Radiation Oncology/Heel Spurs

See also: Level I Evidence

Plantar fasciitis / Heel Spurs

• Heel spur first described in 1900 as exostatic plantar bone formation at the insertion of the plantar fascia
  • Plantar heel spur - into calf
  • Dorsal heel spur - into Achilles tendon
• Overall prevalence estimated 8-10%
• Symptoms: extensive pain under heel, may radiate into lower leg. Usually gait and mobility impairment
• Etiology: Pain is driven by active inflammation and degenerative process at the insertion of plantar fascia onto the medial calcaneal tuberosity. Heel spur may or may not form, and may be completely asymptomatic. Presence of absence of heel spurs has no bearing of clinical efficacy of LDRT, which treats the soft tissue inflammation
• Treatment: as for osteoarthritis; decreasing weight-bearing, NSAIDS, corticoid crystal suspensions, local anesthesia, iontophoresis, microwave/ultrasound
• RT role:
  • RT does not dissolve heel spur, if present.
  • RT dose 3 Gy total in 0.5 Gy/fx twice weekly effective

• Wiesbaden, 2007 (Germany) (1990-2002) PMID 17453376 -- "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, Acta Oncol. 2007;46(2):239-46.)
  • Retrospective. 502 patients with painful heel spurs. Low-dose RT. Median F/U 2.1 years
  • RT: 6 or 10 MV beam: 5 Gy in 10 fxs twice weekly, or 5 Gy in 5 fxs twice weekly; 175 kVP beam: 6 Gy in 6 fxs three times weekly
  • 8-year EFS: 61%; prognostic factors: only one RT course, age >58, megavoltage photons
  • Conclusion: low-dose RT very effective for painful heel spurs

• Offenbach, 2007 (Germany) PMID 17225939 -- "Radiation Therapy for Painful Heel Spurs : Results of a Prospective Randomized Study." (Heyd R, Strahlenther Onkol. 2007 Jan;183(1):3-9.)
  • Randomized. 130 patients with painful heel spurs. RT low-dose 3 Gy in 0.5 Gy/fx twice weekly vs. high-dose 6 Gy in 1.0 Gy/fx twice weekly
  • Outcome: 6-month excellent/good LD 66% vs. 68% (NS)
  • Conclusion: RT effective, shouldn't give more than 3 Gy