The areas where your tendons and ligaments attach to your bones are called entheses. If these areas become painful and inflamed, it’s called enthesitis. This is also known as enthesopathy.
You’ll notice this type of pain more when you use the joint or attachment point that’s affected by enthesopathy. For example, if you’re experiencing enthesopathy in your ankle or Achilles tendon, you’ll feel pain whenever you move or put pressure on your foot or tendon area.
Enthesopathy often happens when you’re affected by one or more types of arthritis. Arthritis occurs when the cartilage or bone in your joints breaks down. Spondyloarthritis, a term for types of arthritis conditions that cause inflammation in your joints, is sometimes linked to enthesopathy.
Like many types of arthritis, enthesopathy can have many causes. These include:
- overuse of the joint
- obesity, which can put stress on your joints
- conditions that cause your immune system to attack your joint tissue
- a family history of arthritis
Keep reading to learn how to identify enthesopathy, how it affects certain joints, and how it’s treated.
Enthesitis and enthesopathy are different names for the same condition. This means that the symptoms are the same.
The most noticeable symptom of enthesopathy is pain in the area around a joint when you use that joint. You may also notice that the area of the tendon that attaches to the bones is tender to the touch.
The level of pain you feel can vary widely. With mild enthesopathy, the pain may only be an annoyance. You’ll likely be able to do everyday tasks without a lot of discomfort.
With severe enthesopathy, the pain may keep you from being able to do everyday activities.
Enthesopathy can also be a symptom of an underlying condition. This includes:
- psoriatic arthritis
- joint space narrowing
Other symptoms associated with these potential underlying conditions include:
- inability to move a joint in the directions it’s normally supposed to go
- stiffness of a joint, especially after sleeping or sitting down for an extended period of time
- swelling in the area of a joint
- a feeling of grating around a joint when you move it
If these symptoms begin interfering with your daily life, see your doctor. They can assess the area that’s causing you pain. Diagnostic tests, such as ultrasonography, can help them determine the cause.
Conditions that affect the spine, such as spondyloarthritis, can cause pain in your hip bones. They can also cause general lower back pain. You may also feel less able to move your spine, as spondyloarthritis can cause your vertebrae to fuse together.
Hip enthesopathy can also sometimes be linked to bowel conditions, such as inflammatory bowel disease, or to a gene that’s passed down in families.
Knee enthesopathy is usually linked to overuse or stress put on your knees. This type of enthesopathy often results from conditions such as patellar tendonitis. Patellar tendonitis is also called runner’s knee.
Pain with this condition is usually worse when you’re exercising and putting stress on your knees. You may also feel pain when performing certain daily tasks, such as getting up from a sitting position or going up stairs.
Enthesopathy in your foot usually affects your plantar fascia. This is the tissue under your foot arch. It can also affect your calcaneus, or heel bone. This pain usually happens because the enthesis of your plantar fascia has thickened. This can result in pain in your heel and around your foot arch when you walk or put stress on your foot.
Enthesopathy in your ankle and tarsus, or Achilles tendon, usually affects the point where your Achilles tendon attaches to your heel bone.
If you have enthesopathy in this area, you’ll usually feel pain when you move your foot around. You may also feel pain when you step down and put pressure on either your heel or the front of your foot. For example, it may hurt to stand on the tip of your toes.
If you’re experiencing symptoms of enthesopathy, see your doctor. After making a diagnosis, they will recommend a treatment plan based on the severity of your symptoms and the areas affected. Your plan may also involve treating any underlying conditions that may be causing the enthesopathy.
To help you deal with the pain that comes along with enthesopathy, your doctor will likely prescribe nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help relieve the pain and inflammation of enthesopathy.
- aspirin (Ecotrin)
- naproxen (Aleve)
- ibuprofen (Advil)
Over time, light strengthening exercises or stretching techniques can help relieve some of the pressure on affected joints.
For example, calf muscle stretches can help ease pain caused by Achilles tendon enthesopathy. To do these, put both of your hands on a wall, extend your leg out behind you, and bend your foot up. This stretches the muscles attached to your Achilles tendon without putting pressure on it.
Your doctor may recommend making lifestyle changes if overuse or excessive activity has caused your enthesopathy or an underlying condition.
If you use the affected joint area often for work or for leisure activities, your doctor may suggest that you reduce the amount of work or activity that may be making the pain or inflammation worse.
If you exercise regularly and the exercise is putting stress on your joints, your doctor may help you develop a new exercise plan that allows you to continue exercising regularly while putting less pressure on the affected joint area.
If over-the-counter medications aren’t helping, your doctor may recommend corticosteroid injections. These can help reduce inflammation.
If an immune system disorder, such as psoriatic arthritis, is causing your enthesopathy, your doctor will likely recommend medications to reduce the immune system response that’s causing the pain.
A disease-modifying antirheumatic drug (DMARD) can help treat immune responses. An immunosuppressant, such as cyclosporine (Neoral) or azathioprine (Imuran), may also help relieve symptoms.
Surgery is typically seen as a last resort. When it’s necessary, it’s often due to enthesopathy caused by an underlying condition.
In these situations, your doctor may recommend a total joint replacement. In this procedure, your doctor surgically removes your affected bone and puts in a plastic or metal prosthesis.
In most cases, enthesopathy can be managed through a combination of medication, treatment, and lifestyle changes. In some cases, it can be cured completely. Mild cases caused by overuse, stress, or trauma can be resolved by addressing the cause.
If your enthesopathy is being caused by an immune system condition, such as psoriatic arthritis, your doctor will develop a treatment plan to relieve your symptoms. They’ll also try to treat the immune system response causing the pain.
You may be able to reduce the short-term discomfort caused by the symptoms. A long-term plan will be necessary to keep the condition from getting worse and causing more damage to the entheses and the joint itself.