Bone spurs in the feet
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Bone spurs in the feet can be due to either "traction" or to osteoarthritis.
We'll discuss traction types first. Attachment of ligaments or tendons to bone become calcified. This can occur on the bottom of the heel due to traction placed on the heel by the plantar fascia or at the back of the heel due to traction exerted by the Achilles tendon.
One of the most common causes of heel pain in the bottom of the heel 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. Others develop the condition because they wear shoes with little arch support.
The pain is described as being a dull aching or a sharp pauin and can be reproduced by flexing the toes upwards (dorsiflexion). Symptoms tend to worsen after standing and walking, first thing in the morning after awaking or after prolonged sitting. This happens because the fascia is being stressed again after a rest. As the person walks, the fascia “warms up” and lengthens slightly, reducing the tension and the associated pain.
Repetitive stretching of the fascia over time can irritate the insertion site of the fascia at the heel bone and lead to the growth of a hook-shaped spur. 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.
Resting provides only temporary relief. A special custom splint worn at night to keep the plantar fascia in a gentle stretch is sometimes effective. Another modality is taping of the feet with athletic bandages. Wearing shoes with higher than ordinary heels, firm heel pads, arch supports, or special orthototics may work. Special exercises that stretch the Achilles tendon, and reduce the stress on the plantar fascia also are advised. Sometimes a patient needs to replace old running shoes. And sometimes patients may need to switch their exercise regimen from foot dependent exercises with non foot straining sports such as swimming. Losing weight reduces the load on the affected heel.
The treatments recommended for plantar fasciitis include symptomatic treatment for pain, treatment directed to improve the blood flow to the heel, anti-inflammatory medications, and reduction of the load or stress on the plantar fascia. 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
More recent effective treatments include ultrasound-guided injections of platelet-rich plasma (PRP) or Botox, and shock wave therapy. Steroid injection should be used very sparingly as steroids thin the heel fat pad and aggravate the condition. Surgical treatment is only of last resort and is often not very successful.
Surgery is a last resort treatment that 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.
A similar situation occurs at the Achilles insertion and the same types of treatment are often aimed at the Achilles. Special exercises that stretch the Achilles tendon may be helpful. Again, ultrasound-guided injection of PRP is often curative for Achilles problems. Steroids should never be used here because they increase the risk of Achilles rupture.
Osteoarthritis can cause bone spurs, called osteophytes, to develop usually at the base of the big toe or in the tarsal metatarsal joints of the top of the foot.
These spurs are difficult to treat. Occasionally steroid injection and physical therapy along with padding and wearing non-compressive shoes can help. Ultrasound-guided needle tenotomy with injection of platelet-rich plasma (PRP) may be very helpful. Surgery is a last resort and is usually not very successful. One exception might be severe osteoarthritis with the formation of a bunion involving the great toe where surgery is often effective.
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