| A bone spur is an irregular projection or outgrowth of bone that appears most often on the spine and the heel but may also appear on the knee, elbow, hip, shoulder, nose, mouth, finger, toe, or neck.
Bone spurs resulting from changes to bones that occur over time are caused by degenerative processes including repetitive stresses and inflammation (osteoarthritis). In the case of the spine, the discs between vertebrae tend to toughen and shrink with age. Meanwhile, the tough, elastic cartilage at the ends of the bones progressively hardens. As the space between the vertebrae narrows, the bone tends to compensate for the loss by growing the knobby-like enlargements known as bone spurs. Microscopic instability develops. The body attempts to compensate for this instability by the growth of bone spurs, which attach to ligaments and thus stabilize the spine.
Unlike the rounded ends of bones in normal joints, bone spurs do not develop a layer of protective cartilage. In some cases, the new bony surfaces eventually smooth themselves through normal movement. When they do not, bone spurs can rub against other bony surfaces, nerves, or blood vessels, causing pain and inflammation.
In the case of the heel, bone spurs are thought to be caused by excessive pulling on the heel bone by the plantar fascia, a ligament like structure on the bottom of the foot. As the abnormal pulling of the fascia irritates the heel bone, the body responds by producing a bone spur as a protective mechanism. The spur is the body's attempt to anchor the plantar fascia to the bone as it tries to pull out of the bone. While these spurs on the os calcis (heel bone) can be seen on x-rays, they do not cause pain.Risk: Risk factors for bone spurs in general include advancing age, heredity, disc problems, an occupation requiring unusual, repetitive stress (e.g., dancer, athlete, laborer), and traumatic forces (e.g., motor vehicle accidents and sports-related injuries). Incidence and Prevalence: The incidence of spurs increases with advancing age. In persons over age 60, bone spurs are quite common ("Bone Spurs"). |
Source: Medical Disability Advisor
| History: Heel spurs, although visible on x-ray, are asymptomatic. Plantar fasciitis is the real name for the "heel spur pain syndrome," although the spur is not the cause of the pain. Individuals with spinal osteophytes (spurs involving the spine) may have worked in occupations with heavier ergonomic stress, or may have inherited a tendency to develop these degenerative changes. Physical exam: When the physician touches (palpates) the affected area, the individual with a bone spur may experience discomfort or pain. Most spurs are asymptomatic on examination. Tests: The usual test to confirm bone spurs is an x-ray of the affected area. However, x-ray results should be viewed with caution. First, x-ray does not always detect very small bone spurs, and, second, many individuals with a bone spur on their x-ray never develop symptoms. Magnetic resonance imaging (MRI), computed tomography (CT), or electromyography (EMG) may be used if symptoms suggest impairment of nerves or muscles. |
Source: Medical Disability Advisor
| Treatment is directed at the cause of the patient's pain. Other than in the spine, osteophytes are not usually a cause of pain. Spinal osteophytes may cause nerve root compression, and acromioclavicular osteophytes may impinge on the rotator cuff. Treatment varies depending on the joint involved.
Spinal osteophytes that cause symptoms by impinging on the nerve roots or the spinal cord may require surgical treatment. Acromioclavicular osteophytes that impinge on the rotator cuff may require arthroscopic or open debridement (surgery). |
Source: Medical Disability Advisor
| In general, the predicted outcome for bone spurs is good in that the symptoms associated with many bone spurs can be resolved with conservative treatment. However, even though symptoms usually resolve, the spur persists and may gradually enlarge. Surgical results (removal) for bone spurs are not predictable. Occasionally, pain persists even after surgery. And, surgical relief may be temporary because bone spurs can and do grow back. |
Source: Medical Disability Advisor
| Note on research and authorship Rehabilitation for bone spurs depends on the location of the bone spur as well the extent of the condition. Individuals with bone spurs may require outpatient physical therapy to address pain and swelling, whether or not surgery is anticipated.
The primary focus of rehabilitation is to reduce the pain associated with the spur. This can be achieved by reducing pressure on the surrounding tissue and using heat and cold. The therapist will reduce the pressure on the spur through activity modification, and/or use of orthotics, such as heel cushions (Probe). However, night splints have not been shown to reduce the pain associated with bone spurs on the heel.
A general stretching and strengthening exercise program is indicated to normalize muscular imbalances in the involved area. In addition to undergoing supervised rehabilitation, the individual should be instructed in a home exercise program to be practiced daily and continued independently under physician supervision after the completion of rehabilitation. |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical Therapist | | Up to 12 visits within 6 weeks | |
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| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| As spurs enlarge, in some locations they can cause symptoms by impinging on adjacent structures (spinal nerve roots, rotator cuff, etc). |
Source: Medical Disability Advisor
| The treatment and the condition itself may limit the individual's ability to return to previous work activities (temporarily in some cases). If a lower extremity is involved, use of an assistive device, such as a cane or walker, may be necessary to minimize weight and pressure on the area. If an upper extremity (shoulder) is involved, restrictions may include limited or no overhead lifting and heavy carrying. Use of prescribed medications for management of pain and inflammation may require review of drug policies. Safety issues may need to be evaluated. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Where are the bone spurs located?
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Is pain present? Do numbness or pin-and-needles sensations occur? Does individual report sharp pain when putting weight on the feet?
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On physical exam, was the area tender to palpation?
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Was an x-ray done? MRI, CT, or EMG? Gait analysis?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Are anti-inflammatory agents being used for pain relief?
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Does individual have appropriate orthopedic support?
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Were physical therapy modalities used?
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Was surgery necessary?
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Does individual have a recurrent bone spur?
Regarding prognosis:
- Is individual active in rehabilitation?
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Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Has individual developed osteoarthritis or inferior calcaneal bursitis?
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Source: Medical Disability Advisor
| "Bone Spurs (Osteophytes) and Back Pain." Spine-health.com. 1 Dec. 2004 <http://www.spine-health.com/topics/cd/spurs/spurs01.html>.Probe, R. A., et al. "Night Splint Treatment for Plantar Fasciitis. A Prospective Randomized Study." Clinical Orthopaedics and Related Research 368 (1999): 190-195. National Center for Biotechnology Information. National Library of Medicine. 1 Dec. 2004 <PMID: 10613168>. |
Source: Medical Disability Advisor
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