Osteophytosis: Diagnosis and Treatments

What is osteophytosis?

We call osteophytosis the set of bony outgrowths of a joint, otherwise known as osteophytes. There are two main mechanisms for the production of osteophytes.

• Osteoarthritis corresponds to the loss of widespread cartilaginous tissue within a joint. Cartilage acts as a shock absorber for joint pressure. In the case of cartilage defects, the subchondral bone is subjected to increased pressure. The bone will therefore increase its surface area to better distribute the pressure by forming bony outgrowths, known as osteophytes. This mechanism affects all arthritic joints of the ankle and foot, including in certain deformities such as humped tarsus where mechanical stresses can favor the formation of osteophytes.
• In cases of repeated trauma, bone contacts and capsular stretching at the extreme ranges of a joint can cause the production of reactive osteophytes. Ligament injuries, particularly in the ankle, result in increased bone stress and bone pressure, which can lead to osteophytosis.

Osteophytosis: Diagnosis

The diagnosis may be suspected during the clinical examination in the presence of pain and visible bony prominences at the level of cutaneous swellings. Osteophytes can also be felt at the ankle and foot. Osteophytes are true bony outgrowths that can limit the range of motion of a joint.

However, be aware that osteophytes are often not painful themselves. In addition, a clinical examination may have difficulty distinguishing osteophytosis from other joint pathologies: osteoarthritis, arthritis, capsulitis, etc.

X-rays

Weight-bearing X-rays are essential in cases of ankle and foot pathology. They allow visualization of osteophytes and cartilage wear.

CT scan

The CT scan makes it possible to analyze the bone in all planes and is indicated to clarify the lesions responsible for the production of osteophytes and the extent of osteophytosis.

MRI

MRI is not indicated in this case, as it is less effective than the CT scan for bone analysis. It is used to analyze ligament and tendon structures.

Ultrasound

Ultrasound is also not indicated for the analysis of osteophytes, but it allows the study of ligament and tendon structures, especially in the presence of metallic surgical material causing artifacts and thus poor MRI images.

Osteophytosis: Treatment

The treatment of osteophytosis addresses the underlying pathology, such as osteoarthritis or joint instability due to ligament injuries.

Medications

Painkillers and anti-inflammatories may be tried. They will relieve the pain but will not be sufficient, as they do not eliminate the contact between the bony spurs that cause the pain.

Physical Therapy

Cryotherapy and pressotherapy are good methods for reducing pain during inflammatory flare-ups.

Rehabilitation sessions should be carried out in cases of ligament injuries. Muscular control of joint stability reduces joint pressure, helping to relieve pain.

Intra-articular injections have variable effectiveness depending on the underlying condition responsible for the presence of osteophytes.

Surgery

The surgical treatment of osteophytosis depends on its etiology.

In cases of ankle ligament injuries with osteophytes, and without osteoarthritis, treatment consists of removing all the osteophytes and reconstructing the ankle ligaments.

The presence of an osteophyte without ligament injury may be due to osteoarthritis. If osteoarthritis is associated, resecting only the osteophytes can potentially lead to painful and functional decompensation of the affected joint. In this case, it is necessary to treat the osteoarthritis at the same time as resecting the osteophytes.

When osteophytosis is present without osteoarthritis, osteophyte resection can be performed alone, and the procedure is generally done by arthroscopy.

Conclusion

In the case of osteophytosis, it is necessary to identify the pathology responsible for the formation of bone spurs.

In the absence of osteoarthritis, the removal of osteophytes can relieve pain and provide a sense of joint freedom.

In the presence of osteoarthritis, it may be necessary to treat the osteoarthritis by resecting the osteophytes during the same surgical procedure.