Efficacy of Radiotherapy
The authors mention low-dose radiotherapy as an established method for the treatment of plantar heel pain (1). We fully agree with their statement that, while the exact mechanism of action is not yet understood, very good outcomes have been reported in retrospective and prospective studies.
We would like to add that in recent years several prospective randomized trials from Erlangen and Homburg/Saar (Germany)—which the authors regrettably did not mention in their article—on the one hand, provided evidence of the efficacy of radiotherapy in comparison to a very low (placebo) dose (2), and, on the other hand, searched for the optimum dose in two further studies (3, 4). The updated S2-guideline (5) recommends that radiotherapy with a total dose of 3 Gy should be administered in individual doses of 0.5 Gy twice a week.
Prof. Dr. med. Marcus Niewald
Klinik für Strahlentherapie und Radioonkologie
UKS – Universitätsklinikum des Saarlandes, Homburg, Germany
Conflict of interest
The author declares no conflict of interest.
|1.||Gutteck N, Schilde S, Delank KS: Pain on the plantar surface of the foot. Dtsch Arztebl Int 2019; 116: 83–8 VOLLTEXT|
|2.||Niewald M, Seegenschmiedt MH, Micke O, et al.: Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose—mature results after 12 months’ follow-up. Int J Radiat Oncol Biol Phys 2012; 84: e455–e62 CrossRef MEDLINE|
|3.||Prokein B, Holtmann H, Hautmann MG, et al.: Radiotherapy of painful heel spur with two fractionation regimens. Results of a randomized multicenter trial after 48 weeks`follow-up. Strahlenther Onkol 2017; 193: 483–90 CrossRef MEDLINE|
|4.||Ott OJ, Jeremias C, Gaipöl US, Frey B, Schmidt M, Fietkau R: Radiotherapy for calcaneodynia. Results of a single center prospective randomized dose optimization trial. Strahlenther Onkol 2013, 189: 329–34 CrossRef MEDLINE|
|5.||DEGRO – Leitlinien in der Strahlentherapie: „Strahlentherapie gutartiger Erkrankungen. Version2.0 v. 02.11.2018. www.degro.org/wp-content/uploads/2018/11/S2-Leitlinie-gutartiger-Erkrankungen-update- 2018-Endversion.pdf (last accessed on 18 March 2019).|