Bone spur treatments
Bone spurs are of three basic types. One is the kind that arises near a joint affected by osteoarthritis (degenerative joint disease.) The body tries to repair this damage. But the repairs result in growth of new bone along the sides of the existing bone (bone spurs). These "spurs" are called osteophytes. They are common features of the osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these osteophytes is an important part of joint replacement surgery, but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms. The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. Thus can occur on the bottom of the foot, around the Achilles tendon, and in the coroacoacromial ligament of the shoulder. The third method occurs when trauma to a bone or joint causes damage to the bone. As the body tries to heal this damage, new bone growth can develop causing a bone spur in that location. Hallux rigidus is the medical name for arthritis affecting the big toe. The joint at the base of the big toe is called the metatarophalangeal joint, or MTP joint. This is the junction of the long bone of the forefoot, and the small bone of the big toe. Because of the mechanics of our feet, this joint is especially prone to developing arthritis. In fact, hallux rigidus, or big toe arthritis, is the most common site of arthritis in the foot. The most common symptom, and the most common reason to seek medical attention for this problem, is pain around the base of the big toe. This pain is accentuated with activity, especially running or jumping. Often wearing firm soled shoes that prevent motion at the base of the big toe will help relieve symptoms. Your doctor will test the mobility of the joint, usually comparing it to the opposite foot to see how much motion is lost at the joint. X-Rays are done to determine if the joint cartilage is worn away, and to see if bone spurs have formed in this area. Determining the extent of the arthritis will help guide treatments. The most common treatments include: • Wearing stiff-soled shoes limits motion at the base of the big toe. Inserts can be made for shoes that can help your existing footwear. Other shoe-wear modifications include shoes with a wider toe box, or rocker-bottom heels that allow foot motion without as much bending. There are many causes for heel pain--from a sprain to fractures and arthritis--but one of the most common causes of heel pain is inflammation of the plantar fascia (plantar fasciitis), with or without associated spur bone formation. The inflammation is due to repetitive and excessive stretching of the plantar fascia. Most people develop irritation and inflammation of the plantar fascia because of “overuse” of their feet by excessive running, jumping, jogging or twisting of the feet, resulting in excessive pronation (inner turning of feet). The injury may also result in small tears of the plantar fascia. The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia. Symptoms tend to worsen after standing and walking, in the morning, after awaking or after prolonged sitting. This happens because the fascia is being stressed again after a protracted rest. As the person walks, the fascia “warms up” and lengthens slightly, reducing the tension and the associated pain. The repetitive stretch of the fascia over years can also irritate the insertion site of the fascia to the heel bone and lead to the growth of a hook-shaped spur of the heel bone. A common misconception is that the heel pain is mostly due to the bone spur. The truth is that the pain is due primarily or exclusively to the inflammation of the fascia (plantar fasciitis) and not to the bone spur because significant heel pain occurs in the absence of spurs, and large bone spurs can be detected by X-rays in people with no heel pain. The treatments recommended for plantar fasciitis include symptomatic treatment for pain, treatment directed to improve the blood flow to the sole, anti-inflammatory medications, and treatment designed to reduce the load or stress on the plantar fascia. Surgical treatment is only of last resort and is often not very successful. Outpatient physical therapy for ultrasound treatment and muscle stimulation is helpful. Alternate hot and cold applied locally will increase the blood flow to the foot and “wash out” pain chemicals that accumulate in the area. Your doctor will advise you how to do that safely. People with diabetes, peripheral neuritis, and any condition making them insensitive to temperature changes, should not try at all the alternating hot/cold treatment unless specifically approved by a physician. Resting provides only temporary relief. A special custom splint worn at night to keep the plantar fascia on a gentle stretch so that any injuries to the plantar fascia may heal in a proper position is sometimes effective. Another modality is taping of the feet with athletic or podiatric bandages. Wearing shoes with higher than ordinary heels, firm heel pads, arch supports, or special orthototic support shoes are other things that work. Special exercises that stretch the Achilles tendon, lengthen this tendon, and reduce the stress on the plantar fascia also are advised. Sometimes a patient needs to replace jogging or running and other foot dependent exercises with non foot straining sports such as swimming. Losing weight reduces the load on the affected heel. A last resort treatment, surgery is usually done under