Radiotherapy for heel spurs

NewsBot · Oct 17, 2006

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Heel spur radiotherapy and radiation carcinogenesis risk estimation.
Radiat Med. 2006 Oct;24(8):573-6
Surenkok S, Dirican B, Beyzadeoglu M, Oysul K

PURPOSE: Radiotherapy is a nonsurgical alternative therapy of painful heel spur patients. Nonetheless, cancer induction is the most important somatic effect of ionizing radiation. This study was designed to evaluate the carcinogenesis risk factor in benign painful heel spur patients treated by radiotherapy.

MATERIALS AND METHODS: Between 1974 and 1999, a total of 20 patients received mean 8.16 Gy total irradiation dose in two fractions. Thermoluminescent dosimeters (TLD(100)) were placed on multiple phantom sites in vivo within the irradiated volume to verify irradiation accuracy and carcinogenesis risk factor calculation. The 20 still-alive patients, who had a minimum 5-year and maximum 29-year follow-up (mean 11.9 years), have been evaluated by carcinogenic radiation risk factor on the basis of tissue weighting factors as defined by the International Commission on Radiological Protection Publication 60.

RESULTS: Reasonable pain relief has been obtained in all 20 patients. The calculated mean carcinogenesis risk factor is 1.3% for radiation portals in the whole group, and no secondary cancer has been clinically observed.

CONCLUSION: Radiotherapy is an effective treatment modality for relieving pain in calcaneal spur patients. The estimated secondary cancer risk factor for irradiation of this benign lesion is not as high as was feared.
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Admin2 · Oct 17, 2006

Heel spurs

Related discussions:
Plantar Fasciitis Discussions

Craig Payne · Mar 3, 2017

Heel spurs ?

I think someone needs to point out to them that heel spurs aren't a problem:
Is a calcaneal spur in the plantar fascia?

NewsBot · Apr 25, 2007

Demographic, clinical and treatment related predictors for event-free probability following low-dose radiotherapy for painful heel spurs - a retrospective multicenter study of 502 patients.
Muecke R, Micke O, Reichl B, Heyder R, Prott FJ, Seegenschmiedt MH, Glatzel M, Schneider O, Schafer U, Kundt G.
Acta Oncol. 2007;46(2):239-46

A total of 502 patients treated between 1990 and 2002 with low-dose radiotherapy (RT) for painful heel spurs were analysed for prognostic factors for long-term treatment success. The median follow-up was 26 months, ranging from 1 to 103 months. Events were defined as (1) slightly improved or unchanged pain after therapy, or (2) recurrent pain sensations during the follow-up period. Overall 8-year event-free probability was 60.9%. Event-free probabilities of patients with one/two series (414/88) were 69.7%/32.2% (p <0.001); >58/ </=58 years (236/266), 81.3%/47.9% (p =0.001); high voltage/orthovoltage (341/161), 67.9%/60.6% (p =0.019); pain anamnesis </=6 months/ >6 months (308/194), 76.3%/43.9% (p =0.001); single dose 0.5/1.0 Gy (100/401), 86.2%/55.1% (p =0.009); without/with prior treatment (121/381), 83.1%/54.9% (p =0.023); men/women (165/337), 61.2%/61.5% (p =0.059). The multivariate Cox regression analysis with inclusion of the number of treatment series, age, photon energy, pain history, single-dose and prior treatments revealed patients with only one treatment series (p <0.001), an age >58 years (p =0.011) and therapy with high voltage photons (p =0.050) to be significant prognostic factors for pain relief. Overall low-dose RT is a very effective treatment in painful heel spurs.
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DaVinci · Apr 25, 2007

Without a control group, how can they reach the conclusion

Overall low-dose RT is a very effective treatment in painful heel spurs.
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Why did the journal editor/reviewers let them make that statement?

NewsBot · May 16, 2007

Heel spur radiotherapy and radiation carcinogenesis risk estimation.
Surenkok S, Dirican B, Beyzadeoglu M, Oysul K.
Radiat Med. 2006 Oct;24(8):573-6.

PURPOSE: Radiotherapy is a nonsurgical alternative therapy of painful heel spur patients. Nonetheless, cancer induction is the most important somatic effect of ionizing radiation. This study was designed to evaluate the carcinogenesis risk factor in benign painful heel spur patients treated by radiotherapy.

MATERIALS AND METHODS: Between 1974 and 1999, a total of 20 patients received mean 8.16 Gy total irradiation dose in two fractions. Thermoluminescent dosimeters (TLD(100)) were placed on multiple phantom sites in vivo within the irradiated volume to verify irradiation accuracy and carcinogenesis risk factor calculation. The 20 still-alive patients, who had a minimum 5-year and maximum 29-year follow-up (mean 11.9 years), have been evaluated by carcinogenic radiation risk factor on the basis of tissue weighting factors as defined by the International Commission on Radiological Protection Publication 60.

