Skip to main content
SpringerLink
Log in

Radiotherapy for calcaneodynia

Results of a single center prospective randomized dose optimization trial

Strahlentherapie bei Calcaneodynie

Ergebnisse einer monoinstitutionalen, prospektiven, randomisierten Dosisoptimierungsstudie

  • Original article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

The aim of this work was to compare the efficacy of two different dose fractionation schedules for radiotherapy of patients with calcaneodynia.

Patients and methods

Between February 2006 and April 2010, 457 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received radiotherapy using the orthovoltage technique. One radiotherapy series consisted of 6 single fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, immediately after, and 6 weeks after radiotherapy using a visual analogue scale (VAS) and a comprehensive pain score (CPS).

Results

The overall response rate for all patients was 87 % directly after and 88 % 6 weeks after radiotherapy. The mean VAS values before, immediately after, and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 65.5 ± 22.1 and 64.0 ± 20.5 (p = 0.188), 34.8 ± 24.7 and 39.0 ± 26.3 (p = 0.122), and 25.1 ± 26.8 and 28.9 ± 26.8 (p = 0.156), respectively. The mean CPS before, immediately after, and 6 weeks after treatment was 10.1 ± 2.7 and 10.0 ± 3.0 (p = 0.783), 5.6 ± 3.7 and 6.0 ± 3.9 (p = 0.336), 4.0 ± 4.1 and 4.3 ± 3.6 (p = 0.257), respectively. No statistically significant differences between the two single dose trial arms for early (p = 0.216) and delayed response (p = 0.080) were found.

Conclusion

Radiotherapy is an effective treatment option for the management of calcaneodynia. For radiation protection reasons, the dose for a radiotherapy series is recommended not to exceed 3–6 Gy.

Zusammenfassung

Ziel

Vergleich der Effektivität zweier Dosis-Fraktionierungskonzepte bei der Strahlentherapie von Patienten mit Calcaneodynie.

Patienten und Methoden

Zwischen 2006 und 2010 wurden 457 auswertbare Patienten in diese prospektive und randomisierte Studie eingeschlossen. Alle Patienten erhielten die Bestrahlung in Orthovolt-Technik. Eine Bestrahlungsserie bestand aus 6 Einzelfraktionen/3 Wochen. Bei ungenügendem Ansprechen der Schmerzsymptomatik nach 6 Wochen wurde eine zweite Bestrahlungsserie durchgeführt. Die Patienten wurden auf die beiden Studienarme randomisiert und erhielten je nach Ergebnis Einzeldosen von 0,5 bzw. 1,0 Gy. Der Endpunkt der vorliegenden Analyse war die Schmerzreduktion. Die Schmerzintensität wurde vor, unmittelbar nach sowie 6 Wochen nach der Strahlentherapie mittels visueller Analogskala (VAS) und einem umfassenden Schmerzscore (CPS) gemessen.

Ergebnisse

Die Gesamtansprechrate aller Patienten betrug 87 % direkt nach und 88 % 6 Wochen nach Bestrahlung. Die mittleren VAS-Werte vor, nach und 6 Wochen nach der Strahlentherapie waren für die 0,5-Gy- und die 1,0-Gy-Gruppe jeweils 65,5 ± 22,1 und 64,0 ± 20,5 (p = 0,188), 34,8 ± 24,7 und 39,0 ± 26,3 (p = 0,122) sowie 25,1 ± 26,8 und 28,9 ± 26,8 (p = 0,156). Die mittleren Schmerzscore-Werte betrugen vor, nach und 6 Wochen nach der Strahlentherapie jeweils 10,1 ± 2,7 und 10,0 ± 3,0 (p = 0,783), 5,6 ± 3,7 und 6,0 ± 3,9 (p = 0,336) sowie 4,0 ± 4,1 und 4,3 ± 3,6 (p = 0,257). Es konnten keine statistisch signifikanten Unterschiede im Therapieansprechen (CPS) zwischen den beiden Studienarmen unmittelbar nach (p = 0,216) und 6 Wochen nach Strahlentherapie (p = 0,080) festgestellt werden.

