Bone Spurs

A bony growth formed on a normal bone is termed osteophyte or bone spur. It is an extra bone. Although bone spur can be smooth, it can cause wear and tear with pain in the area when a bone rubs with other bones or soft tissues such as ligaments, tendons or nerves in the body. The most common places in the body where bone spurs occur include the spine, shoulders, hands, hips, knees and heel.

Causes of bone spurs

The body tries to repair itself by building extra bones. These are formed in response to pressure, rubbing and stress that exist over a period of time. Bone spurs can also be formed due to the aging process. Cartilage breaks down and wears away with age. This leads to pain and swelling in some cases when bone spurs are formed along the edges of the joint. When ligaments get tight, bone spurs could be formed. Activities such as dancing and running that lay stress on the feet, excess weight or poorly fitting shoes could lead to formation of bone spurs.

During such times that long ligament gets inflamed and the bone tries to mend itself, a bone spur can form on the bottom of the heel. Pressure behind the heel from frequently wearing shoes that are too tight can cause bone spur at the back of the heel. This is also popularly called 'pump bump' as women who wear high heels suffer from this.

When tendons move through a narrow space between the top of shoulder and upper arm, they rub on the bones. Bone spurs can form in this narrow area. This can pinch the rotator cuff tendons resulting in irritation, inflammation, stiffness, weakness and pain. This condition is called rotator cuff disorder. It occurs with age and due to repetitive tearing of the tendons, especially among athletes, baseball players and in painters who frequently have to work with arms above their heads. Traumatic injury and poor posture can also be potential bone spur causes and can lead to spine bone spurs.

Bone spur symptoms

Signs and symptoms of bone spurs depend upon their location. A bone spur in the knee is painful to the extent that it can bend your legs and prevent the knee from operating smoothly. A bone spur on the vertebra can narrow the space that contains spinal cord and can cause weakness or numbness in the arms and legs. A bone spur in the hip can make movement painful and reduce the range of the hip joint. Bone spurs in the shoulder can hinder rotator cuff movement. Bone spur in fingers appear as hard lumps under the skin and they can make the joints in the fingers look knobbly. When bone spurs begin to press on other bones or tissues thereby causing a muscle or tendon to rub, they can break that tissue can cause swelling, pain, and tearing. Bone spurs in the foot can cause corns and calluses when tissue builds up to provide an added pad over the bone spur.

Bone spur diagnosis

A bone spur is visible through an x-ray. But it is rare to take x ray just to see whether a person has bone spur or not. For instance if an X ray is taken to evaluate, say, an arthritis problem, bone spurs should be visible. During physical exam the doctor can feel around the joints to determine exactly where the pain comes from.

Treatment of bone spurs

As such bone spurs do not require any treatment unless they cause pain and damage to other tissues. Treatment should be directed at the causes, symptoms rather than the bone spurs themselves. Such treatment aimed at the cause of bone spurs include weight loss to take the pressure off the joints and for stretching the affected area when bone spurs occur in the heel cord or at the bottom of the your feet. In the case of plantar fasciitis and shoulder pain, it is better to get an ultrasound done or deep tissue massage on the advice of a physical therapist. Treatment could include rest, ice, stretching and non steroidal anti inflammatory drugs such as ibuprofen. Learn to protect your joints in case you are suffering osteoarthritis. In case of bone spur on the foot, changing footwear or adding padding or a shoe insert may help. A podiatrist may be consulted if the corns and calluses become bigger problems. A doctor could suggest a corticosteroid injection at the painful area to reduce pain and inflammation if the spur continues to cause symptoms. Bone spurs can be surgically removed or treated as part of surgery to repair or replace a joint when osteoarthritis has caused considerable deformity or if the range of motion becomes limited.

Osteoarthritis

Also known as degenerative joint disease or wear and tear arthritis, osteoarthritis is the most prevalent type of arthritis. The cartilage (a protein substance present in all joints, this substance serves as a cushion in between the bones) in the joints deteriorates over time thus leading to osteoarthritis. Generally women are more at risk of osteoarthritis when compared to men.

Osteoarthritis can affect any joint in the body but it largely affects the joints of the hips, feet, knees, spine and hands. The weight bearing joints get affected the most due to osteoarthritis. Usually a single joint is affected due to osteoarthritis but if osteoarthritis sets in the finger joints, it can affect more than one joint at the same time.

Causes for osteoarthritis

Protein content of the cartilage drops and water content increases with age. This will degenerate the cartilage thus causing osteoarthritis. Increased mechanical stress on the joints due to obesity can cause osteoarthritis. The knee joint, in particular, unable to take the excess weight will degenerate thus leading to osteoarthritis. People who are born with abnormally shaped joints risk osteoarthritis as their joints are put to undue stress thus causing early deterioration. Any external injury can cause degeneration of the joints thus leading to osteoarthritis. In rare cases heredity can be a cause for osteoporosis.

Symptoms of osteoarthritis

Symptoms for osteoarthritis vary from person to person depending on the severity of the problem. The most commonly prevalent symptoms for osteoarthritis are:

• Tenderness/softness of the joints even when light pressure is applied to the joint.
  