RESULTS: Reasonable pain relief has been obtained in all 20 patients. The calculated mean carcinogenesis risk factor is 1.3% for radiation portals in the whole group, and no secondary cancer has been clinically observed.

CONCLUSION: Radiotherapy is an effective treatment modality for relieving pain in calcaneal spur patients. The estimated secondary cancer risk factor for irradiation of this benign lesion is not as high as was feared.
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NewsBot · Sep 19, 2007

Retrospective evaluation of radiotherapy in plantar fasciitis.
Miszczyk L, Jochymek B, Wozniak G.
Br J Radiol. 2007 Sep 17; [Epub ahead of print]

Background: Plantar fasciitis is a common painful syndrome that is usually treated by irradiation with a fraction dose (fd) of 1 Gy up to a total dose (TD) of 6 Gy according to clinical experience. By analyzing our experiences with numerous former patients, we have attempted to find the relationship between dose and effect. Purpose: To evaluate the effectiveness of radiotherapy and assess the impact of fd and TD in plantar fasciitis radiotherapy.

Materials and methods: 1624 irradiations (856 patients) were performed using a fd of 1-3 Gy and a TD of 1-45 Gy. Analysis was carried out on the 623 irradiations (327 patients) for which complete follow-up data were available. The mean follow-up period was 74 months. The following parameters were evaluated: pain relief level; period of anaesthetic effect preservation after treatment; presence of pain and the moment of its appearance; and the intake of analgesic drugs at the last follow up.

Results: After treatment, 48% of the patients reported a lack of pain, 21% reported pain relief greater than 50% and 17% reported pain relief less than 50%. The mean pain relief duration was 72 months. The last follow up found that pain at rest afflicted 25% of the patients, and pain during walking afflicted 32%. A dose-effect relationship was not found.

Conclusions: Radiotherapy is an effective treatment for plantar fasciitis. A fd of 1.5 Gy and TD of 9 Gy should probably not be exceeded.
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NewsBot · Sep 20, 2008

Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur) using very low doses - a study protocol.
Niewald M, Seegenschmiedt MH, Micke O, Graeber S.
Radiat Oncol. 2008 Sep 18;3(1):27.

ABSTRACT: BACKGROUND: A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis) is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases) of the DEGRO (German Society for Radiation Oncology) decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. METHODS: In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0Gy in single fractions of 1.0Gy applied twice a week experimental arm: total dose 0.6Gy in single fractions of 0.1Gy applied twice a week (acting as a placebo) Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores): Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms). This trial protocol has been approved by the expert panel of the DEGRO as well as by the Ethics committee of the Saarland Physicians' Chamber. The trial is supported by a HOMFOR grant (Saarland University Research Grant). Trial registration: Current controlled trials ISRCTN94220918.
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NewsBot · May 15, 2010

Low-dose radiotherapy in the treatment of plantar fasciitis
HajtmanovÃ¡ E, KinclovÃ¡ I, KostkovÃ¡ L, Hajtman A, PÃ©c M
Klin Onkol. 2010;23(2):104-10

BACKGROUNDS: To evaluate the analgesic effect of low-dose radiotherapy in the treatment of plantar fasciitis and to analyse prognostic factors.

PATIENTS AND METHODS: Retrospective analysis was used in the assessment of the analgesic effect after the 1st and 2nd series of low-dose radiotherapy. The treatment regime of 273 patients included total dose of 4.0 Gy, with fraction dose 1.0 Gy, received 2-3 times a week. Recommended follow-up was 3 months. In 323 cases of plantar fasciitis, prognostic factors (age, sex and pain duration before treatment) were evaluated.

RESULTS: Analgesic effect of total dose of 4.0 Gy was 55.7% after the 1st series and 74.8% after the 2nd series. The results are comparable to published results. Pain duration before treatment shorter than 6 months had a significant effect on the treatment. Age was also a significant prognostic factor, with benefits in the group of patients younger than 50 years.

CONCLUSION: Results confirm the advantageous analgesic effect of the dose regime received by our group of 273 patients. Analysis of prognostic factors shows greater benefit of treatment in the acute stage of plantar fasciitis. When treating young patients, however, the possible risks of radiotherapy should be considered compared to other treatment modalities.
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NewsBot · Jul 27, 2012

Press release:
Standard radiation therapy dose provides relief for painful heel spurs

Patients with plantar fasciitis (painful bone heel spur) experience significantly less pain and improved quality of life following a standard dose of external beam radiation therapy, a common cancer treatment similar to receiving an X-ray, according to a randomized, cooperative group study that was published online July 25, 2012, in the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO).

