Bone Spurs

A bone spur (osteophyte) is a bony growth formed on normal bone. Most people think of something sharp when they think of a “spur,” but a bone spur is just extra bone. It’s usually smooth, but it can cause wear and tear or pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body. Common places for bone spurs include the spine, shoulders, hands, hips, knees, and feet.

Cause

A bone spur forms as the body tries to repair itself by building extra bone. It typically forms in response to pressure, rubbing, or stress that continues over a long period of time.

Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis).  Bone spurs due to aging are especially common in the joints of the feet.

Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes.

For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a “heel spur”). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a “pump bump,” because it is often seen in women who wear high heels.

Symptoms

Bone spurs may or may not cause symptoms. When they do cause symptoms, the symptoms depend on their location.

Bone spurs can be associated with:

  • Pain
  • Numbness
  • Tenderness if they are irritating adjacent tissues, such as skin, fat pads, nerves or tendons.
  • Heel spurs cause local foot pain, tenderness, and sometimes swelling.
  • Difficulty walking due to pain at the bottom of the foot with weight-bearing.
  • Inflammation of the entire bottom of the foot (plantar fasciitis) when the heel spur occurs in the bottom of the heel bone.
  • Occasionally, bone spurs in this location are a result of inflammatory arthritis, such as from reactive arthritis, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis (DISH or Forrestier’s disease).

Diagnosis

After you describe your symptoms and discuss your concerns, your Wisconsin Bone & Joint doctor will examine your foot. Your doctor will look for these signs:

  • A high arch
  • An area of maximum tenderness on the bottom of your foot, just in front of your heel bone
  • Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down
  • Limited “up” motion of your ankle

Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem.

X-rays
X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray.

Other Imaging Tests
Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.

Treatment

Bone spurs are treated only if they are causing symptoms.

Initial treatment is directed toward decreasing inflammation and avoiding reinjury when possible.

Local cold application can help when the location of the bone spur is accessible.

Anti-inflammatory medications, administered both orally and by local injection (Kenalog, Depomedrol, Celestone), are commonly used, depending on the location of the spur.

Local mechanical measures, such as orthotics, or shoe inserts, and local bone spur pads might be considered, depending on the location of the bone spur.

Bone spurs that are causing irritation of nerves, tendons or ligaments and that are resistant to conservative measures can require surgical operations for treatment.

Procedure

Most surgical procedures are aimed at detaching the plantar fascial ligament from its attachment into the heel bone. This may be accomplished with a small incision on the bottom of the heel or on the side of the heel.

The surgery is generally performed in an outpatient surgical center or hospital operating room. It can be performed under a local anesthesia, twilight anesthesia or a general anesthesia. At the completion of surgery a gauze dressing is applied and the patient placed in a post operative shoe or cast.

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