A closer look at a thorny problem
By Lance Silverman, MD
From Minnesota Health Care News
Bone spurs (osteophytes) are a common ailment. A spur is a tiny, rigid outgrowth of bone that develops in the capsules (coverings) of joints and within tendons and ligaments. This condition occurs when individuals put wear and tear on their bodies over an extended period of time. That’s why spurs are common in athletes and people who are middle-aged or older. Sometimes, symptoms of bone spurs become less noticeable after extensive physical therapy, while at other times, surgery is necessary to address the problem.
Bone spurs are the body’s response to repetitive stress and typically form along an area of bone where there is excessive pull on a tissue as it inserts into bone. When this tension is repetitive, eventually the tissue tears. Tearing tissue bleeds internally and forms a clot, which results in the formation of scar tissue. In a setting of repeated stress or recurrent injury, scar tissue tears. If scar tissue tears repeatedly, the body may make something it knows is more permanent and resistant to tearing: bone.
There are several situations that make bone spurs develop. For example, muscles that are too tight can stress a tendon at the point where it inserts into a bone. This situation eventually makes the tendon tear. Calcifications (i.e. calcium deposits) subsequently develop within the tendon and ultimately become bone spurs.
Another situation occurs when cartilage degenerates in a joint, and the space within the joint subsequently collapses. As a result, the joint becomes slightly loose. This looseness can lead to abnormal motion and stress on the connective tissue surrounding the joint (the joint capsule), causing small tears in the tissue. Eventually, those tears form spurs.
Spurs develop rapidly when there are chronic ligament injuries around a joint that cause the joint to move abnormally. Spurs also develop rapidly if rips in muscle or tendon make joints move in dysfunctional patterns because the resulting stress imparted to the joint capsule is abnormal.
Spurs themselves rarely hurt unless they press on soft tissue and cause pain, numbness, and/or weakness. They also have specific symptoms depending where they develop.
Knee. Bone spurs in the knee can make it difficult to fully extend the leg. Some spurs rub on tendons or ligaments that help support the knee joint. Spurs in the knee may cause further damage to ligaments or tendons near the affected area.
Spine. These spurs can cause nerve or spinal cord damage. Spurs form in the cervical (neck) or lumbar (lower back) areas of the spine because of joint instability or from joint degeneration. If the spurs press on nerves that pass from the cord into arms or legs, they can
cause radiating pain, numbness, and muscle dysfunction. If spurs in the cervical or lumbar spine take up space within the spinal canal, nerves become crowded, and symptoms of stenosis can develop: incontinence and/or persistent pain, numbness, or weakness in the back, legs, or arms.
Shoulder. Spurs here can injure muscles in the rotator cuff, a common condition affecting baseball pitchers and quarterbacks. Rotator cuff injury can cause spurs because if the rotator cuff doesn’t move perfectly, its abnormal motion puts stress on the joint and the deltoid muscle. Stress in these areas can lead to the development of spurs that can further injure the rotator cuff, causing more abnormal motion.
Heel. These spurs typically develop in two locations: the insertion of the Achilles tendon at the back of the heel and just above the plantar fascia on the bottom of the foot. Symptoms of the former include pain in the back of the heel that makes wearing shoes difficult. In contrast, a plantar heel spur forms within the muscle of the foot and is rarely painful because it presses on no other tissues. It is a sign, however, that the foot muscle has felt excessive stress, as the plantar fascia support has failed. This torn tissue forms a painful,
thick scar that may cause additional symptoms if it presses on nerves in the foot.
Ankle. In patients who develop flat feet as adults, spurs develop as the pressure in the ankle is distributed more to the outside, creating an imbalance. More commonly, spurs develop in the front of the ankle as a result of repetitive ankle instability. A bad sprain from childhood can come back to haunt someone 20 or 30 years later. Ankle spurs limit range of motion in the ankle, which may lead to an altered gait and contribute to tendon tearing.
Toes and fingers. Bone spurs in these areas can lead to tenderness and a knobby appearance. Fingers and toes may look disjointed if spurs prevent them from fully extending or contracting. Abnormal muscle forces cause the toes to bend and form hammertoes, a condition
in which toes resemble hammers. Spurs subsequently develop within the small toe joints.
Most doctors can diagnose bone spurs in an affected region based on symptoms, but routine imaging techniques are used to get an idea of spurs’ size and cause. Common ways a doctor looks for bone spurs include X-rays, ultrasound, MRI scan, or CT scan. If spur symptoms interfere with a patient’s activity, goals, athletics, or daily comfort, treatment is recommended.
If symptoms are minimal, a doctor may prescribe anti-inflammatory drugs to help manage pain. Physical therapy also is used to build strength and promote functional motion that may prevent the spur from creating or worsening symptoms.
When anti-inflammatories or physical therapy don’t manage pain sufficiently or don’t return the patient to his or her desired level of function, surgical removal of the spur may be recommended. Surgical procedures differ based on where the spur is located.
Many people focus on the spur as the source of the problem, but spurs, as discussed above, form for a reason. The body is trying to tell us something is wrong with a specific joint. Consequently, cutting spurs out is a short-term solution to a longer-term problem. It is often not the best solution. However, simple surgical removal does make a patient feel better quickly without much downtime. Consequently, doctors and patients are often drawn to this as a quick fix.
In certain areas of the spine, for example, surgically removing a spur can relieve pain caused by the spur pressing on a nerve, but it will not fix the dysfunctional motion that led to the spur formation. Only physical therapy can do that. Sometimes, spinal fusion is performed to address pain caused by a spur. Fusion, however, may create more stress on surrounding joints and make them develop spurs, necessitating more surgery.
In the foot or ankle, removing a spur without addressing its cause similarly fails, typically within five years, and the spur recurs.
Patients can help prevent spur formation by maintaining a healthy weight, as excess weight stresses joints. Every excess pound lost dramatically reduces force around the hip, knee, ankle, and foot. Undergoing a functional movement screen by a physical therapist can identify abnormal muscular patterns that promote spurs and that are correctable with simple exercises. Finally, patients who have had spurs are more likely to prevent their recurrence with physical
therapy and surgical procedures that reconstruct ligaments or treating tendons rather than by spur removal alone.
Lance Silverman, MD, is board-certified in orthopedic surgery and sees
patients at the three locations of Silverman Ankle and Foot, including
Apple Valley Medical Center.