Heel Spurs, Other Spurs, and Bunions

Spurs are a bone’s response to stress. Take any bony protuberance, like the heel of a hand, and tap lightly but often on a hard surface, like a table. At a certain point the bone “freaks out” and the body sends calcium to the site to protect it. This calcium buildup is the spur. I have a nice, little spur on a part of my thumb from the repetitive shock of a musical instrument. My thumb hits in just the “right” way, and often enough, to produce a spur.

Heel spurs can form at the back of the heel, near the Achilles tendon, usually because of shoes being too short or too narrow or both. The heel is forced back against the counter, or back portion, of the shoe. Over time, a spur is created. These can be quite painful. At first, the wearing of proper, non-compressive footwear can make symptoms worse because the non-compressive shoes allow circulation to come back and thus pain. This is short lived though and soon the spur will calm down. We do not recommend surgery.

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A heel spur can form on the bottom of the calcaneous, as well, usually in the form of a “hook.” This spur can irritate the tissue that makes up the fat pad of the heel. It feels like a needle in the heel with each step. Happily, this is an easy condition to manage. With proper support the pressure on the calcaneous is lessened to the point that the spur ceases to be a problem. It doesn’t go away, it just stops hurting. There is no surgical procedure for this condition that warrants the risk. Especially since proper EuroPedorthic footwear and orthotics manage the condition perfectly.

There is no genetic component to bunions although many people who come to us for help try to assert that their bunions are hereditary. But contrary to this, bunions are created by compression, by ill-fitting footwear. When enough pressure is applied to the hallux (big toe) or the first metatarsal head over a significant period of time the result is an enlargement of that joint and the accompanying deformation and deviation of the hallux itself.

How does this happen? What is the mechanism? Basically, bunions are bone spurs and are the bone’s response to stress. The stressed bone sends calcium to protect itself against the unwanted pressure or stress. As in spurs, the calcium buildup is the bunion. Bunions can be formed in as little as 18 months.

Remember, the human foot must not be compressed except in its reaction with the ground. But a bunion can be formed even by compression from below if conditions are right, that is if the pressure is focused and constant enough. Because of Design Flaw #3: The Concave Insole, most American feet live at least 10-14 hours per day in an environment where the metatarsal heads two, three and four sink down into the insole of the shoe and metatarsal heads one and five are pulled upwards. This means that even if we remove the compression side to side and top to bottom on the hallux and its joint, if compression is constant from below the bunion continues to form. Proper management of bunions includes removing all compression as any residual compression will continue to irritate or form them.

Orthotics are essential to a foot with a bunion. They redistribute the body’s weight and transfer the pressure on the first metatarsal head to the entire plantar surface of the foot.

Socks alone can cause compression of the foot by simply pulling on the toes. That amount of compression can actually form a bunion, or exacerbate and escalate an already existing bunion. It has been years since Americans have had real socks at their disposal, fitted socks that do not pull on toes. At Zócalo Shoes, we carry socks from Germany. German socks come in sizes. They stay in place on the heel and will not pull on the toes.

Surgery is indicated only when the bunion is so large and advanced that the foot will no longer enter into the widest, most accommodative shoe or when pain is constant, in short, when the bunion cannot be managed. We see those feet once in a while and refer those patients to an orthopedic surgeon. But remember, a bunionectomy is a temporary procedure if proper footwear is not adopted postoperatively and the shoe environments that produced the bunion in the first place are not rejected.

A bunion will not go away. But if a person does the right thing and wears the correct shoes 100% of the time, a bunion won’t bother a person at all.