Myth: Bone Spurs Are Painful
- chelsie462
- 46m
- 10 min read
This article is a transcribed, edited summary of a video Bob and Brad recorded in October 2024. For the original video, go to https://youtu.be/fzRwYJVSJJY
Mike: Today, we're tackling the question, "Do bone spurs really cause pain?"
Brad: That's right, we're going to bring in an expert to actually explain this and settle this myth once and for all.
Mike: Brad, take it away.
Brad: Alright, now, bone spurs can occur in many parts of the body, and they do, but what we're going to do is focus on the heel, and show how the symptoms of heel bone spurs can really throw off a diagnosis. But it can happen with any bone spur, including in the back, the knee, the shoulder, and it all relates as one.
Mike: So to clear this up, we're going to bring in an expert, since we're talking about heel spurs specifically. We have podiatrist Dr. Ray McClanahan, who is an expert in this area and sees this a lot. So we're actually going to go to a clip from him, an interview we did with him a few years ago, and he explains it a lot better than we can.
Brad: That's right, and then actually, in a bonus at the end, if you happen to have heel pain, this is going to be really directed towards you near the end on how to correct it on yourself.
Mike: So we're going to start talking about heel pain. So what are some common causes that create heel pain?
Dr. Ray McClanahan: Yeah, there are probably two or three common ones, but we have to be careful with heel pain, because there are outliers as well. And we could talk about some of those outliers. For instance, if somebody comes in and both of their heels hurt at the same time, we definitely talk about footwear. We set up the rehab, we talk about toe separators and some of the other things that we do, but we also keep our thinking cap on in terms of autoimmunity, connective tissue disorders, infectious diseases like Lyme disease, and so forth, medication side effects. I've had people take antibiotics, and have bilateral plantar fascial irritation, but overwhelmingly, most people that we see are dealing with something called plantar fasciosis. For the audience, it used to be called plantar fasciitis, which suggested that the ligament on the bottom of our foot, known as the plantar fascia, was getting inflamed. Actually, before I go into that, Mike, there are also probably two other things that we see fairly regularly, which are a bursitis under the heel, which usually doesn't hurt first thing out of bed in the morning, as fasciosis does. Usually, bursitis also hurts centrally under the heel instead of on the inside back part. There are also a couple of nerves that go down the side of the heel that can get irritated by a hiking boot, a running shoe, a stiff orthotic, or a seam inside the shoe. But I'd say overwhelmingly, what I've seen in 27 years is probably eight or nine out of 10 of those people have first-thing-out-of-bed pain in the morning that gets a little bit better as they move around, sit down again at lunch, and hurts again until they move around a little bit. One of my medical school professors in Philadelphia, Dr. Harvey Lemont, is not only a podiatrist, but he's a dermatopathologist. So he looks at tissue specimens under the microscope to find out, like, what kind of disease is this? What kind of inflammation is this? And he's like a lot of podiatrists and physical therapists, and orthopedists who are seeing a lot of heel pain. And some statistics say it might be 40% of what we see. He did a histopathological examination of 50 of his patients, because if you fail what podiatry calls conservative therapy, which is ice, orthotics, and injections, anti-inflammatories, physical therapy, and maybe immobilization, you're going to get offered some kind of an operation to release your plantar fascia. And I did a lot of that early on in my career, and I'm glad I don't do that anymore. And I wish people wouldn't have that, because some of those folks never really recover. But the point is, Dr. Lemont did that operation on 50 of his patients, and during the operation, he took a piece of their plantar fascia ligament, and he looked at it under his microscope. And this study's also on our website, published in 2003 in the Journal of the American Podiatric Medical Association. When he examined his specimens, nobody had any inflammation. All 50 of them had dead tissue or degenerated tissue, which was a shock and a surprise to all of us. And we'd sit around the seminars talking about how this can be dead tissue? Because some of these people are young people, and these people are not folks that have diabetes, they're not smokers. I feel their pulses, their feet are warm, they've got hair, there's nothing wrong with their circulation until they put on the kind of footwear that we talked about at the outset of the show. And this is pivotal for anybody listening today who has heel pain, this kind of heel pain, if it's fasciosis, I'll mention a study done in 2009 in the Journal of Foot and Ankle Research, not on our website, but maybe you could look it up. A group of researchers took people's big toes and purposefully put them in a bunion. And then they took an ultrasound machine, and they measured the blood flow coming into the bottom of the foot, right where people get plantar fasciosis. And when the toe was in bunion position, there was a 22.4% reduction in blood flow to the area of the heel where people hurt first thing out of bed in the morning. So it's no longer a mystery why this does not respond when we treat it as if it's an inflammatory entity. It's also no strange mystery when people get their big toe out of bunion position, and resolve their plantar fasciosis. And so to your earlier point, Mike, this is an example of where we shouldn't be treating the location of the pain, because in plantar fasciosis, it's not where you hurt under the