department. You sound as though you have been down a similar route already without success. I have had more success with the orthotics department than podiatary when its come to insoles/shoes etc. Good luck with your appointment.

    Jacey xXx

  • Hi Jacey15

    Thanks for your reply. i will ask about orthotics at my appointment next week to make sure I'm getting referred to the right place.

    It's really helpful to have this info before my appointment. I feel as though I have to fight for any referrals, the hospital is even reluctant to do monitoring X-rays. I know I will have to be assertive, so it will be useful to go in well prepared.

    Very pleased to hear your tendonitis seems to have resolved. Best wishes

  • Just checked for you. It was definitely orthotics I was referred to. Fortunately my rheumatology hospital has an orthotic department on same sight.

  • Thank you! That's some nice of you Nettac!

    I will have to ask when I see the Rheumatologist. At my last appointment in January she said she'd refer me to podiatry for insoles. I will check and say I think I need orthotics. I'm not sure we have an orthotics dept at the hospital I attend, but I would rather get referred somewhere else to get the right insoles.

  • sorry only just cstching up on this - but orthotics moulds taken at hospital here were made by 3d computer and look like nothing but really helped and got me walking again, only short distances but great help. have flat feet and often swollen ankles inc tendonitis. loss of collagen in RA makes it worse. Pool / sea exercises help too. Good luck x

  • Hi Fiona, i went to podiatry and then orthotics for casts taken for insoles to be made and once again back to podiatrist for toe supports modelled and made then and there. I'm now waiting for orthotics again for ankle supports to be made. Think in the end I'm gonna be almost bionic! M x

  • Oh my goodness! It will all be worth it to have comfy feet!

    Hope all goes well.

  • Hi, I have rheumatoid arthritis and I have plantas fac in both feet, I have had it for a year and half now, had physio and wear inner soles, but it does not go away, what to do? I don't know either

  • Hi Masymae.

    Really sorry to hear of the trouble you are having. For me, my foot problems are the straw that broke the camel's back. It's difficult enough dealing with Rheumatoid disease and aching joints without for problems on top. I expect you feel the same.

    If I find anything that helps, I'll post it on here.

    Best wishes and hope your feet improve soon!

  • I have a bump about the size of a pea on each Achilles tendon . Getting up in the mornings or even after sitting for only a few minutes is agony. My rheumy is scheduling an MRI of my feet.

    I feel your pain!! Hope we all can get some relief soon.

  • Oh dear. Sounds like a similar problem. I hope your MRI will show what's happening and you get some treatment which helps.

    Since my posting I've now seen the Rheumatologist (registrar) who tells me my tendon problems are not caused by RA and are mechanical, rather than inflammatory. This is after she spent 10 mins looking at joints and tender ligament insertion points and telling me it was all inflammation!

    My GP is being very supportive. I've never had any scans at Rheumatology, they just go by looking at feet and by ESR results, so he's sending me for an ultrasound to see if it is indeed inflammation that she causing the problem.

    I waited months for a hospital podiatry appointment only to be told the front arch in both feet has now collapsed and I have a deformity on the heel bone where the achillies is pulling it. They've given me off the shelf insoles, but they have made things much worse, so painful and I'm unable to wear them. I'm going to try and get another appointment within my 3 month window, but they said if they made me insoles they'd be so thick I'd never get them in any shoes.

    So, still hobbling!

    Best wishes

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