title: Painful plantar heel spur treatment with Co-60 teletherapy: factors influencing treatment outcome.
abstract: 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.
authors.affiliation: Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
authors.forename: Timur
authors.initials: T
authors.lastname: Koca
authors.affiliation: Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
authors.forename: Ayşen
authors.initials: A
authors.lastname: Aydın
authors.affiliation: Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
authors.forename: Duygu
authors.initials: D
authors.lastname: Sezen
authors.affiliation: Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
authors.forename: Hamit
authors.initials: H
authors.lastname: Başaran
authors.affiliation: Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Karaca
keywords: Böhler’s angle; Cobalt-60 therapy; Fat pillow thickness; Painful plantar heel spur; Visual analogue scale