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FAQs

What is a bone spur?

A bone spur is simply a buildup of bone or dense calcium at an area where it is not supposed to be.  Common areas for bone spurs in the foot are at the bottom of the heel and in the back of the heel. The first is caused by a very popular ligament, the plantar fascia, and when it becomes inflamed and injured over time (plantar fasciitis), calcium can deposit there and form a bone spur. The second is a bone spur within the Achilles tendon, which can develop over time in people with long standing inflammation of the tendon (tendonitis). 

Another common location for bones spurs in the foot and ankle are over joints that have significant arthritis in them or wearing away of their cartilage lining.  These bone spurs are formed around the joint and is a protective mechanism by the body to reduce motion of the joint, and thereby reduce the pain of arthritis.  The bone spurs however, may be painful on their own as they rub against shoes or other structures.  

In general, if you have bone spur and it’s not painful, then it is not a cause for concern and does not require treatment.

What exactly is a bunion?

The term “bunion” is a term that’s misunderstood.  A bunion is not just an overgrowth of bone along the big toe joint.  That would be a bone spur.  A bunion is a complex deformity that involves rotation and movement of the long bone (metatarsal) of the great toe away from the second metatarsal.  This causes the width of the front of the foot to appear wider.  As the long bone moves, it slips off of the actual toe bone (phalanx) and the great toe appears to move towards the second toe.  This movement can be due to several reasons.  There is a risk of developing a bunion if a close relative has bunions (hereditary); you can develop a bunion at a very young age (congenital); improper shoe wear like narrow, high or flat shoes can lead to a bunion over time; and arthritis in the joints that touch the first metatarsal bone can cause a bunion. 

Given the complexity of bunions, there have been too many surgeries to count to treat them.  If you have a bunion and it doesn’t bother you, then surgery is not necessary. For painful bunions, first try some simple shoe changes, such as a wider shoe or toe spacers.  If this fails, then you should certainly see a foot specialist.

Why does the back of my heel hurt when I stand, run or walk?

The most common culprit for this problem is the Achilles tendon.  This is the large tendon in the back of the ankle that connects the calf muscle to the heel bone.  It attaches all the way to the bottom of the heel from behind.  After you have been sitting or laying down for a long period of time, the Achilles gets tight and shortens.  Once you stand and begin activity, the tendon stretches out as your foot moves up.  Hopefully, after a brief warm up, the pain goes away.  If the Achilles has been hurt from overuse (like repetitive exercise and improper stretching), the pain can be present nearly constantly. 

You should see a doctor if your pain has not resolved after a period of rest for a week and home remedies.  To prevent this from happening, perform a Runner’s a stretch against a wall at least 3 times a day, particularly in the morning, for just 60 secs on each side.  You can even stretch your feet up towards you while sitting! It’s that easy.

Why are my feet getting flatter?

Acquired flat feet is a common condition that most commonly affects middle age women but can affect anyone.  This term means that the height of your arch lessens over time. This condition does not refer to people born with a flat foot that remains unchanged over time. But believe it or not, flat feet can get flatter, and that is also problematic.  This condition is primarily due to a problem with a tendon (the posterior tibial tendon) whose primary job is to hold up the arch.  The tendon comes from a muscle that starts at the back of the calf, runs towards the inner part of the ankle (behind the inner ankle bone) and connects to a bone along the inner part of the arch in the middle of the foot (navicular).  This tendon helps to move your ankle inward and helps you stand on your toes when it contracts.  This tendon can be injured with overuse (such as running, especially in shoes with poor arch support), walking or standing barefoot or in flat shoes, or the tendon can be injured from a trauma.  People who are overweight are more likely to have problems with this tendon also.  If you notice your arches have fallen and you have pain, you should see you doctor.  If you have pain but your arches are unchanged, rest, use over the counter arch supports or ankle lace up braces, and try home remedies to reduce inflammation.  If pain continues beyond a week, then you should see your doctor.

I recently started exercising and I have pain along the top of my foot that runs up my ankle. What causes this?

When I hear this description, my first thought is extensor tendonitis.  This a common overuse condition that affects people who are just starting or accelerating an exercise program.  The extensor tendons are a group of tendons that run along the shin bone and attach to the toes to pull them upward.  These tendons are important when the foot is drawn upward during walking and running.  Overuse causes these tendons to get inflamed.  The tendon to the big toe is especially vulnerable to this problem given its important job in pulling up the great toe.  Swelling is usually very mild or not present with tendonitis and pain starts gradually and typically improves with rest.  If you have significant swelling, pain present all the time, pain that starts suddenly, numbness, or tingling these are red flags and are likely NOT due to tendonitis.  If these symptoms are not present then try some simple solutions such as a short course of OTC medicines to reduce inflammation (if cleared by your doctor), rest, activity modification, change the lacing of your shoes, and then resume a gentle stretching program of pulling the towards downward and upward along with calf stretching.  See your doctor if your pain doesn’t improve after a week or right away if it is associated with red flag signs.