Approximately 8-10 percent of the population has severe bone heel spurs, with the most common treatments for alleviating the pain being ice, heat, and various anti-inflammatory agents. Steroids and local anesthetics can be injected, and oral analgesic medications may be prescribed, but most of these methods have only provided short-term pain relief. The results of this study demonstrated that up to 80 percent of standard dose patients experienced complete pain relief, and pain relief remained constant or even improved for up to 64 percent of the study participants during the follow-up period of 48 weeks post-treatment.

"Severe plantar fasciitis is a chronic health issue, and it can be extremely painful—many of these men and women cannot walk or stand for a long time," said Marcus Niewald, MD, PhD, a radiation oncologist at Saarland University Medical Center in Homburg/Saar, Germany, and one of the study's authors. "Radiation therapy has been used for its anti-inflammatory effect for more than 60 years. We are extremely encouraged by the results of our research because evidence of improved quality of life for patients is clearly evident with the standard dose regimen."

This study was a prospective, randomized trial of a total of 66 patients, with evaluation every six weeks until 12-months post treatment. Four patients were secondarily excluded after the trial began; 29 patients received a standard dose regimen, and the remaining 33 patients received a low dose of radiation therapy. The standard dose patients were treated with a total dose of 6.0 Gy, applied in 6 single fractions of 1.0 Gy twice weekly on non-consecutive days. The low dose arm received 0.6 Gy, applied in 6 single fractions of 0.1 Gy twice weekly on non-consecutive days.
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Randomized, Multicenter Trial on the Effect of Radiation Therapy on Plantar Fasciitis (Painful Heel Spur) Comparing a Standard Dose With a Very Low Dose: Mature Results After 12 Months' Follow-Up
Marcus Niewald, et al
International Journal of Radiation Oncology*Biology*Physics Available online 24 July 2012

Purpose
To conduct a randomized trial of radiation therapy for painful heel spur, comparing a standard dose with a very low dose.

Methods and Materials
Sixty-six patients were randomized to receive radiation therapy either with a total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy twice weekly (standard dose) or with a total dose of 0.6 Gy applied in 6 fractions of 0.1 Gy twice weekly (low dose). In all patients lateral opposing 4- to 6-MV photon beams were used. The results were measured using a visual analogue scale, the Calcaneodynia score, and the SF12 health survey. The fundamental phase of the study ended after 3 months, and the follow-up was continued up to 1 year. Patients with insufficient pain relief after 3 months were offered reirradiation with the standard dosage at any time afterward.

Results
Of 66 patients, 4 were excluded because of withdrawal of consent or screening failures. After 3 months the results in the standard arm were highly significantly superior compared with those in the low-dose arm (visual analogue scale, P=.001; Calcaneodynia score, P=.027; SF12, P=.045). The accrual of patients was stopped at this point. Further evaluation after 12 months' follow-up showed the following results: (1) highly significant fewer patients were reirradiated in the standard arm compared with the low-dose arm (P<.001); (2) the results of patients in the low-dose arm who were reirradiated were identical to those in the standard arm not reirradiated (reirradiation as a salvage therapy if the lower dose was ineffective); (3) patients experiencing a favorable result after 3 months showed this even after 12 months, and some results even improved further between 3 and 12 months.

Conclusions
This study confirms the superior analgesic effect of radiation therapy with 6-Gy doses on painful heel spur even for a longer time period of at least 1 year.
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NewsBot · Oct 15, 2013

Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?
Hermann RM, Meyer A, Becker A, Schneider M, Reible M, Carl UM, Christiansen H, Nitsche M.
Int J Radiat Oncol Biol Phys. 2013 Oct 10.

PURPOSE:
Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved.
METHODS AND MATERIALS:
A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses.
RESULTS:
Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident.
CONCLUSION:
Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.
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Craig Payne · Oct 15, 2013

Re: Heel spurs ?

Craig Payne said: ↑

I think someone needs to point out to them that heel spurs aren't a problem:
Is a calcaneal spur in the plantar fascia?
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If you look at the institutions that most of the above research is from, many are from East Europe .... "heel spurs" must be a big thing in that part of the world!

NewsBot · Jan 24, 2014

Re-irradiation for painful heel spur syndrome : Retrospective analysis of 101 heels.
Hautmann MG, Neumaier U, Kölbl O.
Strahlenther Onkol. 2014 Jan 24.

