bony spurs

Feel it in your bones

Your Health
DR GITA MATHAI

When babies are born, they have about 350 bones. Many of these eventually fuse and adults are left with 208 bones. Locomotion and movement are possible because the bones form joints, which “articulate” with each other. Carpenters have taken a leaf out of God’s book and based the joints in their trade on this. Like us, they too have metal and plastic sliding, hinged and ball and socket joints. Just like in mechanical joints, in human joints too mechanical failure, slipping and degeneration can occur with age, overuse, lack of proper lubrication and misalignment.
Unlike carpentry joints, human joints are protected from injury by muscles and tendons. Wear and tear and overuse can cause microscopic tears in these. Calcium gets deposited in the tears, forming bony projections called spurs, which are meant to actually protect the joint.
The symptoms caused by spurs depend on their location. Spurs are usually too deep to be felt. They can be asymptomatic and be discovered accidently in an X-ray taken for some other reason. But they can cause discomfort if they press on nerves.
One of the commonest locations for spurs is the heel. If you feel a severe shooting pain, especially while placing the foot on the ground first thing in the morning, be sure it is a spur. It affects 10 per cent of the population at some point in their life.
Spurs are common in women, especially if you have gained weight. It is yet another symptom brought on by the “middle aged spread”. Feet have to bear the weight of the entire body, and an increase in weight tends to increase the pressure on the heels. Other factors that can bring on a spur are a faulty gait with the foot turned too far inwards or prolonged use of footwear with hard unyielding soles.
Heel pain and spurs can also occur if the calf muscle becomes tight and contracted. These muscles are attached to the heel. If they are not adequately stretched before and after exercise, they can pull on the heel, causing pain.
The heel is attached to the front of the foot by thick tissue called plantar fascia. Shortening or injury of this fascia can also cause strain on the back of the heel and result in spurs.
In the neck vertebrae, spur formation can press on nerves, leading to dizziness and giddiness, especially with a change in posture. It can press on the oesophagus, causing difficulty in swallowing.
Further down in the lumbar vertebra, osteophytes can press on the nerves going to the leg. They can cause pain, weakness in the legs, loss of sensation and difficulty in sitting and squatting.
Osteoarthritic changes in the fingers cause spurs to develop. The fingers appear disfigured and knotted. The range of movement is restricted. Sudden incapacitating shooting pains can also develop.
The shoulder needs to move in a full circle. Spurs restrict this so that the hand can be lifted only to 90 degrees. Combing hair and dressing become difficult.
Spur formation and degenerative changes are not a disease of old people alone. They can form in athletes and people who exercise. It tends to occur when proper stretching techniques before and after exercise are not followed.
Sometimes the extra bone formed breaks off and enters the joint space. It can suddenly make the joint painfully stuck and “locked” in an awkward position.
Symptomatic spurs require treatment. In 95 per cent of cases, simple remedial measures are sufficient and the pain disappears in six months. Ice packs alternating with hot compresses relieve pain rapidly. This may need to be combined with physiotherapy. Active and passive exercises to improve the range of motion and strengthen the muscles around the joint are essential for quick improvement. Shock wave therapy using ultrasound is also very effective.
A short course of NSAIDs (non steroidal anti inflammatory agents) will help to relieve pain in the acute phase. They should not be taken for longer than two weeks continuously as they have side effects.
Corticosteroid can be injected into the joints. The relief is significant and may last four to six months. But it can cause further degeneration of the joint if given too frequently.
Loose bodies that get stuck have to be surgically removed. Endoscopic minimally invasive surgery means hospital stay is minimal. Surgery is also indicated if there is compression on a nerve, resulting in wasting and weakness in addition to pain.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in


Gita Mathai