Occupation, constitutional features and sporting activities are considered to be important aetiological factors for plantar fasciitis in Orchard’s article.1
The Assessment of Spondyloarthritis International Society (ASAS) includes heel enthesitis (defined as ‘past or present spontaneous pain or tenderness at examination at the site of insertion of the Achilles tendon or plantar fascia at the calcaneus’) as one of the classification criteria for axial spondyloarthritis.2 More recently, enthesitis, together with arthritis and dactylitis, was included as a major classification criterion for peripheral spondyloarthritis by the same group.3
The incidence of spondyloarthritis tends to peak at middle age which overlaps greatly with the age that the occupational and sporting activities mentioned in Orchard’s article mostly occur (policemen on patrol, athletes etc).
It is important to point out therefore, that the clinical evaluation of plantar fasciitis should include a full enquiry about other spondyloarthritis features, particularly inflammatory back pain.
1. Orchard J. Plantar fasciitis. BMJ 2012;345:e6603
2. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl II):ii1-ii44.
3. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31.
Rapid Response:
Re: Plantar fasciitis
Occupation, constitutional features and sporting activities are considered to be important aetiological factors for plantar fasciitis in Orchard’s article.1
The Assessment of Spondyloarthritis International Society (ASAS) includes heel enthesitis (defined as ‘past or present spontaneous pain or tenderness at examination at the site of insertion of the Achilles tendon or plantar fascia at the calcaneus’) as one of the classification criteria for axial spondyloarthritis.2 More recently, enthesitis, together with arthritis and dactylitis, was included as a major classification criterion for peripheral spondyloarthritis by the same group.3
The incidence of spondyloarthritis tends to peak at middle age which overlaps greatly with the age that the occupational and sporting activities mentioned in Orchard’s article mostly occur (policemen on patrol, athletes etc).
It is important to point out therefore, that the clinical evaluation of plantar fasciitis should include a full enquiry about other spondyloarthritis features, particularly inflammatory back pain.
1. Orchard J. Plantar fasciitis. BMJ 2012;345:e6603
2. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl II):ii1-ii44.
3. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31.
Competing interests: No competing interests