The average person who lives to be 80 years old will walk the equivalent of five times around the world. That’s a lot of steps. So, it’s not surprising that many people develop foot and ankle problems, including bone spurs. Although bone spurs can develop on the hands, knees, and spine, they’re particularly common on the foot. Some people don’t even notice a bone spur on their foot. Others deal with crippling pain that makes it difficult to walk, stand, or wear shoes. Untreated bone spurs in the foot can damage the joint and tissues that surround the joint space. Because bone spurs are different for everyone, it’s important to consult with an experienced orthopedic specialist like those at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado. Early diagnosis and treatment can help keep you on your feet pain-free.

OVERVIEW

Bone spurs, or osteophytes, are bony growths that form where bones meet each other in the joints. They can occur in the neck, shoulders, elbows, spines, knees, and feet. 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. Bone spurs are common as one ages. About 80% of men and 60% of women over the age of 50 have them. By age 70, 95% of both men and women have bone spurs. When they grow on the foot, it is typically on the top of the foot, the toe, and the back of the heel where the Achilles tendon connects to the heel bone.

ABOUT THE FOOT

The foot is a complex mechanical structure composed of 33 joints, 26 bones, and more than a hundred muscles, tendons, and ligaments that all work together to bear weight, allow for locomotion, and transmit force. The foot has three parts: the forefoot, midfoot, and hindfoot. Because the foot has so many joints, it is one of the most common areas for developing bone spurs.

WHAT ARE BONE SPURS?

Joint damage from osteoarthritis is the most common cause of bone spurs. Osteoarthritis breaks down connective tissue called cartilage that cushions the ends of bones. The inflammatory reaction that occurs when cartilage or tendons are damaged leads to bone remodeling and the development of excess bone that leads to the formation of bony outgrowths, or bone spurs. It takes years for a bone spur to form, one reason that age is the greatest risk factor. The three major areas of bone spurs on the foot are:

Toe:

Bone spurs around the toes are often present around the bunion joint or within the toes themselves. Toe spurs are often associated with corns or calluses in the front part of the foot (known as the forefoot). A small deformity or bump can start to form over the top of the toes along the joints. A bone spur can also limit the mobility of the affected toe leading to a stiff big toe, or hallux rigidus, making it difficult to walk.

Midfoot:

A bone spur that develops in the midfoot is called a tarsal boss. They usually form on top of the foot, and some can be seen as lumps or calluses. This bony outgrowth can become painful when it is inflamed or rubs on surrounding neurovascular structures in the foot. An irritation can develop on the top of the foot in the arch area. This area becomes painful when shoelaces are tied or from pressure from a slip-on shoe. Examination of this area often shows redness and hardness beneath the skin. The skin irritation is associated with a spur or overgrowth of bone in the midfoot area.

Heel:

Heel spurs occur on the underside of the foot and may feel like a dull ache or sharp pain when walking or standing for long periods. Sometimes the discomfort from a heel spur may cause one to change their gait, potentially exacerbating structural issues in the foot.  Bone spurs in the foot and plantar fasciitis are related conditions but they’re not the same. Plantar fasciitis happens when overuse stretches or tears the plantar fascia — the ligament that runs between the heel and the ball of the foot. Heel spurs can happen as a reaction to stress and inflammation caused by plantar fasciitis.

CAUSES

There are multiple causes for bone spurs in the foot depending where they occur. They include:

• Wearing tight shoes, especially ones that pinch the toes or squeeze the midfoot
• Aging
• Genes
• Being overweight or obese
• Tight Achilles tendon
• Chronic plantar fasciitis
• Injury such as after a bruise or a fracture
• Flat feet—low or nonexistent arches
• Excessive physical activity—while it is overall good for the body, it can put extra stress on the feet, such as in runners or young dancers
• Charcot foot, a condition that causes weakness in the bones of the foot due to nerve damage (may or may not be due to diabetes)

SYMPTOMS

Some people may not even know they have bone spurs of the foot until they grow to the point of causing serious issues or when they press on nerves, tendons, and other structures. Symptoms include:

• Pain in the affected joint that can be sharp or dull and may worsen with activity or pressure on the affected area
• Swelling
• Tenderness
• Reduced range of motion
• Visible lump
• Difficulty wearing shoes
• If spur compresses a nerve, it can lead to sensations of numbness, tingling, or a pins-and-needles feeling
• Change in gait–altering walking pattern to avoid putting pressure on the affected area, can lead to further issues with posture and mobility.

NON-SURGICAL TREATMENTS

• Cold compresses and ice packs after performing weight-bearing activities
• Over-the-counter medications, such as Advil or Tylenol, may be used to treat pain if symptoms are mild or moderate
• Muscle relaxers
• Nerve membrane stablers such as Neurontin or Lyrica
• Cortisone injections
• Orthotic inserts that offer arch support
• Supportive shoes
• Walking boot to help relieve pressure

WHEN IS SURGERY INDICATED?

More than 90% of people with heel spurs recover without surgery. However, if symptoms do not improve with conservative treatment and there is an incidence of neurological impairment due to bone spurs, surgery may be indicated. The size or shape of a spur has nothing to do with the incidence or severity of symptoms. Large spurs can often cause no pain, while tiny ones can cause excruciating pain and extreme loss of mobility. Heel spur surgery is not used because a bone spur is large—or simply because it’s there—but rather because it is causing refractory (treatment-resistant) pain. Surgery options can require open surgery or arthroscopic surgery. This is done using a few small incisions and a lighted viewing tube called an arthroscope.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

Because of the complexity of the foot, it takes an experienced orthopedic specialist like those at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, to differentiate the varying types of bone spurs and create the most effective treatment plans. For example, a bone spur near the big toe joint is often mistaken for a bunion. While these two issues may feel similar, the treatment is different if you have a bone spur. Properly diagnosing bone spurs in the foot typically involves a combination of medical history assessment, physical examination, and imaging studies. These may include X-rays that provide detailed images of bones in the foot and can clearly show any abnormalities like bone spurs, MRIs to get more detailed images of the soft tissues around the bone spur which can help assess the extent of damage or inflammation, ultrasounds, or blood tests to rule out other conditions. The experts at Advanced Orthopedics are not only immensely skilled, but they take the time to listen to your concerns, answer your questions patiently, and explain treatment options—including surgery if needed—in an understandable manner. If you want the best care and the best outcomes, look no further than Advanced Orthopedics. Schedule an appointment today.