PURPOSE:
Painful heel spur syndrome is a common disease with a lifetime prevalence of approximately 10 %. One of the most effective treatment options is radiotherapy. Many authors recommend a second or third series of radiation for recurrent pain and partial or no response to the initial treatment. As the results of re-irradiation have not been systematically analyzed the aim of this study was to document the results of repeated radiation treatment and to identify patients who could benefit from this treatment.
MATERIAL AND METHODS:
The analysis was performed on patients from 2 German radiotherapy institutions and included 101 re-irradiated heels. Pain was documented with the numeric rating scale (NRS) and carried out before and directly after each radiation therapy as well as for the follow-up period of 24 months. The median age of the patients was 56 years with 30.1 % male and 69.9 % female patients. Pain was caused by plantar fasciitis in 72.3 %, Haglund's exostosis in 15.8 % and Achilles tendinitis in 11.9 %. Repeated radiation was indicated because the initial radiotherapy resulted in no response in 35.6 % of patients, partial response in 39.6 % and recurrent pain in 24.8 %.
RESULTS:
A significant response to re-irradiation could be found. For the whole sample the median NRS pain score was 6 before re-irradiation, 2 after 6 weeks and 0 after 12 and 24 months. Of the patients 73.6 % were free of pain 24 months after re-irradiation. All subgroups, notably those with no response, partial response and recurrent pain had a significant reduction of pain.
CONCLUSION:
Re-irradiation of painful heel spur syndrome is an effective and safe treatment. All subgroups showed a good response to re-irradiation for at least 24 months.
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NewsBot · Apr 1, 2014

Painful plantar heel spur treatment with Co-60 teletherapy: factors influencing treatment outcome.
Koca T, Aydın A, Sezen D, Başaran H, Karaca S.
Springerplus. 2014 Jan 10;3:21. doi: 10.1186/2193-1801-3-21. eCollection 2014.

BACKGROUND:
Painful plantar heel spur (PPHS) is a benign disorder with painful heels as a result of plantar calcaneal bone spur. Exact etiological factors are still unclear. Treatment typically consists of osteoarthritis tretment schedules and surgical techniques. External radiotherapy is another treatment option. This study is aimed to determine effectiveness and treatment outcomes of external radiotherapy in patients with PPHS.
METHODS:
Sixty-two patients with PPHS were analysed for radiotherapy success and other possible prognostic factors. All patients were treated with Co-60 units from parallel opposed lateral portals, to a total dose of 8 Gy. Responses to radiotherapy was assessed by visual analogue scale (VAS) of pain. Follow-up completed in December 2012 with 28 months median duration (range 22 to 35 months). Age, sex, patient number, spur settlement site, prior treatments, time interval between diagnosis and radiotherapy, pain scores (before and after radiotherapy), plantar fat-pillow thickness (PFPT; thickness of the plantar fat pad) and Böhler's angle estimations were analysed.
RESULTS:
Study included 53 female and 9 male patients with median age 57 (range 43-70). Time interval between PPHS diagnosis and radiotherapy were median 33 months (range10-60). Radiotherapy response time interval were 6 months (range 3-10 months). Responses to radiotherapy were no response in 13 patients (21%), partial response in 13 patients (21%)- pain relief below 50% and complete response - no pain in 36 patients (58%) respectively. Median PFPT of patients were 3.5 cm (range 1.20-4.50 cm). Complete response rate was statistically significant in patients whom PFPT is greater than 3.5 cm. The Böhler's angle range is about 20-40 deg. Complete response rates were higher in patients with degree of Böhler's Angle 30 and below.
CONCLUSIONS:
Simplicity of treatment, lack of acute adverse effects and low cost, seem to make radiotherapy one of the safest, cheapest and also an effective treatment modality for PPHS
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NewsBot · May 21, 2014

Role of radiotherapy in the management of heel spur.
Uysal B, Beyzadeoglu M, Sager O, Demıral S, Gamsız H, Dıncoglan F, Akın M, Dırıcan B.
Eur J Orthop Surg Traumatol. 2014 May 17.

AIMS AND BACKGROUND:
The purpose of this study is to investigate the use of low-dose radiotherapy (RT) in benign painful heel spur management.
METHODS:
Between the years of 2009 and 2012, in Gulhane Military Medical Academy Radiation Oncology Department, patients with heel spur undergoing radiotherapy for pain relief were analyzed retrospectively. In the evaluation of treatment response, Verbal Numeric Scale (VNS) scoring method was used to compare the pain status before and after radiotherapy. Age, gender, laterality, VNS score before RT, VNS score after RT, RT doses of the patients and patients undergoing second course of radiotherapy were recorded. All patients received 8 Gy RT in two fractions with Co-60 teletherapy machine. Statistical Package for Social Sciences, version 16.0 was used for data analysis with the level of significance set at p < 0.05.
RESULTS:
The total number of patients receiving RT for heel spur pain was 450. Median age was 52 years (range 40-85 years). Two hundred and ninety-two (65 %) of the patients were women and 158 (35 %) were men. Radiologically calcaneal spurs were bilateral in 432 (96 %) patients, whereas unilateral left in 8 (1.8 %) patients and unilateral right heel location in 10 (2.2 %) patients. Ten (2.2 %) of the patient group received second course of RT due to refractory pain. Comparative evaluation of VNS scores before and after RT revealed statistically significant pain relief by radiotherapy (p < 0.05).
CONCLUSION:
Low-dose radiotherapy is an effective and reliable painkilling treatment method that can be used in the treatment of epin calcanei refractory to medical and surgical treatment.
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NewsBot · Aug 9, 2014

Radiotherapy for benign calcaneodynia: long-term results of the Erlangen Dose Optimization (EDO) trial.
Ott OJ, Jeremias C, Gaipl US, Frey B, Schmidt M, Fietkau R.
Strahlenther Onkol. 2014 Jul;190(7):671-5.

