A bone spur is an outgrowth of bone that develops along the edges of bones, often where two or more bones meet. When the body detects an injury or inflammation, it triggers a cellular response to repair the damage by producing excess bone in the area. Bone spur is actually way of body trying to heal the damage.
Common areas for bone spur include the shoulder, hand, hip, knee, heel and spine. Degenerative arthritis (osteoarthritis) is a leading cause of bone spur development on weight bearing joints in the spine, knee and hip. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time.
In a lot of cases, bone spur is small, smooth and non-painful. Many people live with bone spur for years and only discover it after getting an X-ray for another reason. However, it can cause symptoms when it is compressing or irritating nearby soft tissues such as ligaments, tendons, or nerves in the body.
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Signs and Symptoms
The most common symptoms of bone spur are pain, stiffness and loss of movement in the affected joint.
Signs and symptoms vary depending on where the spur is located.
In the shoulder, spur may rub against the rotator cuff tendons, leading to tendonitis or a tendon tear.
In the hand, spur may form in the finger joints, causing loss of joint movement and a knobby appearance in the fingers.
In the hip and knee, spur can lead to stiffness and a loss in range of motion.
In the foot and ankle, spur can cause pain in the bottom of the foot or heel for weight bearing activities like standing, walking, jogging, or running. In the spine, weakness or numbness in the arms or legs caused by the bone spur pinching its nerve roots.
Risk factor
(a) Aging
Aging is associated with higher bone spur grade at the lumbar spine (lower back) and outward bone spur size at the knee. Spinal bone spurs have been reported in up to 60% of women and 80% of men aged 50 years.
(b) Obesity
Increased body mass index (BMI) is associated with larger bone spurs at multiple joints.
(c) Types of activity
In 51 subjects with a mean age of 60 years who exercised regularly, painless weight bearing activity did not accelerate osteophytosis in the knee. Yet, in a UK study of 499 men, heavy physical activity was associated with development of bone spurs. In a Japanese cross-sectional study, occupational kneeling and squatting (defined as > 1 hour per day) was associated with increased area of knee bone spurs.
(d) Dietary factor
The bone spur area was associated with a low level intake of vitamin E, vitamin K, vitamin B1, vitamin B2, Niacin and vitamin B6. In a cross-sectional study of elderly people, low serum β-carotene level was a strong risk factor for lumbar bone spur formation.
Conservative Treatment
Non-painful spur does not require any form of treatment. If it is causing pain and symptoms, physiotherapy is an alternative method for pharmacology. A course of physiotherapy can be beneficial in reducing the inflammation, regaining joint movement and range of motion, strengthening the muscles, and increasing the level of physical activity.
Therapeutic ultrasound and especially extracorporeal shock wave therapy (ESWT) can be considered as the first step of treatment for heel spur associated with inflammatory of plantar fasciitis, due to the effectiveness, the reduced costs and the safety of the procedure (Pawel Lizis, 2018). The heat produced by electrotherapy leads to various changes typical of this energy: congestion, increased metabolism, increased the extensibility of collagen fibers, increased enzyme activity, decreased muscle tone, changes in nerve conduction, pain relief, and decreased joint stiffness.
Non Conservative Treatment
In some cases, bone spur is directly pressing on nerves causes significant pain, weakness and loss of movement. If pain and symptoms are not relieved with the conservative treatment options, then surgery may be necessary. Many bone spur removal surgeries can be performed with minimally invasive techniques.
References:
1. Siu Him Janus Wong, Kwong Yuen Chiu, Chun Hoi Yan. 2016. Review Article: Osteophytes. Journal of Orthopaedic Surgery 24(3):403-10.
2. Pawel Lizis. 2018. Chosen Conservative Treatments on the Symptoms of Calcaneal Spur: A Short Review. Int J Foot Ankle 2:006.
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