Dear Editor,

I read with interest the article “Role of radiotherapy in the management of heel spur” by Uysal et al. in your publication Vol 25 No 2. The authors’ findings on the efficacy of low-dose radiotherapy for the treatment of painful heel spur in patients who are unresponsive to traditional treatment modalities may be useful in the clinical environment.

However, I would like to draw the readers’ attention to the following issues with the study’s methodology:

  1. 1.

    In the country from which the authors write, patients suffering from symptoms reminiscent of heel spurs are not directly admitted to the Radiation Oncology Department without first being evaluated by physicians in other polyclinics such as PMR, orthopaedics, or family medicine. The social security system of Turkey does not cover the costs of radiotherapy application for patients diagnosed with heel. It is therefore unclear as to how such treatment in this patient population (i.e. those that were not evaluated by the doctors in the related divisions) could be applied. In addition, the authors did not include clinicians working in the family medicine, PMR, or orthopaedic surgery fields and no mention was made of doctors from a division capable of evaluating the patients applying due to heel spur pain. Therefore, it is unclear as to how the authors selected the patients for the study.

  2. 2.

    Although the abstract referred to the study as a “retrospective” study, the authors wrote that they had obtained patient approval. Such an application is not possible in a retrospective study as such.

  3. 3.

    The inclusion criteria were insufficient and did not address whether the heel spur was determined through physical examination and/or radiography.

  4. 4.

    In addition, while the authors did discuss the carcinogenic risk of radiotherapy in other studies in their discussion, they did not mention any encountered or possible side effects of the applied radiotherapy application in their own study.

Pınar Doruk Analan, MD

Baskent University, Ankara, Turkey,

Faculty of Medicine, Physical Medicine and Rehabilitation Department