Enthesopathy of the heels in juvenile onset seronegative B-27 positive spondyloarthropathy.

Severe heel enthesopathy was diagnosed in 4 of 18 cases of juvenile onset seronegative spondyloarthropathy. The plantar fascia was affected in each case, whereas the insertion of the Achilles tendon was involved in only one case. All were males over the age of 8 at the onset of arthropathy; HLA-B27 was present in each patient. Mild heel pain was found in 4 other patients. The prognosis was poor in patients with severe talalgia but better in patients with mild or no talalgia. When compared with the adult onset spondyloarthropathy, the incidence of severe heel pain was almost the same. No cases of Achilles tendon thickening were found in the juvenile patients.