bottom of the heel. There's a muscle there that tugs on that very location, and not only tugs on the plantar fascia and the heel bone, which makes a spur, which doesn't hurt, by the way, and doesn't need to be removed. That same muscle strangulates the lateral plantar artery. And that's what that article showed. We also did a similar infrared study. A friend of ours in Spain did, where he took his infrared camera, put correct toes on only his right foot, waited half an hour, didn't put one on his left foot, and captured the heat signal of the blood flow going to the tips of his toes. The tips of his toes were five degrees Fahrenheit warmer. So we really do ourselves a terrible disservice to our circulation, believe it or not, with our footwear. And this isn't just stiletto, high-heeled shoes. This is our walking, running, hiking shoes. And you can tell if you're doing this to yourself, audience, by pulling the sock liner out, as we mentioned. Superimpose your foot on it. If your big toe is spreading beyond it, you're probably unknowingly creating some circulatory inflow problem. So here's where, again, we try to focus on the big toe as opposed to where the patient hurts. On the other hand, like bunions, once we've outlined the natural educational material, we can treat these people, and I do treat these people. Fasciosis is dead tissue. So in addition to all the education, I will sometimes tape these people. I might do some shockwave on them, and I also inject them. And I inject them with a variety of different things. I inject them with cortisone, believe it or not, which you have to be very careful with, because it can be dangerous if used inappropriately. But I use it for tissue that we don't want to be there. So if somebody comes in with fasciosis, I try to get the body to break it up and clear it out of there. And that's what cortisone does. I will use cortisone for neuromas, which are abnormal nerve tissue or ganglion cysts, which is abnormal fluid that we don't want. So we'll also use regenerative injection therapies, which are biological injections, designed to, believe it or not, create inflammation on purpose, so that the patient can actually heal their own body. And this is a prolotherapy, which is a sugar solution, platelet-rich plasma, where we take your own blood cells, and we put your platelets where you hurt. Your platelets will make new tissue, and we will repair the area. More recently, we're using stem cells, which are immature cells. They don't know what to become. And if you put them in the area of fasciosis, they'll start to remodel that tissue too. Beyond that, we just give it a tincture of time. We generally don't rest these people like I used to. When I thought it was inflammatory, I put them in a boot. I told them not to run. But when I took them out of the boot, and I told them to slowly get back into running, their pain came right back, which puzzled me. But it also indicated that stopping activity and curing inflammation or calming inflammation didn't cure their problem. So now I show the patients in the clinic the abductor hallucis muscle strangulating their tibialis posterior artery; they see it with their own eyes. So they don't believe in a theory about this, and it's very straightforward. And that inspires them on their path to fixing their big toe position, which, for the most part, gets the plantar fasciosis gone. If it doesn't and they come back, then we put our thinking cap on like I mentioned before, and start asking, "Is there something else going on? Is this person not well, or are they on a medication? Do they have another disease?" Those people are fairly rare, but if people don't respond, we start testing a little bit more.
Brad: So the myth is busted. Dr. McClanahan did a nice job of explaining it. You can have a bone spur, but it is asymptomatic. The pain can be from something else. They've actually done scans where they looked at any parts of the body, showed a bone spur, and the patient is asymptomatic. In other words, no pain associated with it.
Mike: So, if you are still having heel pain specifically, we would like to take a look at your footwear, because, as Ray McClanahan talks about, you want to have a type of shoe with zero drop and a wide toe box. Brad and I are both wearing those style shoes. We have three different brands here. There are many different brands. We don't endorse one specifically, but just find something that's comfortable for you. These are very minimalist.
Mike: You can see there's not much cushioning. These are still zero drop, because the distance off the floor from your toe to your heel is the exact same. But as you can see, there's much more cushioning.
Mike: So just try which one works well for you, and they should feel comfortable. But just take your time if you've been wearing normal shoes your entire life, because different muscles and ligaments have to get stronger and stretch out.
Brad: Oh, wait, Mike, there's more.
Mike: There is?
Brad: Yeah, well, we're talking the zero drop, but another major component is a wide toe box. You look at these, all have one common denominator. They all have this weirdly shaped toe. It doesn't have the typical pointed toe, wide toe box, so your forefoot and the bones in your forefoot can relax and not get squished together, creating a lot of problems.
Mike: And if you didn't catch it, Dr. Ray was explaining that's how your vascularity gets not pinched off, gets the blood flow to your plantar fascia, which is probably causing your foot pain and not the heel spur.
Brad: Right.
Mike: Anyway, if you just want to watch the whole interview with Dr. Ray McClanahan, because he talks about all foot issues, check out "FIXING YOUR FEET WITH DR. RAY MCCLANAHAN."
Brad: That's right. It is a really good video. I listen to the podcast, very educational and entertaining.
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