Health Matters: Bone spurs common in lower extremity

ESCANABA — What follows is a common scenario: an individual experiences pain from the bottom of their heel. They mention it to their primary care provider who sends them for x-rays, an effective means of evaluating osseous tissue, i.e. bone. Examining the radiographs, the PCP finds a large spike of bone exactly where the patient is experiencing their pain. The obvious conclusion is the spur is causing the individual’s pain.

Bone is an interesting tissue, at least in part because of how it responds to stress. Obviously, bone must be produced for growth and repair. And many things can stimulate the process of bone growth, with the individual’s metabolism, nutrition, and blood flow, all being important factors, although this list is not inclusive. Unfortunately, bone production can be pathologic, meaning many situations can lead to abnormal bone growth.

Our patient has been told they have painful bone spurs, and naturally wonder what’s next? Does the spur need to be removed to obtain relief? For this patient, the healthcare provider injected a corticosteroid into the area (colloquially referred to as cortisone). Lo and behold,

tremendous relief is obtained. But if it’s a bone problem, how could an anti-inflammatory provide relief?

Not all bone spurs are painful. A spur on the bottom of the heel is rarely a weight-bearing structure, but instead is pointing outwards, towards the toes, hiding under the arch. This type of spur results from the pulling of the arch ligament on the heel bone. Bone reacts to stress, not by wearing out, but by overgrowing. Thus, this spur develops over time from a tight arch ligament (which is what generates the pain). When this type of tissue is physically stressed, painful inflammation frequently results.

Another common site for spur formation is around a joint that is not moving or functioning correctly. When joint motion produces a jamming phenomenon of the two bones composing the joint, the physical stress leads to inflammation, and over time, bony overgrowth, aka spurring.

The changes leading to inflammation will also commonly lead to pain as well. Maybe more important in the long run, degeneration of the cartilage lining the surface of the joint always degrades over time.

A frequent destination for spur formation is at the top of the big toe joint. The anatomy of this particular articulation is quite complex, and its motion found nowhere else in the human body. Alignment of the structures involved is critical to normal function, and when abnormal, physical stress is going to occur with gait. With time, this jamming leads to pain and spurs. These can become quite large and externally obvious. Naturally, shoe pressure is a common source of problems when these occur.

Certain disease processes will lead to bone spurs. Rheumatoid arthritis, an autoimmune disease, frequently leads to joint pain and swelling, along with enlargement and overgrowth of the bone around the joint. But bone loss is seen as well in this and other conditions making for significant deformity, a digit so affected becoming bent out of position, leaning off in some bizarre direction. Consequently, shoe fit can be treacherous.

Bone spurs in certain locations will understandably lead to symptoms, such as the top of the instep of the foot, where shoes are a consistent source of pressure. Extra bone is produced here usually due to the aforementioned jamming process, with a person’s foot shape and function having a tremendous influence over the severity of the pain. Almost as common as spurs at the bottom are those behind the heel bone, in back where the Achilles tendon attaches. These form also as a result of the pull of this large tendon. Numerous factors go into the formation of these bony growths, like a tightened Achilles which increases the pull of the tendon on the bone.

A discussion of therapeutic measures is difficult since there are so many types, with an even greater number of causes. Often a bone spur produces no symptoms and demands no treatment. This may seem counterintuitive, as in the case of the (bottom) heel spur, where an often debilitating pain originates.

Making room for the spur is a frequent approach and is occasionally successful. The inflammation that leads eventually to bone production can be reduced with an injection of anti-inflammatory medicine, although we currently have no medication which will dissolve bone. Surgical removal can be a simple matter, depending once again on the location and type of spur. This can often be performed through a tiny incision utilizing minimally invasive techniques.

Spurs are common but need not be a source of difficulty or discomfort. A bump of bone can sometimes be a tumor, but that’s a wholly different discussion. The most productive approach when symptomatic will generally be utilized by a physician specializing in care of that structure or region of the body. But there are going to be a plethora of different methods and varying benefits. Be an educated health consumer. It’s the only body you have, so take care of it: find good people to help you care for it.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.


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