Schlussfolgerung

Die Strahlentherapie ist eine effektive Maßnahme in der Behandlung der Calcaneodynie. Aus Strahlenschutzgründen wird empfohlen, eine Gesamtdosis von 3–6 Gy pro Bestrahlungsserie nicht zu überschreiten.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Barrett SJ, O’Malley R (1999) Plantar fasciitis and other causes of heel pain. Am Fam Physician 59:2200–2206

    PubMed  CAS  Google Scholar 

  2. Basche S, Drescher W, Mohr K (1980) Results of x-ray therapy of calcaneal spur (author’s transl). Radiobiol Radiother (Berl) 21:233–236

    Google Scholar 

  3. Cocchi U (1943) Erfolge und Mißerfolge bei der Röntgenbestrahlung nicht krebsiger Leiden. I. Gutartige nicht tuberkulöse nicht aktinomykotische Prozesse. Strahlentherapie 73:255–305

    Google Scholar 

  4. Cole C, Seto C, Gazewood J (2005) Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician 72:2237–2242

    PubMed  Google Scholar 

  5. Glatzel M, Bäsecke S (2001) Radiotherapy of the painful plantar heel spur. Benig News 2:18–19

    Google Scholar 

  6. Hajtmanova E, Kinclova I, Kostkova L et al (2010) Low-dose radiotherapy in the treatment of plantar fasciitis. Klin Onkol 23:104–110

    PubMed  CAS  Google Scholar 

  7. Heyd R, Dorn AP, Herkstroter M et al (2010) Radiation therapy for early stages of morbus Ledderhose. Strahlenther Onkol 186:24–29

    Article  PubMed  Google Scholar 

  8. Heyd R, Rabeneck D, Dornenburg O et al (2011) Gorham-Stout syndrome of the pelvic girdle treated by radiation therapy: a case report. Strahlenther Onkol 187:140–143

    Article  PubMed  Google Scholar 

  9. Heyd R, Seegenschmiedt MH, Rades D et al (2010) The significance of radiation therapy for symptomatic vertebral hemangiomas (SVH). Strahlenther Onkol 186:430–435

    Article  PubMed  Google Scholar 

  10. Heyd R, Tselis N, Ackermann H et al (2006) Functional outcome after megavoltage irradiation for heel spurs. Strahlenther Onkol 182:733–739

    Article  PubMed  Google Scholar 

  11. Heyd R, Tselis N, Ackermann H et al (2007) Radiation therapy for painful heel spurs: results of a prospective randomized study. Strahlenther Onkol 183:3–9

    Article  PubMed  Google Scholar 

  12. Lodermann B, Wunderlich R, Frey S et al (2012) Low dose ionising radiation leads to a NF-kappaB dependent decreased secretion of active IL-1beta by activated macrophages with a discontinuous dose-dependency. Int J Radiat Biol 88:727–734

    Article  PubMed  Google Scholar 

  13. Mantell BS (1978) Radiotherapy for painful heel syndrome. Br Med J 2:90–91

    Article  PubMed  CAS  Google Scholar 

  14. Micke O, Seegenschmiedt MH (2004) Radiotherapy in painful heel spurs (plantar fasciitis)—results of a national patterns of care study. Int J Radiat Oncol Biol Phys 58:828–843

    Article  PubMed  Google Scholar 

  15. Miszczyk L, Jochymek B, Wozniak G (2007) Retrospective evaluation of radiotherapy in plantar fasciitis. Br J Radiol 80:829–834

    Article  PubMed  CAS  Google Scholar 

  16. Mitrov G, Harbov I (1967) Our experiences with radiation treatment of non-tumorous diseases. Radiobiol Radiother (Berl) 8:419–422

    Google Scholar 

  17. Mucke R, Schonekaes K, Micke O et al (2003) Low-dose radiotherapy for painful heel spur. Retrospective study of 117 patients. Strahlenther Onkol 179:774–778

    Article  PubMed  Google Scholar 

  18. Mucke R, Seegenschmiedt MH, Heyd R et al (2010) Radiotherapy in painful gonarthrosis. Results of a national patterns-of-care study. Strahlenther Onkol 186:7–17

    Article  PubMed  Google Scholar 

  19. Muecke R, Micke O, Reichl B et al (2007) 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. Acta Oncol 46:239–246

    Article  PubMed  Google Scholar 

  20. Neu B, Sautter V, Momm F et al (2011) Radiotherapy for prevention and therapy of gynecomastia due to antiandrogen treatment in prostate cancer patients: a patterns-of-care study. Strahlenther Onkol 187:771–777

    Article  PubMed  Google Scholar 

  21. Niewald M, Seegenschmiedt MH, Micke O, Graber S (2008) Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur) using very low doses—a study protocol. Radiat Oncol 3:27

    Article  PubMed  Google Scholar 

  22. Oehler W, Hentschel B (2000) Niedrigdosierte analgetische Radiotherapie von Arthrosen. Arztebl Thur 11:92–95

    Google Scholar 

  23. Ott OJ, Hertel S, Gaipl US et al (2012) Benign painful elbow syndrome: initial results of a single center prospective randomized radiotherapy dose optimization trial. Strahlenther Onkol (in press)

  24. Richarz A (1924) Die Röntgenbehandlung der Epikondylitis und Kalkaneodynie. Fortschr Röntgenstr 32:460

    Google Scholar 

  25. Rodel F, Frey B, Gaipl U et al (2012) Modulation of inflammatory immune reactions by low-dose ionizing radiation: molecular mechanisms and clinical application. Curr Med Chem 19:1741–1750

