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How does inflammation at tendon and ligament attachment sites cause heel pain?
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arthritis
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Inflammation at the sites where tendons or ligaments attach to bone is known as enthesitis. This condition is a hallmark feature of a group of inflammatory conditions called spondyloarthropathies, which include ankylosing spondylitis, reactive arthritis (Reiter syndrome), and psoriatic arthritis.1
In the context of these diseases, heel pain arises specifically when enthesitis affects the insertion points of the plantar fascia and the Achilles tendon at the heel bone. Unlike plantar fasciitis, which is primarily a degenerative condition caused by mechanical stress and microtears, the heel pain associated with spondyloarthropathies is driven by the underlying systemic inflammatory process characteristic of these arthritic diseases.12