Are single fractions of radiotherapy suitable for plantar fasciitis?

Abstract

The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow-up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use.

RE: F Schwarz et al.− Are single fractions of radiotherapy suitable for plantar fasciitis?

“…We do share the sentiments expressed by Schwarz et al 1 . that there seems to be an inordinate demand on proponents of radiotherapy for plantar fasciitis to include a sham or placebo arm whereas nearly all other current standard radiotherapy treatments have never required this to be done.…”

“…We read with great interest the article by Schwarz et al . in the June 2004 edition of Australasian Radiology , regarding the radiotherapeutic management of plantar fasciitis 1 . We congratulate the authors for their article, as we are strong proponents of the use of radiotherapy in this debilitating condition.…”

“…Schwarz et al . comment in their discussion that the 8 Gy single‐dose regimen was ‘comparable to other settings in which radiotherapy has been used to obtain an anti‐inflammatory effect in the treatment of benign conditions affecting connective tissues such as heterotopic ossification, pterygia and keloids’ 1 .…”

“…Regrettably, this was rejected by TROG for reasons which Schwarz et al 1 . highlight in their paper; namely, the concerns that patients with benign disease should be competing with cancer patients for treatment spaces in a climate of long waiting lists and limited resources.…”

“…Paradoxically, the waiting list argument was part of the reason TROG chose not to support the trial and yet the feedback we were given was that we should consider re‐submitting the study as a double‐blind randomized controlled study with a sham radiotherapy control arm! As Schwarz et al 1 . pointed out, this would put further strains on already stretched departments and would be virtually impossible to blind the patient and staff to sham versus real treatment.…”