5 Tips for Enthesitis Relief When You Have Psoriatic Arthritis

I can hear my alarm going off. I know that it’s time to get up and start the day — but I hesitate. I pause because I know that once my feet hit the ground, I’ll be met with the same persistent burning heel pain that greets me each morning.

Eventually, I get up and try to take a deep breath, but I can’t because my rib cage feels stiff and inflamed. It feels like the air is trapped in my lungs and with each exhale I’m left with an ache in my chest.

Through the pain in my chest and my feet, I make my way to the kitchen. As I reach up toward the cabinet to grab a mug, pain shoots through my elbow.

If you are living with psoriatic arthritis (PsA) like me, this morning routine might sound familiar. The source of these frustrating, constant pains is enthesitis. Approximately 1 in 3 people with PsA will develop enthesitis.

We have over 100 entheses throughout our bodies, and they are involved in every move we make. An enthesis is the site where a tendon or ligament connects to bone. Enthesitis occurs when one or more entheses become inflamed.

Some of the areas that are most commonly affected by enthesitis are the bottoms of the feet, the Achilles’ tendons, and places where connective tissues attach to the ribs, spine, and pelvis.

While enthesitis is not exclusive to people living with PsA, we do have a predisposition to chronic inflammation, resulting in pain and stiffness that does not resolve the same way it would in someone who doesn’t live with arthritis.

PsA causes a range of symptoms, challenges, and comorbidities. For me, enthesitis pain seems to be the most prevalent and persistent of all.

I’ve found that enthesitis pain often exceeds any joint pain I experience. It can be shocking just how badly it hurts. Looking back on my diagnosis journey, enthesitis near my elbow was definitely one of the earliest PsA symptoms I experienced.

Years later, I developed enthesitis in my ribs. The pain with each breath was so intense that it led me to the emergency room.

Enthesitis is no joke and is an everyday struggle for many of us living with PsA. Here are some tips and tricks I’ve found help ease the burning ache of my enthesitis.

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Heat and ice

Heat is usually my first line of defense for enthesitis pain. Not only can heat feel comforting, but it can also help with stiffness. This can be in the form of a heating pad or a hot water bottle for localized pain.

I find heat particularly helpful when I experience enthesitis in my ribs, chest, and sacroiliac (SI) joint. When the pain extends beyond one area, a hot bath can be more effective. I find that Epsom salt adds an additional soothing element.

A great way to use heat while on the go is with feet warmers. You can pop them into your shoes before heading out and keep your feet warmed up for hours.

Alternatively, ice can also bring relief. Personally, I find an ice pack particularly helpful for elbow and knee enthesitis pain, especially if there is any swelling.

There are several products that can be made cold or hot, which allows you to try both and see which application feels best for you.

Compression and support

Compression sleeves, socks, and supports provide relief by keeping affected areas warm and promoting circulation. They also add extra support.

When enthesitis acts up along the bottoms of my feet I reach for these arch supports first. They fit comfortably under my socks and shoes and ease the ache when I have to be on my feet during the day.

While some might enjoy the snug support of compression, it isn’t for everyone. An alternative way to provide support is by using kinesiology tape. You have perhaps seen athletes using this tape during games and matches, but it can be helpful for arthritis patients, too.

I like that this tape provides support without limiting mobility as many traditional braces and supports do. I often tape my SI joint and knee when I know I’ll have a long day on my feet. Kinesiology tape adheres to the skin and lifts it. It is believed that this creates space between your skin and muscles which can help alleviate joint irritation.

It’s important to note that proper application of the tape is key. I recommend seeking the help of a physical therapist before trying to apply kinesiology tape on your own.

Stretching and physical therapy

When my enthesitis pain comes on, the last thing I want to do is move. However, stretching the affected areas seems to provide some pain relief.

I have found this especially true for heel and foot pain. Stretching out the calf muscles seems to release tension. I first tried this calf stretcher at a physical therapy office and found it so helpful that I decided to purchase my own.

Physical therapy for enthesitis has been shown to increase range of motion and decrease pain. Per my rheumatologist’s recommendation, I have seen a physical therapist for enthesitis in my elbow.

Learning the appropriate stretches and exercises for the affected area has been very helpful. I have found that the key is to continue to do the stretches beyond the appointment for continued relief.

Massage and topical treatments

For me, massaging areas affected by enthesitis with a CBD salve or analgesic rub can provide quick relief from the burning ache of enthesitis. Enthesitis is often the result of overuse so giving these hardworking joints, ligaments, and tendons extra care can go a long way.

I love this salve. it is unscented, works quickly, and comes in a small jar easy for carrying in your bag.

Every morning I take a hard lacrosse ball, place it on the ground and roll the arches of my feet and heels against it. It works as a makeshift massage when my arthritic hands are aching.

I find this simple motion helps my feet “wake up” at the start of the day but can be done at any point in the day to help work out stiffness.

Another topical option I keep in rotation for enthesitis relief is lidocaine patches. The adhesive patches contain lidocaine, a numbing gel that is absorbed through the skin. I find these patches work best when placed over back or rib pain because they can cover a large area at once.

They also don’t have a smell, so they can be discreetly used under clothing.

Communication

Lastly, the most important piece of advice I have is to communicate with your doctors.

Let them know if you are experiencing pain that you believe may be enthesitis and they can help come up with a plan that works for you. It’s also important to remember that everyone experiences arthritis differently. There can often a lot of trial and error when it comes to learning which treatments and tips work best for your body.

Keeping a medical journal can be helpful during this process to keep track of what helps and what does not.