    Article  PubMed  CAS  Google Scholar 

  26. Rodel F, Keilholz L, Herrmann M et al (2007) Radiobiological mechanisms in inflammatory diseases of low-dose radiation therapy. Int J Radiat Biol 83:357–366

    Article  PubMed  CAS  Google Scholar 

  27. Rodel F, Schaller U, Schultze-Mosgau S et al (2004) The induction of TGF-beta(1) and NF-kappaB parallels a biphasic time course of leukocyte/endothelial cell adhesion following low-dose X-irradiation. Strahlenther Onkol 180:194–200

    Article  PubMed  Google Scholar 

  28. Sautter-Bihl ML, Liebermeister E, Scheurig H, Heinze HG (1993) Analgetic irradiation of degenerative-inflammatory skeletal diseases. Benefits and risks. Dtsch Med Wochenschr 118:493–498

    Article  PubMed  CAS  Google Scholar 

  29. Schafer U, Micke O, Glashorster M et al (1995) The radiotherapy treatment of painful calcaneal spurs. Strahlenther Onkol 171:202–206

    PubMed  CAS  Google Scholar 

  30. Schafer U, Micke O, Heinrich Seegenschmiedt M, Mucke R (2010) Correspondence (letter to the editor): low-dose radiotherapy. Dtsch Arztebl Int 107:603–604

    PubMed  Google Scholar 

  31. Schneider O, Stuckle CA, Bosch E et al (2004) Effectiveness and prognostic factors of radiotherapy for painful plantar heel spurs. Strahlenther Onkol 180:502–509

    Article  PubMed  Google Scholar 

  32. Schreiber H, Böhnlein G (2000) Strahlentherapie des schmerzhaften Fersensporns. In: Seegenschmiedt MH, Makoski HB (Hrsg) 10. Kolloquium Radioonkologie/Strahlentherapie. Radiotherapie von gutartigen Erkrankungen. Diplodocus-Verlag, Altenberge, S 186

  33. Seegenschmiedt MH, Keilholz L (1998) Epicondylopathia humeri (EPH) and peritendinitis humeroscapularis (PHS): evaluation of radiation therapy long-term results and literature review. Radiother Oncol 47:17–28

    Article  PubMed  CAS  Google Scholar 

  34. Seegenschmiedt MH, Keilholz L, Stecken A et al (1996) Radiotherapy of plantar heel spurs: indications, technique, clinical results at different dose concepts. Strahlenther Onkol 172:376–383

    PubMed  CAS  Google Scholar 

  35. Surenkok S, Dirican B, Beyzadeoglu M, Oysul K (2006) Heel spur radiotherapy and radiation carcinogenesis risk estimation. Radiat Med 24:573–576

    Article  PubMed  Google Scholar 

  36. Toomey EP (2009) Plantar heel pain. Foot Ankle Clin 14:229–245

    Article  PubMed  Google Scholar 

  37. Trott KR, Kamprad F (2006) Estimation of cancer risks from radiotherapy of benign diseases. Strahlenther Onkol 182:431–436

    Article  PubMed  Google Scholar 

  38. Pannewitz G von (o J) Degenerative Erkrankungen. In: Diethelm I, Heuck F, Olsson O et al (Hrsg) Handbuch der medizinischen Radiologie, Bd. 17, Springer, Berlin, S 73–107

  39. Pannewitz G von (1933) Die Röntgentherapie der Arthritis deformans. In: Holfelder H, Holthausen H, Jüngling O et al (Hrsg) Ergebnisse der medizinischen Strahlenforschung. Thieme Press, Leipzig, S 61–126

  40. Young CC, Rutherford DS, Niedfeldt MW (2001) Treatment of plantar fasciitis. Am Fam Physician 63:467–474, 477–478

    PubMed  CAS  Google Scholar 

  41. Zschache H (1972) Ergebnisse der Röntgenschwachbestrahlung. Radiobiol Radiother (Berl) 181–186

Download references

Acknowledgements

This work was supported in part by the German Federal Ministry of Education and Research (GREWIS, 02NUK017G), and the European Commission (DoReMi, European Network of Excellence, contract number 249689).

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91054, Erlangen, Germany

    O.J. Ott, C. Jeremias, U.S. Gaipl, B. Frey, M. Schmidt & R. Fietkau

Authors
  1. O.J. Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Jeremias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U.S. Gaipl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Frey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Fietkau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O.J. Ott.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ott, O., Jeremias, C., Gaipl, U. et al. Radiotherapy for calcaneodynia. Strahlenther Onkol 189, 329–334 (2013). https://doi.org/10.1007/s00066-012-0256-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-012-0256-3

Keywords

Schlüsselwörter

Search

Navigation