Radiation Oncology/Heel Spurs

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