• Creaking/annoying feeling in the joint.
  
• Warmth in the joint.
  
• Fluid retention in few cases.
  
• Pain in the joint while using the joint, after use of the joint or after a prolonged period of rest of the joint.
  
• Bone spurs in the form of lumps occur in the joint.
  
• Reduced flexibility of the joint.
  
• Swelling of the affected joint.
  
• Stiffness of the joint, particularly in the mornings while you get out of the bed and after a prolonged period of rest.
  

Diagnosis of osteoarthritis

An x-ray can reveal the extent to which the joint is affected, be it bone spurs and narrowing of the joints. Arthroscopy and Arthrocentesis may be done. Fluid from the joint is drawn using a long sterile needle. This fluid is analyzed for determining the cause for the pain.

Treatment for osteoarthritis

Rest can help the joints recover to a great extent. Reducing weight can help relieve the strain on the joints thus reducing pain. Applying heat and cold packs alternately on the affected joint can relieve pain to a certain extent. Physical therapy can strengthen the muscles around the joints thus reducing the pain. Physical therapy also improves the mobility of the joint. Exercises can help relieve pain; but ensure that you are under supervision by a trained person. Support device like splints, braces, walkers, canes etc can offer extra support for the affected joint. For patients suffering from acute osteoarthritis, surgery is the final respite. Surgery is particularly helpful for patients who have not responded to any of the above mentioned treatments.

Ingrown Toenail

A common foot problem, ingrown toenails or onychocryptosis can be very painful and need to be treated by a chiropodist. If a splinter or the whole nail exert pressure against the skin on any or both sides of the nail, it will result in an ingrown toenail. If this pressure is prolonged, it can cause swelling, infection, and irritation of the skin and pain. An injury to the toe can also cause acute ingrown toenails. In a chronic condition, it lasts for a long time. Though it is the large toe that is affected normally, the other toes are sometimes affected.

Ingrown toenail can be the result of an abnormality of the soft tissue on the side of the nail. It may also be a result of laxity of the skin due to certain rare diseases. Wearing tight fitting shoes normally leads to soft tissue abnormality. Overcrowding of the toes because of these shoes will result in pushing the soft tissue against the sides of the nail. Nail abnormalities is another widespread factor for ingrown toenails.

During the developmental stages of the foot, wearing shoes that are very narrow or short can lead to bunching of the toes that causes the nail to curl into the skin and cause ingrown toenails. If a person cuts the toenail short and curved, it may result in the edges turning in. Sometimes advancing age, poor blood circulation at the extremities due to blockage in blood vessels may also cause curved nails. Ingrown toenails can also be caused by bone spurs beneath the nail, or a direct hit on the nail, or due to multiple infections and certain drugs like Indinavir; but these are not very common.

Trauma that is caused by stubbing the toenail or dropping heavy objects on the toe will injure the flesh and this condition makes the nail to grow irregularly. This nail may also press into the flesh. For some people, there is a tendency of the nails to grow inwardly because they are genetically prone to nail problems and nail deformities. Ingrown toenails are categorized as three stages.

I Stage: Painful to the touch, the skin on both sides of the nail appears red due to inflammation or irritation. This condition may not be due to infection.

II Stage: The skin may bulge over the side of the nail and this may be due to infection. There may be oozing of a clear fluid or pus in the affected area.

III Stage: The infection may try to heal itself if the infection had been there for a prolonged time. By forming granulation tissue, the infection tries to heal, but that will add to the problem by making the tissues bleed easily. These tissues also move over the nail edge.

Clinically ingrown toenails can be diagnosed by looking at their appearance. The presence of pus indicates bacterial infection and should be determined by a culture test. Infections might have spread to the bone or joint space at times and with a x-ray, the physician can rule out this possibility which is rare. Diabetics are more prone to this condition and so should pay proper attention to their feet. These people lose sensation in their feet if they develop peripheral neuropathies.

The treatment of ingrown toenails depends upon its stage. Warm soaks, cutout shoe and elevation of the toenail with a cotton swab are some of the measures taken for stage one. Though the symptoms may improve soon, there will be complete cure only after a few weeks. Along with warm soaks, oral antibiotics are given for stage two ingrown toenails. Surgical options are there to remove a portion of the toenail if it is extremely painful.

If the condition has reached the third stage then partial or full toenail removal is the only way. This procedure is known as partial nail avulsion (PNA). This procedure involves removal of the section of the ingrown nail after injecting the toe with a local anesthetic. It will take 4-6 weeks for the site to heal after this surgery which is very common and painful.

How to prevent ingrown toenails?

1. Cut the nails straight across; do not cut the nails along a curve or very short.
2. Use foot wear that fits well. Shoes that are small in size or width will aggravate any problem that already exists with a toenail.
3. Prevent injuries to the toes by wearing shoes almost always during working or playing.
4. It is a myth that a V cut at the end of the ingrown nail will help the edge of the nail grows together. Only the growing area at the base of the toe determines the shape of the nail and it is not the end of the nail that determines it. It takes almost up to one year for a toenail to grow and this method will in no way hurry the growth.