title: 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.
abstract: OBJECTIVE
  To conduct a randomized trial of radiation therapy for painful heel spur, comparing a standard dose with a very low dose.
  
  
  METHODS
  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.
authors: Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany. marcus.niewald@uks.eu
authors: Marcus
authors: M
authors: Niewald
authors: M Heinrich
authors: MH
authors: Seegenschmiedt
authors: Oliver
authors: O
authors: Micke
authors: Stefan
authors: S
authors: Graeber
authors: Ralf
authors: R
authors: Muecke
authors: Vera
authors: V
authors: Schaefer
authors: Christine
authors: C
authors: Scheid
authors: Jochen
authors: J
authors: Fleckenstein
authors: Norbert
authors: N
authors: Licht
authors: Christian
authors: C
authors: Ruebe
mesh_terms: D019583:Dose Fractionation, Radiation; D036981:Fasciitis, Plantar / Q000532:radiotherapy; D005500:Follow-Up Studies; D005858:Germany; D036982:Heel Spur / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017785:Photons / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D019233:Retreatment / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome