Question:easy
A 20 year old patient presenting with chronic low backache and early morning stiffness since last 2 years. Since 6 months there are bilateral heel pain also. Most likely diagnosis for this patient is
A 20 year old patient presenting with chronic low backache and early morning stiffness since last 2 years. Since 6 months there are bilateral heel pain also. Most likely diagnosis for this patient is
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Bilateral heel pain (enthesitis) with inflammatory back pain in a young male strongly suggests a seronegative spondyloarthropathy.
Updated On: Jun 23, 2026
- TB spine
- Ankylosing spondylitis
- Mechanical pain
- Disc prolapsed
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The Correct Option is B
Solution and Explanation
Diagnostic reasoning using the ASAS criteria and enthesitis:
Patient profile: 20-year-old male, chronic low back pain 2 years, early morning stiffness, bilateral heel pain 6 months.
Step 1 -- Is this inflammatory or mechanical back pain?
Inflammatory: morning stiffness + improves with activity + age $<$ 40 + insidious onset $\rightarrow$ Yes, this is inflammatory.
Step 2 -- What causes inflammatory back pain with bilateral enthesitis?
Seronegative spondyloarthropathies (SpA): AS, Reactive arthritis, Psoriatic arthritis, IBD-associated arthritis.
Bilateral heel pain = enthesitis at Achilles insertion / plantar fascia = the most common SpA enthesis site. The absence of preceding infection, skin disease, or bowel symptoms, combined with the protracted 2-year course in a young male, points specifically to AS.
Step 3 -- Eliminate alternatives:
- TB spine $\rightarrow$ constitutional symptoms + mechanical pain + single level with cold abscess
- Mechanical pain $\rightarrow$ worsens with activity, improves with rest
- Disc prolapse $\rightarrow$ radicular pain, positive SLR, no bilateral enthesitis
\[\boxed{\text{Ankylosing spondylitis}}\]
Patient profile: 20-year-old male, chronic low back pain 2 years, early morning stiffness, bilateral heel pain 6 months.
Step 1 -- Is this inflammatory or mechanical back pain?
Inflammatory: morning stiffness + improves with activity + age $<$ 40 + insidious onset $\rightarrow$ Yes, this is inflammatory.
Step 2 -- What causes inflammatory back pain with bilateral enthesitis?
Seronegative spondyloarthropathies (SpA): AS, Reactive arthritis, Psoriatic arthritis, IBD-associated arthritis.
Bilateral heel pain = enthesitis at Achilles insertion / plantar fascia = the most common SpA enthesis site. The absence of preceding infection, skin disease, or bowel symptoms, combined with the protracted 2-year course in a young male, points specifically to AS.
Step 3 -- Eliminate alternatives:
- TB spine $\rightarrow$ constitutional symptoms + mechanical pain + single level with cold abscess
- Mechanical pain $\rightarrow$ worsens with activity, improves with rest
- Disc prolapse $\rightarrow$ radicular pain, positive SLR, no bilateral enthesitis
\[\boxed{\text{Ankylosing spondylitis}}\]
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