BACKGROUND AND PURPOSE:
The goal of this work was to evaluate the long-term efficacy of two dose-fractionation schedules for radiotherapy of calcaneodynia.
PATIENTS AND METHODS:
Between February 2006 and February 2010, 457 evaluable patients were recruited for this prospective trial. All patients received orthovoltage radiotherapy. One course consisted of 6 fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, right after (early response), 6 weeks (delayed response), and approximately 2.5 years after radiotherapy (long-term response) with a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS).
RESULTS:
The median follow-up was 32 months (range 9-57 months). The overall early, delayed, and long-term response rates for all patients were 87, 88, and 95%. The mean VAS values before treatment, for early, delayed, and long-term response for the 0.5 and 1.0 Gy groups were 65.5 ± 22.1 and 64.0 ± 20.5 (p = 0.19), 34.8 ± 24.7 and 39.0 ± 26.3 (p = 0.12), 25.1 ± 26.8 and 28.9 ± 26.8 (p = 0.16), and 16.3 ± 24.3 and 14.1 ± 19.7 (p = 0.68). The mean CPS values before treatment, for early, delayed, and log-term response were 10.1 ± 2.7 and 10.0 ± 3.0 (p = 0.78), 5.6 ± 3.7 and 6.0 ± 3.9 (p = 0.34), 4.0 ± 4.1 and 4.3 ± 3.6 (p = 0.26), and 2.1 ± 3.3 and 2.3 ± 3.2 (p = 0.34), respectively. No significant differences in long-term response quality between the two arms were found (p = 0.50).
CONCLUSION:
Radiotherapy is a very effective treatment for the management of benign calcaneodynia. For radiation protection reasons, the dose for a RT series should not exceed 3.0 Gy.
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NewsBot · Jan 21, 2015

Randomized multicenter follow-up trial on the effect of radiotherapy for plantar fasciitis (painful heels spur) depending on dose and fractionation ¿ a study protocol.
Holtmann H, Niewald M, Prokein B, Graeber S, Ruebe C.
Radiat Oncol. 2015 Jan 20;10(1):23.

BackgroundAn actual clinical trial showed the effect of low dose radiotherapy in painful heel spur (plantar fasciitis) with single doses of 1.0 Gy and total doses of 6.0 Gy applied twice weekly. Furthermore, a lot of animal experimental and in vitro data reveals the effect of lower single doses of 0.5 Gy which may be superior in order to ease pain and reduce inflammation in patients with painful heel spur. Our goal is therefore to transfer this experimentally found effect into a randomized multicenter trial.

Study design/methodsControlled, prospective, two-arm phase III-multicenter trial: Standard arm: single fractions of 1.0 Gy applied two times a week, total dose of 6.0 Gy (total therapy time: 3 weeks) Experimental arm: single fractions of 0.5 Gy applied 3 times a week, total dose of 6.0 Gy (total therapy time: 4 weeks)Number of patients for each investigation arm: 120 (statistical power calculation)Main inclusion criteria: Age¿>¿= 40 years Clinical and radiologically diagnosed painful heel spur (plantar fasciitis) Current symptoms for at least 6 months
Main exclusion criteria: Former local trauma, surgery or radiotherapy of the heel Pregnant or breastfeeding women Pre-existing severe psychiatric or psychosomatic disorder
MethodsAfter approving a written informed consent the patients are randomized by a statistician into one of the trial arms. After radiotherapy, the patients are seen after six weeks, after twelve weeks and then every twelve weeks up to 48 weeks. Additionally, they receive a questionnaire every six weeks after the follow-up examinations up to 48 weeks. The effect is measured using the visual analogue scale of pain (VAS), the calcaneodynia score according to Rowe and the SF-12 score. The primary endpoint is the pain relief three months after therapy. Patients of both therapy arms with an insufficient result are offered a second radiotherapy series applying the standard dose (equally in both arms)
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NewsBot · Aug 20, 2015

Randomized multicenter follow-up trial on the effect of radiotherapy on painful heel spur (plantar fasciitis) comparing two fractionation schedules with uniform total dose: first results after three months' follow-up.
Niewald M, Holtmann H, Prokein B, Hautmann MG, R?sler HP, Graeber S, Dzierma Y, Ruebe C, Fleckenstein J
Radiat Oncol. 2015 Aug 19;10:174. doi: 10.1186/s13014-015-0471-z.

