Bone spurs: what they are, causes, symptoms and treatment

A bone spur, or osteophyte, is an extra bony growth. They are usually found where a joint has been under stress or has been damaged. NICE Clinical Knowledge Summaries describes osteoarthritis as a long-term disorder of joints in which damage triggers repair processes leading to structural changes, including cartilage loss, remodelling of the adjacent bone and formation of osteophytes. The NHS explains that in osteoarthritis the protective cartilage on the ends of the bones breaks down, causing pain, swelling and problems moving the joint, and that bony growths can develop.

Versus Arthritis says the changes of osteoarthritis can lead to bony growths that can restrict movement or rub against other tissues, and that joints can sometimes still work well even though their structure is altered. It adds that almost everyone will have some changes in their joints as they get older, but may not be aware of them.

Often not. Kent Community Health NHS Foundation Trust says many people who have no symptoms have heel spurs, and describes them as often wrongly blamed as the cause of heel pain. The Royal Orthopaedic Hospital says heel spurs are commoner in people with plantar fasciitis but can be found in people with no heel pain.

When a bone spur is associated with symptoms, they usually come from the underlying joint problem. The NHS lists the main symptoms of osteoarthritis as joint pain and stiffness and problems moving the joint, and says some people also have swelling, tenderness, and a grating or crackling sound when moving the affected joint. A bony swelling or deformity may be found when a clinician examines the joint.

A bone spur that is not causing problems does not need treatment. When symptoms are present, treatment aims at the condition that produced the spur and the pain, rather than the spur itself. The right approach depends on where it is.

For osteoarthritis, the NHS says the condition cannot be cured but does not necessarily get worse over time. Mild symptoms can sometimes be managed with regular exercise, losing weight if you are overweight, wearing suitable footwear and using special devices to reduce strain on your joints during everyday activities. More severe symptoms may need painkillers and a structured exercise plan with a physiotherapist, and in a small number of cases surgery to repair, strengthen or replace a damaged joint.

Bone spurs are a reaction of the body to stress or damage. The NHS says the exact cause of osteoarthritis is not known, but several things are thought to increase the risk. These include joint injury, other conditions that damage a joint such as rheumatoid arthritis or gout, age, family history, obesity and being a woman.

At the heel, the Royal Orthopaedic Hospital explains that extra bone may form near the damaged plantar fascia attachment, usually because of constant mechanical stress. It is commoner in people who spend all day on their feet or are overweight, and stiffness of the ankle or tightness of the calf increase the stress on the heel. People with high arches or flat feet are at greater risk, and sometimes it starts after an injury.

In the neck, the NHS says cervical spondylosis is a normal part of ageing and happens when ageing causes wear and tear to the bones in the spine and the soft cushions of tissue (discs) in the neck. You may be more likely to get it at any age if you have previously had a neck injury or have a family history.

Kent Community Health describes a heel spur as a shelf-like protrusion of bone arising from the underside of the heel bone (calcaneus). The Royal Orthopaedic Hospital says it is a shelf of bone, not a sharp spur. Both say the spur forms because of stress and is rarely the true cause of the pain, which more often comes from the inflamed plantar fascia.

The NHS heel pain page lists plantar fasciitis as sharp pain between your arch and heel that feels worse when you start walking and better when resting. It suggests resting, ice, wide comfortable shoes with a low heel and soft sole, soft insoles or heel pads, regular gentle stretching and painkillers, and says to see a GP if heel pain has not improved after treating it at home for 2 weeks.

Kent Community Health says 90 per cent of cases get better using conservative treatments, that calf stretching is the most important of the treatments listed, and that conservative therapy is usually pursued for at least six to 12 months before surgery is considered. The Royal Orthopaedic Hospital says shockwave therapy may be offered for long-standing heel pain after other treatments have failed, with success rates of around 80%, and that steroid injections are successful in about 50% of patients.

In the neck, spurs form as part of cervical spondylosis, which the NHS says is common, often in people over 40. Many people do not have any symptoms. Where symptoms occur they include neck and shoulder pain or stiffness that can come and go, and headaches that often start at the back of the neck.

The NHS suggests gentle neck exercises, improving your posture, and paracetamol and ibuprofen for pain and stiffness. If symptoms do not improve in a few weeks, you may need physiotherapy. It usually takes a few weeks for treatment to work, although the pain and stiffness can come back.

Surgery is only considered if a nerve is being pinched by a slipped disc or bone (cervical radiculopathy) or if there is a problem with the spinal cord (cervical myelopathy), and the NHS says it is not always a cure but may stop symptoms getting worse.

Surgery for a bone spur is not the usual route. For the heel, the Royal Orthopaedic Hospital says it is rare to need an operation, in less than 5% of its patients, and that it would only be considered if all simpler non-surgical treatments have failed. Kent Community Health says surgery usually involves releasing the plantar fascia, and that sometimes, if there is a large bony spur, it will be removed to help decompress the area. It adds that recovery can take time and that you should expect to be off work for at least six weeks.

For the neck, the NHS says surgery is only considered when a nerve is pinched or the spinal cord is affected. For osteoarthritis, surgery is used in a small number of cases where other treatments have not helped or the damage to the joint is particularly severe.

The NHS says being overweight or obese increases the strain on your joints and the risk of developing osteoarthritis, and that losing weight is one of the simple measures that can help manage mild symptoms. For heel pain, the NHS and the Royal Orthopaedic Hospital both advise trying to lose weight if you are overweight, and the Royal Orthopaedic Hospital adds that a healthy weight and not smoking will likely help foot and ankle pain.

The NHS recommends at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days to keep generally healthy, and good posture, avoiding staying in one position for too long. The sources reviewed do not describe a specific diet or supplement that dissolves or prevents bone spurs.

See a GP if joint pain or stiffness is persistent. For heel pain, the NHS says to see a GP if the pain is severe or stopping you doing normal activities, is getting worse or keeps coming back, has not improved after 2 weeks of home treatment, you have tingling or loss of sensation in your foot, or you have diabetes. For the neck, see a GP for pain or stiffness that does not go away after a few weeks.

• Ask for an urgent GP appointment or call NHS 111 for severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in the arms or legs, or pins and needles in an arm as well as neck pain.

• Call 999 for new problems walking, loss of bladder or bowel control, sudden lack of co-ordination such as difficulty buttoning a shirt, or signs of stroke such as facial droop, arm weakness or slurred speech.

• Contact NHS 111 for severe heel pain after an injury, or if you cannot walk, which could be a broken heel bone or ankle.

On the NHS, bone spurs are managed through the underlying condition: GP, community musculoskeletal (MSK) physiotherapy, podiatry and, if needed, orthopaedic referral. The NHS says in many areas you can refer yourself for physiotherapy through community MSK services without a GP referral.

Some people arrange private physiotherapy, podiatry or an orthopaedic opinion to be seen sooner. The investigations and treatments are the same, and it helps to share any X-ray or scan reports with your GP. Be cautious about treatments that claim to dissolve a bone spur; the sources used here describe none.