What is a heel or bone spur?
A heel spur is a type of bone spur (osteophyte) that develops on the heel bone (calcaneus). 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. In addition to the heel, other common places for bone spurs include the spine, shoulders, hands, hips, and knees.
What causes it?
A bone spur forms as the body tries to repair itself by building extra bone. It typically forms in response to pressure, rubbing, or stress that continues over a long period of time.
Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Also, the discs that provide cushioning between the bones of the spine may break down with age. Over time, this leads to pain and swelling and, in some cases, bone spurs forming along the edges of the joint. Bone spurs due to aging are especially common in the joints of the spine and feet.
Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a "heel spur"). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a "pump bump," because it is often seen in women who wear high heels.
Another common site for bone spurs is the shoulder. Your shoulder joint is able to move in a number of directions due to its complex structure. Over time, the bones, muscles, tendons, and ligaments that make up your shoulder can wear against one another. The muscles that allow you to lift and rotate your arm (called the rotator cuff) start at your shoulder blade and are attached to your upper arm with tendons. As these tendons move through the narrow space between the top of your shoulder and your upper arm, they can rub on the bones. Bone spurs can form in this narrow area that, in turn, pinch the rotator cuff tendons, resulting in irritation, inflammation, stiffness, weakness, pain, and sometimes tearing of the tendon. This condition, rotator cuff disorder, commonly occurs with age and/or repetitive use of the shoulder. It is also common in athletes, especially baseball players, and in people such as painters who frequently work with their arms above their heads.
What are the symptoms?
Many people have bone spurs without ever knowing it, because most bone spurs cause no symptoms. But if the bone spurs are pressing on other bones or tissues or are causing a muscle or tendon to rub, they can break that tissue down over time, causing swelling, pain, and tearing. Bone spurs in the foot can also cause corns and calluses when tissue builds up to provide added padding over the bone spur.
How is it diagnosed?
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see whether you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.
How is a bone spur treated?
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, the symptoms, or the bone spurs themselves.
Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis.
Treatment directed at symptoms could include rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. If a bone spur is in your foot, changing footwear or adding padding or a shoe insert such as a heel cup or orthotic may help. If the bone spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist (foot doctor) may be consulted if corns and calluses become a bigger problem. If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection at the painful area to reduce pain and inflammation of the soft tissues next to the bone spur.
Sometimes the bone spurs themselves are treated. Bone spurs can be surgically removed in some instances but oftentimes, surgery is not required.