Working as a clinician as I do, I have the opportunity to educate many about the causes and treatments for a variety of musculoskeletal conditions. The plethora of orthopedic maladies seen in the foot, ankle and lower leg is great, providing me with a chance to talk to people about their painful problem. During these discussions, it is beneficial to learn what they have been doing for their complaint, and it is this kind information which stimulates this essay.

It is an understandable phenomenon, people like to help. When a friend suffers with pain, others feel obligated to advise, despite their lack of any medical training or education. The suffering individual is offered various bits of “wisdom” about what is the cause of their pain, and especially, what to do about it. Call them ‘old wives’ tales if you must, but much of the medical information dispatched by the non-professional is not only incorrect, it can actually be harmful.

I won’t use this forum to rail against the dangers of offering advice on wound care. This is a specialty of mine, and am board certified in the field, so I am required to stay abreast of new developments. But I hear it so often, you cannot imagine the amusement/horror it elicits. I am referring to the concept that wounds heal better when exposed to the air. This strategy was disproven decades ago and moist wound healing is the standard of care among wound care professionals world-wide. I liken it to living in the Sahara Desert … not very conducive to health and well-being, is it? As most everyone knows, the human body is mostly water, which is why a wound kept moist heals fastest. It prefers its natural environment.

Okay, I feel better. I got that off my chest. How about another example of my favorite aphorisms? “Close the window or you’ll catch a cold.” Actually, I won’t even touch that one.

Let’s move on to the next one: if you have heel pain, it’s because of a heel spur. How many times have I heard that one? Not surprising that even some primary care docs will see that scary, spiked prominence, as the obvious cause of their patient’s pain. Some of these bone spurs certainly can appear forbidding when viewed on x-ray. Turns out, the presence of a spike of bone on the bottom of the heel has no relation to heel pain, or its severity. It almost always points forward and not down. Even in those rare occasions when surgery is required for prototypical heel pain, the spur is not even touched.

What about spurs in the back of the heel? Spurs, the fancy moniker being osteophytes, commonly develop in the back of the heel, as opposed to underneath. These outgrowths of bone are usually inside the Achilles causing irritation of the tendon. These abnormal growths may add significantly to the symptoms experienced, in contrast to the spur on the bottom of the heel. Even after obtaining a resolution of the pain through conservative measures, these will often cause a recurrence of Achilles pain sometime later on.

The spur inside the Achilles tendon is an example of a traction osteophyte, meaning they are an outgrowth of bone developing as a result of a tendon pulling on that bone. These don’t develop as often where a ligament attaches but they can, obviously, since the plantar fascia is not a tendon (although it’s not truly a ligament either). Bone is a dynamic tissue, constantly in a state of flux, being produced and broken down by the body, all at the same time. This balance can be shifted into a state of increased bone production by the physical pull of soft tissue structures, like a tendon,

Osteophytes may also be found in the spine. Here they are often associated with back pain and considered a common sign of osteoarthritis, which is a degenerative process. When a bone spur develops in the spine, it can cause compression of one or more nerve roots, termed an impingement syndrome. Symptoms produced in this situation include pain, numbness, burning and pins and needles in the area served by the affected spinal nerve. The muscles controlled by the pinched nerve can produce such consequences as spasms, cramping, weakness or loss of control of that body part. The spur itself is not producing pain, but its location has an effect on other structures, and that is what leads to problems.

Finding a heel spur obviously means it must be removed, yes? As the cliché goes, “If it’s not broken, don’t fix it!” If the spur is not causing pain, and not damaging nearby structures, it doesn’t need to be removed. Although often inaccurate, in this particular case, the cliché is appropriate. In contrast, a spur at the back of the heel is often symptomatic, adding to the problem, and worsening the pain. When conservative measures fail and surgery is required, the spur is generally removed as part of the operation.

Spurs developing at the edges of a joint can cause real problems to neighboring structures, depending on the location. Areas without much padding, like the toes, can become the source of great pain when a spur creates inflammation of skin and neighboring structures, like a corn (termed a heloma). Spurs are commonly found on phalanges, which are the toe bones, and these can poke into nerves, tendons, skin and blood vessels. Toes tend to find themselves in some very crowded environments, like shoes, leading to pressure to many areas. When a spur develops, significant pain can be experienced, even occasionally an ulcer.

Now you know everything there is to know about bone spurs. Then again, that probably depends on your relationship with bone spurs. If you are suffering from a spur on the spine, perhaps you want to know more. Hopefully, the reader has at least gotten a glimpse of the variety of problems and pains that can result. Some severe, like the spine, and many others completely benign. Also, if we’re lucky, some of you may think twice about reciting some cliched “old wives’ tale” on the topic of medicine. There is a distinct possibility it isn’t actually true.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.