Abstract
AimPlantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition.MethodsWe identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years.ResultsBefore radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment.ConclusionRadiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction.
Highlights
Plantar enthesophyte is a painful degenerative disorder evolving over a long time [1,2,3,4] and is localized at the tuber calcanei [5] (Fig. 1).Plantar enthesophyte, often described as heel spur, was first described by Plettner [6]
We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems
The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain
Summary
Plantar enthesophyte is a painful degenerative disorder evolving over a long time [1,2,3,4] and is localized at the tuber calcanei [5] (Fig. 1).Plantar enthesophyte, often described as heel spur, was first described by Plettner [6]. The plantar enthesophyte develops as a reactive formation of bone due to mechanical stress with degenerative changes and microtraumas at the insertion of the tendons of the abductor hallucis and the brevis flexor digitorum muscles as well as the plantar aponeurosis and can be identified as a result of a plantar fasciitis. This term is misnomer, since the plantar fascia is an aponeurotic rather than a fascial layer.
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