Bone Spurs on feet

Triathlon Forum
1

Anybody have any experience with bone spurs? My wife was told she has bone spur(s) on her foot. I asked her what the resolution is and she said she will just have to deal with it. She has pain after running and massage seems to reduce the intensity. In researching this area I found causes but no solutions.
“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”).”

Peter S. Alfino
www.milehighmultisport.com

2

Depends on where the “bone spur” is. 26 bones and 33 joint in each foot and it makes an enormous difference where/why/what it is. Any more info here?

That said, if it is a “heel spur”, nothing needs to be done as they are found in many people and are often an incidental finding and now believed to not be the source of pain. If she was told it was, she should probably look elsewhere for treatment/guidance.

3

Thanks for the response. I spoke with her some more this even (she is on the road traveling) and she informed me pretty much what you just said. It isn’t the heel spur which is causing the pain. We are going to go to Active imprints in Boulder on Friday to get her some new orthotics.

4

Wow! I am curious about the new “outlook” (?) that heel spurs are found not to be the cause of pain. I have a friend who used to be a very good runner (ran a marathon best of 3hr 46 mins at 43 years - female - good enough to qualify for the US Olympic trials - so pretty good runner) Now is having trouble running at all. Sjhe has a VERY large heel spur. Honestly, she has shown it to me and it is a very large protrusion. I have previously thought that the only real solution was to surgically remove the heel spur. But she is very reluctant to have the surgery. On the other hand would really like to be able to run. Does not have to be competively, as before. But be able to run some. SO, if heel spurs do not cause the pain - got any ideas as to what she can do about this?
I/She would be really interested to know youtr views on this.
Thanks a lot.

5

First, I assume you mean 2:46 and not 3:46? :wink:

Second, yes, they can look pretty impressive on X-ray (I like to call them the “bottle opener sign”).

Third, need just a little more info as there are 2 main/common places one can develop a “heel spur”. The plantar spur that most people are referring to or a posterior spur into the Achilles tendon. They are very different animals. Since posterior heel spurs are more common in overweight people, we can likely assume the inferior variety. Also, she probably has a pes cavus (high arched) foot I’d wager. One would assume an avid runner has sought the advice of a local practitioner who sees runners? Yes, she should be very reluctant to have the spur removed since it probably isn’t necessary.

6

Cetainly I meant 2hr 46 min.
I did not see an x-ray (I am not a doctor - just a friend) So what I saw was the protrusion on the heel.
As for kind, um, not sure of the location of the two types that you mention. I think probably not plantar spur (does not complain about plantar) I think almost certainlyny “posterior spur into the Achilles tendon” Main complaint is that the Archilles gets irritated post running and can radiate up leg.
Yes, she does have a high arch.
Unfortunately when it comes to seeking advice she is somewhat hamperred by being in the Canadian Military. Seems that they have their own doctors and so she is not covered under the normal Canadian Health care system, unless she can persuade a Military doctor to refer her outside of the Military docs.
Can you give me any ideas as to the kind of treatment for this? (She has been told by every military sports med dr. that she has senn that it is due to the bone spur). How long has the thinking been changed on this?
I’m thinking that she should push for an outside referral.
Thanks a lot

7

Ah, unfortunately my reply to the OP was for the inferior “heel spur” variety.

Posterior spurs into the Achilles can very well be a constant source of pain/irritation (esp in a high arch foot which I assumed) in runners. Removal is still not a great idea since a lot of the Achilles tendon often needs to be reflected to get at it and recovery can be VERY long and protracted (like up to 1 year). The procedure itself is quite simple, technically though. However, if she literally couldn’t run because of it, her choice is simple: don’t run any longer (will likely even hurt eventually just walking) or get it fixed. That can be the harsh reality IF she has exhausted typical conservative measures (and there are many - should be discussed with her providers and I’m sure she has been through loads of PT, etc.)

8

http://i48.tinypic.com/al3nro.jpg
Unfortunately, the term “bone spurs” tells very little about the condition. the etiology of different spurs about the foot and ankle varies widely. Not all spurs are symptomatic and, in general, simply removing the spur may do little to alleviate symptoms.

Swelling in the back of the heel implies a disorder of the achilles tendon insertion. This encompasses a spectrum of pathologies from simple bursitis, to tendinosis (or -itis) to calcification within the tendon (see “heel spur”, above).

Conservative treatment includes ice, antiinflammatories, physical therapy, heel lift, orthotics, etc. More current non-operative approaches include injection of platelet rich plasma although long term studies are lacking. If you are Tiger Woods’ doctor, you migh throw in a little hGH. A penicillin injection may also be appropriate for Tiger.Cortisone injection should be avoided as it is associated with an unacceptably high possibility of tendon rupture.

Obviously avoidance of inciting factors may also allieve symptoms. Unfortunately, avoidance is occasionally an unacceptable alternative.

With failure of conservative treatment, surgery is a reasonable option. Surgical options depend upon severity of disease and range from endoscopic decompression to open debridement (“cleaning out”) and repair. When there is calcification within the tendon extensive open debridement with repair is required.

Post-operatively, regardless of procedure, early weight bearing and PT should be encouraged as the Achilles heals better under stress. If simple ecompression is required, one may consider returning to running after 6-8 weeks. If extensive debridement and repair is required, return to running may take 6 months. In either case, healing plateau may not be reached for 18-24 mos.

Certainly, if the only thing that hurts is running, and you can live without running, this may be preferable to surgery. If, however, other activities of daily living are affected, and running is critical to your happiness, surgery is reasonable. A return to painfree running is an obtainable goal. Expected distance and speed are debatable but, in the end, you will run faster and farther than you can now.