Low-Dose Radiotherapy of Painful Heel Spur/Plantar Fasciitis as an Example of Treatment Effects in Benign Diseases

Abstract

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.

Evaluation of the radiotherapeutic management of refractory painful heel spur and plantar fasciitis: a single center experience of 45 years

“…Repetitive microtraumas with resultant damage of the plantar aponeurosis and muscle insertions by excessive stress on the heels may have role in pathogenesis (27). Increased straining may stem from intensive sport activities, foot deformities, increased body weight, and working on hard surfaces (2)(3)(4)12,(27)(28)(29). A plethora of treatments have been used for the management including modification of life style to prioritize resting, losing weight and avoiding from intensive physical workload, analgesics, cold compresses, iontophoresis, antiinflammatory agent and steroid injections, stretching exercises and physical therapy, laser, microwave, ultrasound therapy, orthotics and shoe modifications, heel pads, efforts to decrease pressure on the affected site, orthopedic interventions, and RT.…”

“…Although irradiation for painful heel spur and plantar fasciitis has been considered as a last resort treatment traditionally, there is accumulating data supporting the utility of RT for the management of pain from heel spur and plantar fasciitis (2,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Our study adds to the literature with high number of patients treated using a standard treatment machine and uniform dosefractionation scheme at a single institution over 45 years.…”

“…RT has a long history in the management of painful heel spur and plantar fasciitis. Accumulated data from several centers have consistently reported effective palliation of painful plantar fasciitis and heel spur; however, dose fractionation schemes and treatment fields may vary among the institutions and are typically based on retrospective data and experiences (2,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

“…Plettner, a German surgeon, was first to describe calcaneal spur in 1900 (1). Factors associated with plantar fasciitis include increased body weight, intensive workload and sportive activity and working on hard surfaces (2)(3)(4). Patient symptomatology typically includes stinging and severe heel pain with potential gait and mobility disturbances accompanied by worsened quality of life.…”