Exostosis / Bone Spurs
By Dr. Evan A. Vieira, DPM, AACFAS
An exostosis or bone spur is a formation of new bone on top of the existing or anatomical bone. Many patients might have this, and are not even aware of it. Others have the condition and find it quite painful. It can be found almost anywhere and luckily, there exists a wide array of treatment options, depending on the bone location, size and severity. When the pain starts, the patient usually comes to the podiatrist’s office with the simple question, "what is this bump?” That said, you should never assume that a bump or lump on your foot is “ nothing”, no matter how small or how big it is. Always consult a podiatrist for evaluation first.
Bone spurs can really appear anywhere, including under your nail. These tend to become painful and are usually seen in younger patients who are still developing. They often create a callous or some type of skin irritation at the tip of the toe or deformity of the nail. It becomes symptomatic when wearing shoes. Because of the appearance, location and the age of the patients, many of these are treated as warts. However, if you have a painful bump in the area of your nail, request an X-ray, since it could be the result of a spur protruding up against the nail. Treatments might range from observation, wearing wider shoes, padding the shoe, and finally, surgical excision may be needed. The prognosis is very good if surgically excised, and as with all growths or masses, a biopsy should be obtained to rule out a more serious condition.
Pain in the heel is the most common reason people visit the podiatrist, but when the pain is caused by an exostosis, it is not usually in the bottom, but in the back of the heel. Commonly called a "pump bump" or "retrocalcaneal exostosis," this condition is almost always painful and can be quite debilitating, especially for active patients. The terminology obviously refers to this condition being the sequelae of wearing high heels, however, it is seen in both men and women, varying in age. These can be quite painful. In addition to the bone growth, after chronic irritation, the body will build what is called an "adventitial bursa" or a fluid sac that serves to protect or cushion the region. These bursa sacs can also become inflamed and create another condition known as "bursitis". Treatment options here are slightly more complicated due to the close proximity to the achilles tendon. Generally, we avoid giving therapeutic injections in this area as they can weaken the tendon and create a risk for rupture. Oral anti-inflammatory medications, immobilization, physical therapy, custom orthotics, open-back shoes and padding are all excellent treatments. When these conservative measures don’t succeed, patients may opt to undergo surgical excision of the spur. This procedure, depending on the exact location of the "bump" can be more complex since the tendon may come into play. The recovery varies depending on the procedure, but the prognosis remains very good. Appropriate and thorough evaluation with X-rays and a biomechanical exam are all key components in the evaluation and treatment of this condition.
Many patients will find a little peak right at the top of their midfoot. This is extremely common and can be totally asymptomatic in many patients. However, some will find that in certain shoes and with certain activities, it can become inflamed. This too is a common place to find an exostosis. It is usually located at what is medically termed the metatarsal-cuneiform joint. Sometimes attributed to foot structure and secondary arthritis, these can be quite large and sometimes present a cosmetic issue for patients. Overlying this region there are superficial tendons and nerves that can become impinged or disrupted by the exostosis and cause additional problems. Tendonitis or neuritis (nerve inflammation) secondary to the bone lesion is generally self-limiting and closely tied to the type of shoes the patient wears. The treatment options are similar to the above described courses, but therapeutic injections are also a viable and effective modality here as well. It should be noted that it is not uncommon to find a ganglion cyst form from the overlying tendon when seen here.
Adequate and comprehensive treatment by a podiatrist can help you to a speedy recovery and hopefully a long-term resolution. With that said, anytime you find a lump, bump or mass on your body, regardless of what you think it might be or read about on the internet, there is no substitute for a proper evaluation by your doctor. On rare occasions there can be serious conditions that may have symptoms similar to those discussed in this article. Only your doctor can rule out these problems. Regardless of the location, size or shape, when you develop a painful exostosis it can become a truly debilitating and chronic problem. The good news is, you don't have to suffer anymore.
Evan A. Vieira, DPM, AACFAS
For more information on exostosis or bone spurs, please contact our Long Island foot doctors at Advanced Podiatry today at either our Huntington, Plainview, Manhasset or Maspeth. You may also contact us 24/7 through our Appointment Request Form.