local anesthesia and consists of a fascia release procedure in which the fascia is partially cut to release the tendon’s tension. Although bone spur removal may also be done at the same time, it is not the critical curing procedure. Just above the foot, the ankle may also be affected by spur formation. The ankle consists of two joints. The upper ankle joint is composed of three bones: • the shinbone (tibia) This is called the tibial talar joint and allows the foot to bend up and down. Right below the tibial talar joint is another joint (subtalar), where the talus connects to the heel bone (calcaneus). This joint enables the foot to rock from side to side. Three sets of fibrous tissues connect the bones and provide stability to both joints. The knobby bumps you can feel on either side of your ankle are the very ends of the lower leg bones. The bump on the outside of the ankle (lateral malleolus) is part of the fibula; the smaller bump on the inside of the ankle (medial malleolus) is part of the shinbone. Most bone spurs in the ankle are caused by osteoarthritis. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur. Bone spurs can also be caused by an injury to the ankle joint. In the process of trying to heal the injury to the bone cause by the trauma to the ankle, the body may overcompensate and cause calcium to build up and this turns into a bone spur. Most bone spurs on fingers are caused by osteoarthritis. Nodules affecting the outer row of joints (distal interphalangeal joints) are called Heberdens nodes and the spurs that affect the next row in (proximal interphalageal joints) are called Bouchards nodes. Bone spurs can also be caused by an injury to a finger joint. In the process of trying to heal the injury to the bone cause by the trauma to the finger joint the body sometimes over compensates and in the process causes calcium build up which forms into a bone spur. Most bone spurs in the elbow are caused by osteoarthritis. Bone spurs can also be caused by an injury to the elbow joint. Bone spurs are common in the hip joints. Most bone spurs in the hip are caused by osteoarthritis. They tend to grow outward from the acetabulum (the cup-like part of the pelvis that interacts with the femur). There are two common places for bone spurs in the shoulder. The first is in the joint itself and is caused by osteoarthritis. The second is where tendons meet the bone. The chronic tugging of the tendon from the bone leads to bone spurs. Treatment for bone spurs rests on a few common principles. Pain associated from a bone spur is commonly caused by irritation of the surrounding tissue. Giving that tissue a rest from the irritation can significantly reduce the pain. Anti-inflammatory medications are often given to help control the pain and the inflammation caused by the bone spur. Muscle relaxants are sometimes given when the irritation causes muscle tension or spasms. Some times cortisone injections are given in the area of the bone spur to control the pain and inflammation. One of the more common locations for bone spurs is the spine. Bone spurs, called osteophytes, are due to osteoarthritis. Osteophytes develop as a result of chronic pulling by ligaments over a long period of time. The spine consists of 32 vertebrae separated by intervertebral discs which function as shock absorbers in front and by facet joints in the rear. Motion between each vertebrae is limited by ligaments in the front as well as facet joints in the back. Between each set of vertebrae a pair of nerve roots exit from the spinal cord through small holes called the neural foramina. The process of osteoarthritis in the spine is as follows... 1. As discs degenerate, ligaments loosen. Also, progressive spur formation and ligament enlargement can lead to narrowing of the spinal canal and result in spinal stenosis. This condition can cause nerve and spinal cord pinching, leading to pain down the legs that is worsened with standing and walking, and relieved by sitting. Back pain or neck pain are very common with inflammation of the facet joints and subsequent irritation of neck and back muscles leading to spasm. Patients usually complain of: • Dull pain with standing and walking Not surprisingly, osteoarthritis pain due to bone spurs is made worse with activity and improves with rest. Arthritis pain in the low back improves with bending forward and worsened by extending the low back. If the arthritic progresses and stenosis is severe, bowel and bladder dysfunction occurs Diagnostic evaluation begins with the history and physical examination. Common diagnostic tests include: EMG and nerve conduction test (EMG/NCV) tests will exclude peripheral nerve compression such as cubital tunnel syndrome and carpal tunnel syndrome. X-rays of the spine can determine the extent of arthritic changes and bone spur formation. Computerized tomography (CT scans) and/or MRI scans can provide more detail than x-rays. Most patients with mild or moderate nerve compression from bone spurs can be managed effectively with conservative treatment, such as: • Medications like anti-inflammatory medications and muscle relaxants. Early referral to a neurosurgeon is indicated if there is evidence of progressive neurologic deficit. Surgery for bone spurs becomes necessary only if nerve or spinal cord compression causes intractable pain or progressive neurologic deficit.
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