Bone spurs form when your body grows extra bone tissue in response to pressure, friction, or damage. They’re small, smooth projections of bone that develop over months or years, most often at joints or where tendons and ligaments attach to bone. Think of them as your skeleton’s version of a callus: a protective response that sometimes causes more problems than it solves. Between 73% and 90% of people over age 60 have bone spurs in their spine alone, and many never know it.
The Role of Cartilage Breakdown
The most common trigger for bone spurs is osteoarthritis, the wear-and-tear form of arthritis. Inside a healthy joint, cartilage acts as a slippery cushion between two bones. When that cartilage thins and breaks down, the bones underneath lose their buffer. They begin to rub closer together, and the joint becomes less stable.
Your body responds by trying to shore up the joint. Cells in the thin tissue covering the bone surface (near the boundary where cartilage meets bone) start to multiply. Over time, they build new bone tissue along the joint margins. The result is a bone spur. Cartilage damage confirmed by joint space narrowing on imaging is strongly associated with the presence of these spurs, though the two don’t always progress in lockstep. You can have significant cartilage loss with small spurs, or prominent spurs with relatively mild cartilage damage.
Chronic Tension on Tendons and Ligaments
Not all bone spurs grow inside joints. Many form at the spots where tendons or ligaments anchor to bone. Heel spurs are the classic example. Repeated pulling and stress on the tissue that connects your calf muscle to your heel bone, or the band of tissue running along the sole of your foot, creates low-grade irritation at the attachment point. This condition is called enthesopathy.
When that irritation becomes chronic, the inflammatory signals meant to repair the area can also trigger your bones to grow new tissue by mistake. The body essentially overreacts, laying down bone where it isn’t needed. This process explains why bone spurs are so common in people who spend long hours on their feet, runners who increase mileage too quickly, and anyone whose daily activity places repetitive stress on a specific attachment point.
Where Bone Spurs Develop Most Often
Bone spurs tend to show up on the parts of your skeleton that absorb the most force or friction over a lifetime. The most common locations include:
- Feet and heels: driven by standing, walking, and running forces on the plantar fascia and Achilles tendon attachment
- Spine and neck: a response to disc degeneration and the compressive load your vertebrae carry daily
- Knees and hips: weight-bearing joints where cartilage wears down over decades
- Shoulders: common in the rotator cuff area, where tendons repeatedly glide under bone
- Hands and knuckles: often linked to osteoarthritis in the finger joints
In each case, the underlying pattern is the same. Stress or damage triggers a repair response, and the body lays down extra bone as part of that process.
Systemic and Genetic Factors
Sometimes bone spurs aren’t driven by local wear and tear at all. A condition called diffuse idiopathic skeletal hyperostosis (DISH) causes widespread bone spur formation along the spine and other areas, even in joints that haven’t been overused. DISH has a strong metabolic component. There’s significant crossover between DISH and metabolic syndrome, the cluster of conditions that includes high insulin levels, high cholesterol, elevated uric acid, and obesity.
Genetics play a role too. Many people with DISH carry a specific genetic marker (HLA-B8) that’s also associated with several autoimmune diseases, including type 1 diabetes. DISH itself isn’t classified as autoimmune, but the overlap with diabetes is striking. Obstructive sleep apnea and chronic low-grade inflammation are also linked to the condition. For people with DISH, bone spurs are less about what’s happening in one joint and more about how the entire body handles bone metabolism.
Why Most Bone Spurs Cause No Symptoms
A bone spur is essentially a bony scar. Like a scar on your skin, its mere existence doesn’t necessarily hurt. Many bone spurs sit quietly on the margins of joints or along the spine without pressing on anything sensitive. Between 20% and 25% of people aged 20 to 45 already have spurs visible on spinal imaging, and the vast majority have no idea.
Symptoms develop when a spur grows large enough to crowd nearby structures. In the spine, a spur can narrow the channel where nerves pass through, causing pain, tingling, or numbness that radiates into an arm or leg. In the shoulder, a spur on the underside of the collarbone can catch on a rotator cuff tendon every time you raise your arm. On the heel, a spur can press into the fatty pad on the bottom of your foot with every step. The spur itself is painless bone. The problem is what it pushes against.
How Bone Spurs Are Found
Because most bone spurs don’t cause symptoms, they’re frequently discovered by accident on an X-ray taken for something else. A standard X-ray is usually enough to spot them, since the bony projections show up clearly against surrounding soft tissue. If a spur is suspected of compressing a nerve or affecting a tendon, your doctor may order advanced imaging like an MRI or CT scan to see the soft tissue around the spur in more detail and determine whether it’s the actual source of your symptoms.
Can Bone Spurs Shrink or Disappear?
Once formed, bone spurs are generally permanent. Your body doesn’t have an efficient mechanism for reabsorbing established bone projections the way it can remodel other bone tissue. Managing the symptoms, rather than eliminating the spur itself, is the focus for most people. That means reducing inflammation, maintaining joint mobility through exercise, and addressing the underlying cause (like strengthening muscles around an arthritic knee or wearing supportive footwear for heel spurs).
Surgical removal is an option when a spur compresses a nerve or severely limits joint function, but it’s typically reserved for cases where conservative measures haven’t helped after several months. Even after surgical removal, spurs can regrow if the mechanical stress or joint degeneration that caused them in the first place continues. The most effective long-term strategy is addressing the root trigger: managing body weight to reduce joint stress, staying active to preserve cartilage health, and treating underlying metabolic conditions that accelerate bone overgrowth.