BACKGROUND:
Our first trial on radiotherapy for painful heel spur published in 2012 comparing the analgesic effect of a standard dose (6 ? 1.0Gy within three weeks) to that of a very low one (6 ? 0.1Gy within three weeks) resulted in a highly significant superiority of the standard dose arm. In the meantime, experimental data have shown that lower single doses in the range of 0.5 - 0.7Gy might be even more effective than the current standard dose of 1.0 Gy. Therefore, we conducted a second trial comparing the analgesic effect of standard single doses of 1.0Gy to that of low single doses of 0.5Gy using uniform total doses of 6Gy.
PATIENTS AND METHODS:
One hundred twenty-seven patients were randomized to receive radiation therapy either with a total dose of 6.0Gy applied in 6 fractions of 1.0Gy twice weekly (standard dose) or with the same total dose applied in 12 fractions of 0.5Gy three times weekly (experimental dose). In all patients lateral opposing 6MV photon beams were used. The results were measured using Visual analogue scale (VAS), Calcaneodynia score (CS) and SF-12 health survey. The first phase of this trial ended after a three months' follow-up; it will be continued up to 48 weeks.
RESULTS:
Nine patients had to be excluded after randomization either due to the withdrawal of informed consent to radiotherapy by the patients or radiotherapy with an incorrect dosage. The groups were comparable concerning biographical and disease data. The mean calcaneodynia score (CS) was higher in the experimental group (p = 0.002). After three months' follow-up, we saw a very favorable pain relief in both arms (decline of VAS score: standard arm 42 points, experimental arm 44 points (n.s.), but we did not notice any statistically significant difference between the arms neither concerning the pain parameters nor the quality of life parameters. No relevant acute side effects were recorded.
CONCLUSIONS:
Favorable laboratory results could not be translated into an enhanced pain relief in our patients. This trial was terminated after the interim analysis (127 patients randomized). Further trials will be necessary to explore the best fractionation schedule. This trial has been approved by the expert panel of the DEGRO as well as by the Ethics committee of the Saarland Physicians' chamber.
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NewsBot · Mar 1, 2017

Radiotherapy of painful heel spur with two fractionation regimens : Results of a randomized multicenter trial after 48 weeks' follow-up.
Prokein B et al
Strahlenther Onkol. 2017 Feb 27. doi: 10.1007/s00066-017-1116-y

BACKGROUND:
In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective.
PATIENTS AND METHODS:
A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 × 1 Gy twice a week, while the experimental group was treated with single fractions of 12 × 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks.
RESULTS:
The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded.
CONCLUSION:
Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 × 0.5 Gy was not superior to the current standard dose of 6 × 1 Gy. Further trials are necessary to explore the best fractionation schedule.
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NewsBot · May 4, 2017

Retrospective evaluation of the effectiveness of radiotherapy in patients with plantar fascitis (heel spurs).
Kędzierawski P et al
Rep Pract Oncol Radiother. 2017 May-Jun;22(3):209-211. doi: 10.1016/j.rpor.2016.11.00

AIM:
The aim of the study was the evaluation of the effectiveness of radiotherapy in patients with the feet pain caused by heel spurs.
BACKGROUND:
Treatment options for patients reporting these symptoms include use of suitable orthopedic footwear, the use of general or topical non-steroidal anti-inflammatory drugs or steroids, physiotherapy, manual therapy, shock wave or appropriate surgical procedures. Radiotherapy is one of the method used in patients with chronic pain syndrome.
MATERIALS AND METHODS:
The material consisted of 47 patients treated in Radiotherapy Department at the Holycross Cancer Center. The time of follow-up ranged from 1 to 129 months. After treatment patients were observed.
RESULTS:
During the first follow-up visit a complete relief of symptoms was observed in 37 patients, and the pain was felt by 10 patients for 4 months after the treatment. One patient was re-irradiated 6 months after treatment because of persistent pain. At 16 and 17 months after the onset of treatment, pain was reported by two patients. These patients were re-irradiated. One patient had recurrence of pain 48 months after completion of radiation. After the second irradiation the pain was relieved. The remaining patients, with the exception of two, experienced remission of pain, which has been documented. Tolerance of the treatment was very good. No complications of radiation were observed.
CONCLUSIONS:
Radiotherapy remains an attractive treatment for patients with inflammation of the heel fascia.
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NewsBot · May 23, 2017

Low-Dose Radiotherapy of Painful Heel Spur/Plantar Fasciitis as an Example of Treatment Effects in Benign Diseases
Robert Michael Hermann et al
Radiotherapy

