Bone Spurs

BONE SPURS, limited, pointed outgrowths of bone, most commonly of the heel. The location of bone spurs of the heel bone is the medial prominence of the plantar process of the calcaneal tuberosity, where the m. flex. dig. brev. and m. abd. hallucis, as well as the plantar fascia, attach to it. According to Reclus, Schwartz, Adams, bone spurs of the heel bone occur most frequently. More rarely, bone spurs are noted on the posterior process of the heel bone and on the epiphyses of other bones, for example, on the olecranon process. The etiology of bone spurs is unclear. According to the opinion of most authors (Konig, Jacobsthal, Hohmann, etc.), they arise on the basis of acute or chronic trauma, for example, as a result of excessive load. According to Chrysospates, bone spurs are a variant of the skeleton and develop as a result of deviation during the growth period under the influence of muscle traction. Ebbinghaus considers that heel bone spurs are congenital, but under the influence of mechanical causes they may increase. Pathological-histological examination of bone spurs reveals the structure of bone tissue, in some cases with inflammatory phenomena. Symptomatology. Bone spurs are observed more often in men than in women, occur at various ages (from 16 to 70 years), and in some cases proceed without any symptoms, remaining unnoticed by patients; such 'asymptomatic' bone spurs are sometimes accidentally discovered on X-ray films. The main symptom of bone spurs is pain, and as a result, when the heel bone is affected, patients acquire a characteristic gait. With unilateral disease, the patient walks, placing the affected limb mainly on the toes and thereby freeing the heel from pressure and load. With bilateral involvement, this tendency of the patient to relieve the heels from pressure gives him a characteristic sliding gait, and he little lifts the feet and uses primarily the anterior points of support of the foot. The pain in bone spurs, according to Konig, Jacobsthal, and others, depends on the inflammation of the bursa lying on the spur; according to Roman, inflammation of the nerve branches passing through the bursa plays a significant role in the development of pain; according to Yanovsky, the pain may be associated with flat feet, since in these cases the apex of the spur, directed vertically, presses on the soft tissues; according to Braytsev, the pain is caused by inflammatory changes in the periosteum and possibly inflammation of the bursa. The main role in the diagnosis of bone spurs is played by X-ray film, where they are usually detected in the form of a spike, sometimes with a pointed end. It is necessary to take films symmetrically from both sides. Differential diagnosis must be carried out with chronic arthritis and osteomyelitis of this area, as well as with gout, with radiography playing a decisive role. Treatment of bone spurs in mild cases is conservative, in case of its failure and in severe suffering - operative. In flat feet, correction of the foot must first be carried out. In some cases, wearing shoes with a special rubber cushion in the form of a ring for the heel helps; physiotherapy is desirable. Operative treatment should consist in removing the spur with the surrounding periosteum and bursa, with a flat, if possible extensive, incision of the bone around the spur. With non-radical operation, recurrences are possible, which is often noted in the literature. For better access in bone spurs of the plantar process of the heel bone, an arcuate incision along the posterior edge of the heel is recommended with detachment of the attachment of the plantar aponeurosis and muscles to the tuberosity.