Bone Spurs and Associated Corns
WHAT'S THE PROBLEM?
A bone spur is a prominence of the bone that can often cause irritation to the overlying skin. This "spur" can be an irregularity of the shape of the bone or can be a small outgrowth of bone or cartilage. If this prominence or "spur" is in an area that is prone to pressure from shoes or from the ground during walking, it can become symptomatic and begin to cause discomfort. A bone "spur" can exist and cause no discomfort, if it is not in an area that is irritated by pressure from walking, shoes, etc. Often, the skin overlying the bony prominence can be irritated from shoe pressure or from walking and can result in a build up of skin commonly known as a corn or callus, depending upon the location.
HOW DOES IT FEEL?
Patients can feel discomfort while in shoes if the bony prominence is on the top of the foot or on the toes. If the prominence is on the bottom of the foot, discomfort can be present at any time that the patient is weightbearing, such as walking, running, etc. If the prominence is located on the top of the foot or toes, it can often be felt as a hard lump overlying the bone, and below the skin. If there is a skin lesion present, such as a corn or callus, the bony prominence can usually be felt directly under the skin lesion.
LET'S DO A TEST!
A thorough examination of the clinical signs and symptoms will result in a diagnosis by the treating doctor. To help assess the extent of the problem, the exact location of the bony prominence and the size of the prominence, standard x-rays are utilized. This will allow the doctor to determine the best course of treatment for the patient. A metallic indicator marker may be taped to the corn or callus prior to the x-ray. This will be visible on the developed x-ray and will help to correlate the location of the corn/callus and the underlying bone spur. In some instances, additional tests such as MRI's or CT scans may be indicated. If the doctor believes that there may be some additional involvement of soft tissue structures such as tendons or muscles, an MRI would be used to help visualize these non-bone structures. A CT scan may be used to determine other characteristics of the bony prominence that may not be adequately visualized on standard x-rays. However, an MRI and CT scan are usually not necessary, and standard x-rays coupled with a thorough examination are usually enough to begin a treatment regimen.
HOW DID THIS HAPPEN?
The bony prominence can develop several different ways. The prominence may simply be an irregularity in the shape of the bone as the bone developed. It can also result from chronic irritation to the bone in that area. An injury to the bone can also result in a prominence at the site of injury, which results from irregular or excessive healing of the bone. Additionally, the prominence can occur as a result of a tendon or ligament pulling on the bone. This causes an irritation to the outer covering of the bone and a bony prominence develops. Spurring of the bone can also occur as a result of arthritic changes or narrowing of the joint. When the opposing joint surfaces begin to press into one another, the bone proliferates and causes spurring. The bony prominences or spurs often have overlying callus type lesions from the irritation from walking or the pressure caused by shoes on the bony prominence. The tissue that forms is the body's way of protecting the skin, and is commonly known as a corn or callus. As the irritation continues, the callus or corn will become thicker and thicker, resulting in increased discomfort and pressure. These corns and calluses are simply thick skin, and do not have "roots". These lesions will recur again and again if either the bony prominence is not removed, or the irritation from wearing a tight shoe or walking is not eliminated.
WHAT CAN I DO FOR IT?
Avoidance of tight shoes is the single most significant action a patient can take to relieve the pain from corns associated with bone spurs, and often, the most difficult for the patient to reconcile. Our choice of shoes involves not only considerations of our foot health, but also style, fashion and our self image. All these factors should be weighed and when painful foot problems develop, more consideration should be given to comfort than style.
Corns from bone spurs can be gently and gradually removed at home. After soaking the feet in warm water with a mild soap added, file back and forth over the corn with an emery board. This needs to be done regularly and often, to keep up with the rate of growth of the lesions. This can be dangerous and should not be attempted by persons with diabetes or those with poor circulation.
WHAT WILL MY DOCTOR DO FOR IT?
Your doctor will explain the cause of the underlying problem and offer you various treatment options. There are both conservative and surgical options for this condition. The simplest treatment options often result in considerable and immediate relief. The painful corn or callus can be "trimmed" with little or no discomfort. The hard outer skin is simply and painlessly removed. After removal, a pad can be applied to limit the pressure over the bony prominence. Suggestions may be made regarding change of shoes, pads, inserts for the shoes or over the counter products that may be helpful. If conservative treatments are not successful, if if the lesions reoccur at an unacceptable rate, surgical treatment is recommended and is aimed at removing the painful bony prominence. This is usually performed under local anesthesia at various locations, including the office, surgical center or hospital.
CAN I PREVENT IT FROM HAPPENING AGAIN?
Sometimes recurrence of the painful skin lesion can be prevented. This can often be accomplished by simply eliminating the pressure causing the discomfort. This can be via the use of pads, shoe inserts or change of shoes. The use of over the counter chemicals which "dissolve" the painful lesions is not recommended and can often result in complications or infections. Most importantly, pain and discomfort are your body's signals that a problem exists. Prompt attention and treatment can often result in significant relief with the avoidance of complications.
Author: David S. Wander, DPM, FACFAS
