Can a bone spur occur on the lateral foot?

Bone Spurs on the Lateral Foot

Yes, bone spurs can absolutely occur on the lateral foot, most commonly at the base of the fifth metatarsal and on the lateral aspect of the calcaneus (heel bone).

Common Locations for Lateral Foot Bone Spurs

Lateral Calcaneal Spurs

• Bone spurs frequently develop on the lateral aspect of the calcaneus, particularly in association with Haglund's deformity, where a prominence forms lateral to the Achilles tendon insertion 1
• Calcaneal spurs are bony outgrowths from the calcaneal tuberosity that can form on multiple surfaces of the heel bone, including the lateral side 2, 3
• These lateral prominences are commonly visible on standard radiographs and present with tenderness lateral to the Achilles tendon 1

Fifth Metatarsal Base

• The base of the fifth metatarsal on the lateral border of the foot is another common site for bony prominences and requires specific evaluation using the Ottawa ankle rules, which specifically assess for point tenderness at this location 4
• Standard radiographic evaluation with three views is necessary to properly diagnose any osseous abnormalities in this region 4

Clinical Presentation

Symptoms

• Acute pain and inflammation aggravated by pressure from shoes, with relief when walking barefoot 1
• Localized tenderness on palpation of the lateral foot structures 1
• Swelling and prominence that may be visible or palpable 1

Associated Conditions

• Patients with lateral calcaneal spurs are 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis 5
• Higher body mass index is associated with spur development 5
• Spurs are more common in women and older patients 5

Diagnostic Approach

Imaging

• Standard radiographs (anteroposterior and lateral views) are the primary diagnostic tool and will demonstrate bony prominences on the lateral foot 1, 4
• CT imaging may be beneficial to evaluate the true extent of osseous injury if surgical planning is needed 4
• MRI is valuable for assessing associated soft tissue damage and bone marrow contusions 6

Treatment Algorithm

Initial Conservative Management

• Open-backed shoes to reduce pressure on lateral heel prominences 1
• Orthoses and accommodative padding to offload the affected area 1
• NSAIDs for pain and inflammation control 1
• Physical therapy and stretching exercises 1
• Weight loss if indicated 1

Advanced Conservative Options (if no improvement in 6-8 weeks)

• Immobilization with a cast or fixed-ankle walker-type device 1
• Corticosteroid injections into associated bursae (avoiding the Achilles tendon) 1

Surgical Intervention

• Referral to a podiatric foot and ankle surgeon is appropriate if conservative measures fail after 6-8 weeks 1
• Surgical resection of the prominent bone and inflamed bursa is indicated for refractory cases 1
• Some patients may require calcaneal osteotomy to correct underlying alignment issues 1

Important Clinical Pitfalls

• Do not inject corticosteroids directly into or near the Achilles tendon insertion, as this can lead to tendon rupture 1
• Lateral calcaneal spurs may be symptomatic even without plantar fasciitis, and patients with spurs have more foot pain and poorer functional outcomes than those without spurs 5
• Spurs can fracture with trauma, particularly in patients with pre-existing chronic conditions like plantar fasciitis 2
• The presence of a spur may indicate other associated foot pathology rather than being an incidental finding 5