Radiation Oncology/Heel Spurs


 * See also: Level I Evidence


 * 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
 * Treatment: as for osteoarthritis; decreasing weight-bearing, NSAIDS, corticoid crystal suspensions, local anesthesia, iontophoresis, microwave/ultrasound
 * RT considered a "last resort" approach for refractory cases
 * 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