Degenerative changes in the plantar fascia may cause the so‐called “painful heel” with typical projections of tenderness. This condition is often associated with a plantar heel spur. Radiotherapy with low doses (LD‐EBRT) has been well known for its anti‐inflammatory potential. In the recent years, several microbiological mechanisms were elucidated to explain immunomodulation by LD‐EBRT. Furthermore, a randomized study proved the clinical efficacy of this therapy in plantar fasciitis. Two other trials defined a fractionation schedule of 6 × 0.5 Gy twice weekly as the new standard therapy. Taken together, LD‐EBRT is an effective and safe therapeutic option for patients over 30 years of age and after exclusion of pregnancy. In case of an insufficient response, a second course can be offered to the patient. There are still open questions concerning target volume definition and fractionation of LD‐EBRT. Furthermore, studies randomizing LD‐EBRT with other conservative therapeutic approaches are missing.
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NewsBot · Sep 28, 2017

EFFICACY OF EXTERNAL BEAM RADIOTHERAPY FOR THE MANAGEMENT
OF REFRACTORY PLANTAR FASCIITIS: A PROSPECTIVE STUDY
Ashok K. Chauhan et al
International Journal of Current Research
Vol. 9, Issue, 05, pp.51230-51236, May, 2017

Purpose:
plantar fasciitis and to assess radiation induced side effects, including malignancy.
Material and
(India), on 36 diagnosed cases (56 heels) of plantar fasciitis. These diagnos
fasciitis having pain, refractory to medical treatment, were accrued for and given external beam
radiation therapy (EBRT) during 2005
(1Gy per fraction, 3 fractions per week),
completion of radiotherapy, after six months and one year following radiotherapy.
evaluated using Objective (Calcaneodynia) pain score and Subjective
Acute skin reactions were noted at completion of radiotherapy. Late event as radiation induced
malignancy was noted after at least 6 years following treatment.
Results: S
heels, both by objective and subjective scores. Partial/ good response (PR) was 16.1% on objective
score and 23.3% on subjective score, minor/ fair response (MR) was 12.5% & 7.1% and no/poor
response (NR) was 8.9% and 7.1% respectively. One year
score revealed CR, PR, MR and NR respectively were 80.4%, 7.1%, 8.9% and 3.6%. No
disease was found in any of the heels treated with radiotherapy during treatment or follow
significant acute ski
or second malignancy so far.
Conclusion:
fasciitis pain refractory to medical treatment
without the historical fear of radiation induced malignancy. Though, equally effective in young
patients, conclusive words regarding risk of long term side effects still need longer follow up
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NewsBot · Jan 29, 2021

Long-term effect and prognostic factors of a low-dose radiotherapy of painful plantar calcaneal spurs : A retrospective unicenter study
Volker Rudat et al
Strahlenther Onkol. 2021 Jan 27

Purpose: To estimate the long-term effect of low-dose radiotherapy of painful plantar calcaneal spurs, and to verify possible prognostic factors.

Patients and methods: In this retrospective unicenter study, electronic patient files of patients with painful plantar calcaneal spurs treated with low-dose radiotherapy between July 2009 and February 2020 were reviewed. The low-dose radiotherapy consisted of a total dose of 3.0 Gy given with a fraction dose of 0.5 Gy three times a week. The pain reduction was estimated using a patient questionnaire with a visual analogue scale. Kaplan-Meier statistics and Cox regression analysis were used for the statistical analysis.

Results: Altogether, 864 heels of 666 patients were reviewed. The probability of an insufficient pain control 10 years after low-dose radiotherapy was 45.9% (95% confidence interval 39.4-52.4%) in the subset of patients with a minimum follow-up of 3 months (582 heels of 467 patients). Patients with an unsatisfactory pain reduction 3 months after low-dose radiotherapy were offered a re-irradiation. Forty percent of the patients who received a re-irradiation developed good pain reduction. Occurrence of an initial aggravation of pain during or within 3 months after low-dose radiotherapy (p = 0.005), and treatment of bilateral painful plantar calcaneal spurs (p = 0.008) were identified as significant unfavorable prognostic factors on univariate analysis. On multivariate analysis, the initial aggravation of pain remained as independent significant prognostic factor (p = 0.01). No clear radiation toxicity was observed.

Conclusions: Low-dose radiotherapy is a safe and effective treatment option for patients with painful plantar calcaneal spurs. An initial aggravation of pain during or within 3 months after radiotherapy was identified as unfavorable prognostic factor for the treatment outcome. Re-irradiation of patients with an unsatisfactory pain reduction after low-dose radiotherapy is effective and should be offered to patients.
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NewsBot · Jan 19, 2022

Role of radiotherapy in the treatment of plantar fasciitis
B Alépée et al
Rev Med Liege. 2021 Dec;76(12):855-861.

