Radiotherapy in painful heel spurs (plantar fasciitis)-results of a National Patterns of Care Study

Alfried Krupp Krankenhaus, Essen, Lower Saxony, Germany
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.26). 04/2004; 58(3):828-43. DOI: 10.1016/S0360-3016(03)01620-1
Source: PubMed


After a general patterns of care study, the German Cooperative Group on Radiotherapy for Benign Diseases conducted a multicenter cohort study to analyze radiotherapy (RT) in painful heel spur syndrome (HSS).
In 2001, a patterns of care study was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful HSS were assessed. In addition, the functional and subjective outcomes were evaluated.
Of the institutions, 146 (79.3%) returned the questionnaire: 10 (6.8%) reported no clinical experience with RT for HSS, and 136 (93.2%) treated 3621 patients annually, a median of 23 cases/institution. The indications for treatment were chronic or therapy refractory pain. The total dose ranged between 2.5 and 18.75 Gy (median 6), and single fractions ranged between 0.3 and 1. 5 Gy (median 1). Of the responding institutions, 44.9% applied two fractions and 37.5% three fractions weekly. RT was delivered with orthovoltage units (38.2%), linear accelerators (53.7%), (60)Co units (5.1%), or other treatment units (3%). Seventy-six institutions presented their retrospective clinical evaluation in a total of 7947 patients. Pain reduction for at least 3 months was reported in 70%, and persistent pain reduction was reported in 65% of the treated patients. In 19 institutions, a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed.
The study comprised the largest number of cases reported of RT for painful HSS. Despite variations in the daily RT practice, this national patterns of care study represents a very large number of painful and refractory HSS cases that were treated effectively with RT.

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Available from: Michael-Heinrich Seegenschmiedt, Dec 13, 2013
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    • "Osseous spurring of the plantar aspect of the calcaneus was first documented in 1900 by the German physician Plettner, who coined the term Kalkaneussporn (calcaneal spur).[3] Calcaneal spurs are of two types: Dorsal/posterior spurs and plantar/inferior spurs. "
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    ABSTRACT: Introduction: Calcaneus or os calcis forms a major component of the skeleton of foot providing posterior pillars for bony arches of the foot. It is largest of seven tarsal bones of foot and forms prominence of heel. Many times anterior to calcaneal tuberosity an osteophytic outgrowth has been observed (calcaneal or heel spur) extending along entire width, for about 2-2.5 cm. The apex of spur seen embedded in plantar fascia, directly anterior to its origin. Hence, the study of calcaneal spurs has been undertaken. Materials and Methods: The material for the study consisted of 200 dry (100 right and 100 left), adult calcanei of unknown age and sex obtained from Department of Anatomy. The calcaneal enthesophytes/spurs were studied in detail and classified according to types of calcaneum. Results: Maximum incidence of calcaneal spurs were found in Type I calcanei (11%) and no calcaneal spurs were found in Type III calcanei. Total incidence of dorsal calcaneal spurs in all types of calcanei was maximal (15.5%). The incidence of plantar spurs was 6.5% being highest in Type I calcanei (4%). The incidence and type of calcaneal spurs were compared with those of previous studies and etiology of heel pain has been discussed. Correlation between type of calcanei and spurs has been studied for the 1st time. Conclusion: Calcaneal spurs are related to type of calcanei with the highest frequency in Type I and least in Type III (no spurs seen in Type III and least in Type IV). Other factors, which contribute toward increase in incidence of spurs, are increasing age and weight, concurrent orthopedic diseases, and heel pain.
    09/2014; 4(Suppl 1):S13-6. DOI:10.4103/2229-516X.140709
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    • "Orthopedic shoes, corticosteroid or anesthetic injections, non-steroidal anti-inflammatory drugs, extracorporeal shockwave treatment are the commonly used treatment modalities. There are also several surgical techniques used for PPHS (Micke and Seegenschmiedt, 2004). "
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    ABSTRACT: 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. 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. 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. 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.
    SpringerPlus 01/2014; 3(1):21. DOI:10.1186/2193-1801-3-21
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    • "Typical clinical indication comprise degenerative disorders like rotator cuff syndrome (impingement of the shoulder joint), tennis/golfer’s elbow (Epicondylopathia humeri), painful heel spur (plantar fasciitis), exacerbated refractory, and painful osteoarthritis, or hyper-proliferative syndromes like Dupytren’s disease or the prevention of heterotopic ossification (Seegenschmiedt et al., 2004, 2008). Concerning the most clinical relevant endpoints pain relief, response, and analgetic effects, LD-RT is reported to result in a 33–100%, a 47–100%, and a 12–89% efficacy, respectively (Kutzner et al., 2003; Micke and Seegenschmiedt, 2004; Niewald et al., 2007; Adamietz et al., 2010; Betz et al., 2010; Heyd et al., 2010). Moreover, due to the low-doses used in actual clinical practice, radiogenic acute or chronic side effects were not observed in the treatment of inflammatory diseases (Seegenschmiedt et al., 2008). "
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    ABSTRACT: Inflammatory diseases are the result of complex and pathologically unbalanced multicellular interactions. For decades, low-dose X-irradiation therapy (LD-RT) has been clinically documented to exert an anti-inflammatory effect on benign diseases and chronic degenerative disorders. By contrast, experimental studies to confirm the effectiveness and to reveal underlying cellular and molecular mechanisms are still at their early stages. During the last decade, however, the modulation of a multitude of immunological processes by LD-RT has been explored in vitro and in vivo. These include leukocyte/endothelial cell adhesion, adhesion molecule and cytokine/chemokine expression, apoptosis induction, and mononuclear/polymorphonuclear cell metabolism and activity. Interestingly, these mechanisms display comparable dose dependences and dose-effect relationships with a maximum effect in the range between 0.3 and 0.7 Gy, already empirically identified to be most effective in the clinical routine. This review summarizes data and models exploring the mechanisms underlying the immunomodulatory properties of LD-RT that may serve as a prerequisite for further systematic analyses to optimize low-dose irradiation procedures in future clinical practice.
    Frontiers in Oncology 09/2012; 2:120. DOI:10.3389/fonc.2012.00120
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