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Bunions vs. Bone Spurs: Understanding the Differences

By Steven Gershman DPM / Feb 13, 2024

This blog will explain what bunions and bone spurs are, how they differ, the general causes, the effects on the foot and person, and how to deal with them for comfort.

What is a bunion?

To understand bunions, it's important to describe the bony anatomy of the foot.  

There are five long bones just before the toes, called metatarsals. The first metatarsal bone connects the midfoot to the big toe. It is the strongest and thickest of the five metatarsals, as it bears more weight and force during gait. It is at this juncture that bunions are born. 

A bunion is a bump on the inside (medial side) of the big toe joint - the connection between the first metatarsal and the big toe. The medical term is hallux abducto valgus, which means the big toe is bent toward the second toe and twisted, with the associated bump on the side of the big toe joint. 

The bump is actually not a new bone, but in fact the head of the first metatarsal sticking out. With a bunion, or hallux abducto valgus deformity, what occurs over time is that the first metatarsal slides out away from the second metatarsal. This protrusion from the foot gives the appearance of a bump of new or enlarged bone. To add to the bump, there may also be a bursal (fluid filled sac) over the bump, accompanied by soft tissue swelling and inflammation. 

What is a bone spur? 

A bone spur is actually a new pathological bone that grows from normal bone tissue. 

Wolff's law describes how bone adapts to increased loads by growing larger and stronger, and some bone spurs may develop as a direct result of this process. 

Examples of this phenomenon in the foot include bone spurs on the bottom and back of the heel bone (calcaneus). On the bottom of the heel, the plantar fascia attaches to the heel bone. It is theorized that the increased pull of the plantar fascia on the attachment to the heel bone causes a spur to develop. Similarly, on the back of the heel, the Achilles tendon attaches to the heel bone, and again, increased tension on the tendon is theorized to contribute to bone spur formation. 

Another cause of bone spur formation is arthritis. Arthritis can result in osteophytes or spurs wherever there are joints. In the foot, a common area affected is the top of the midfoot, where patients often present with painful bumps. 

Comparative analysis 

Bunions can develop due to a myriad of reasons, including biomechanical abnormalities in the foot that result in abnormal motion and increased pronation. This causes increased forces on the first metatarsal, leading to a gradual shift in its position over time. Other contributing factors include loose ligaments, pregnancy, genetics, and wearing ill-fitting shoes that squeeze the forefoot or elevate the heel. 

Bone spurs can also occur for many reasons. Spurs on the back of the heel often arise due to arthritis and increased pronation. Overpronation causes the calf muscles, which attach to the Achilles tendon, to overwork in an attempt to compensate. This constant extreme pull can stimulate the growth of new bone. 

Plantar heel spurs can also result from overpronation, as the plantar fascia, a ligament that stabilizes the foot, is stretched when the foot elongates during pronation. This stretching exerts tension on the attachment at the heel, potentially leading to spur formation. Generally, any stress on the heel, such as being overweight or arthritis, can contribute to the development of a heel spur. 

Spurs on the top of the foot often result from the foot's shape. Higher arches are particularly prone to these spurs because ground force can push back against the forefoot, causing jamming in the midfoot joints. This stress on the joints can lead to the formation of spurs. Again, arthritis can also contribute to their development. 

How do I know if I have a bone spur or a bunion?

Bunions can lead to issues with shoe fitting as the foot widens over time, making it increasingly difficult to find comfortable shoes. Many shoes can rub against the bunion, causing irritation, inflammation, or pain. In addition, the displacement of the big toe often results in it pressing against the second toe, causing it to deform.

Bone spurs often result in pain. In my practice, I have found that spurs on the back of the heel are the most difficult to deal with. Even lying down with the heel flat on the bed can cause pain with these spurs. Plantar (bottom of the heel) spurs can cause pain during running and walking, and they are often associated with plantar fasciitis. Spurs on the top of the foot can be painful when pressure is applied, such as when the shoe vamp, tongue, or laces rub against the area, making it difficult to wear closed shoes.

Prevention and care 

For bunions, wider and deeper shoes are a good starting point. In addition, the toe box should be round and not pointed. Shoes that are only wider shoes with a non-round toe box may not be enough to accommodate the bump. Shoes should also have a low or flat heel, as elevating the heel places stress on the big toe joint, which can make the bunion worse

For heel spurs, every part of the shoes should be stable to control motion and pronation. Quality inserts are also important for pronation control. Deep extra depth shoes help with Achilles spurs, as they reduce rubbing on the back of the shoe and can accommodate orthotics. Extra depth shoes are also helpful for top of the foot spurs, as they reduce the chances of the spur rubbing against the shoe.  

Orthofeet’s footwear solutions 

In many foot conditions, starting with well-made, appropriate shoes is always recommended. Orthofeet offers a wide selection of comfortable and well-made shoes, making them an excellent starting point for addressing various foot problems or simply for enhancing comfort.

Orthofeet shoes come with wide to double-wide widths that comfortably accommodate even severely widened feet from bunions

In addition, most Orthofeet shoes have round toe boxes, which are critical when you have bunions. The brand also designs many shoes with stretchable materials to further provide comfort with bunions, as they adjust to the unique contours of each foot, including protrusions.

For individuals dealing with spurs at the top of the foot, Orthofeet shoes offer an extra-deep design to accommodate this condition. These shoes are constructed with high-quality inserts that help with pronation and motion control, and they are removable to accommodate orthotics, if needed.