Plantar fasciitis is the most common cause of talalgia in adult. It can affect a variety of individuals and its etiology is still unknown. Several factors are probably involved (repeated micro-traumatisms excessive tension, chronic inflammation…). In plantar fasciitis bone exostosis can be observed. The latter may also result into a functional incapacity due to major pain and therefore has a major impact on the quality of life. Several treatments with different efficacy are proposed to the patient. The role of radiotherapy is very limited, even if it's more frequently applied in Germany. The main goals of this article are to evaluate the place of the radiotherapy in the therapeutic approach, to confirm its efficacy and to assess the associated risks.
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NewsBot · Feb 25, 2022

Low-dose radiation treatment for painful plantar enthesophyte: a highly effective therapy with little side effects
Freddy Djiepmo et al
Eur J Med Res. 2022 Feb 23;27(1):28

Aim: Plantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition.

Methods: We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years.

Results: Before radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment.

Conclusion: Radiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction.
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NewsBot · Mar 18, 2022

Low-dose radiation treatment for painful plantar enthesophyte: a highly effective therapy with little side effects
Freddy Djiepmo, Bálint Tamaskovics, Edwin Bölke, Matthias Peiper, Jan Haussmann, Judith Neuwahl, Danny Jazmati, Kitti Maas, Livia Schmidt, Roman Gelzhäuser, Christoph Schleich, Stefanie Corradini, Klaus Orth, Martijn van Griensven, Amir Rezazadeh, Kimia Karimi, Wilfried Budach & Christiane Matuschek
European Journal of Medical Research volume 27, Article number: 28 (2022)

Aim
Plantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition.

Methods
We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years.

Results
Before radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment.

Conclusion
Radiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction.
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NewsBot · Aug 23, 2022

Heel Spur and Radiotherapy: Case Report and Systematic Literature Review
Antonio Piras et al
J Am Podiatr Med Assoc. 2022 Jul-Aug;112(4):21-090

Heel spur is a chronic inflammatory condition causing pain and other typical symptoms. Therapeutic recommendations include the use of several drug or orthotic/physical therapies, performed alone or in combination. Surgery is usually reserved for refractory conditions. Radiotherapy has been shown to ensure good clinical outcomes in this clinical setting. A systematic review was performed to describe the feasibility and effectiveness of radiotherapy in the treatment of heel spur, evaluating its role in alleviating pain and consequently ensuring a better quality of life. A case report of 45-year-old patient treated for refractary right hindfoot pain was reported. A single fraction of 6 Gy RT was delivered with symptomatic complete response at 2 months observed. A systematic database search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The systematic review included studies describing heel spur treatment and providing complete information about radiotherapy. Fifteen articles published between 1996 and 2020 were reviewed. Study characteristic analysis resulted in seven prospective randomized studies and eight retrospective studies. Radiotherapy of painful heel spur seems to be safe and effective, with high response rates even at low doses and with an overall favorable toxicity profile. Predictive parameters and modern tailored treatment should be investigated with further studies.
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NewsBot · Dec 15, 2022

Feet Don’t Fail Me Anymore! Single-Centre Results Using Low-Dose Radiation Therapy for Feet Inflammatory Disorders and Review of Current Evidence
Beatriz Álvarez1, Angel Montero et al
Source

Background: Plantar fasciitis- and tendinopathy-related foot pain are common cause of functional disability. Low-Dose Radiation Therapy (LDRT) has proven to be effective in the symptomatic relief of these disorders.

Material and methods: Between February 2016 and December 2021, 31 patients were included in this prospective register. Seventeen patients suffered from calcaneodynia, 11 from tendonitis and 3 from osteoarthritis. 6 Gy (1 Gy/fraction) or 3 Gy (0,5 Gy/fraction) were delivered and repeated after 12 weeks if no adequate relief. Response was evaluated at the end of the planned courses, after 3 months and subsequently every 6 months using Visual Analogic Score (VAS), the Von Pannewitz Score (VPS) and daily analgesic drug needs.

Results: Overall, 87% of the patients experienced pain relief. Patients with a VAS score above 5 dropped from 35.5% at the end of LDRT to 32%, 13% and 6% after 3, 6 and 12 months, respectively. According to the VPS, 74% showed improvement and 26% remained stable. Lastly, 39% of patients stopped or reduced analgesic intake. Nine patients have been followed up for more than 12 months. The median pre-treatment VAS score in this group was 9 (range 7-10), whereas median VAS scores after 3, 6 and 12 months stood at 5 (range 1-7), 3 (range 0-6) and 1 (range 0-6), respectively (Fig. 2). An improvement in functionality was reported by 7 out of 9 individuals (77.7%). No acute or late complications were observed.

Conclusion: LDRT appears to be useful for symptomatic treatment of inflammatory and degenerative disorders of the foot.
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