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Efficacy of external beam radiotherapy for the management of refractory plantar fasciitis: a prospective study

Author: 
Ashok K. Chauhan, Yashpal Verma, Sukhbir Singh Sangwan, Dinesh Kumar and Paramjit Kaur
Subject Area: 
Health Sciences
Abstract: 

Purpose: To evaluate the efficacy of external beam radiotherapy for the management of refractory plantar fasciitis and to assess radiation induced side effects, including malignancy. Material and Method: The study was carried out in Department of Radiotherapy, PGIMS, Rohtak (India), on 36 diagnosed cases (56 heels) of plantar fasciitis. These diagnosed patients of plantar fasciitis having pain, refractory to medical treatment, were accrued for and given external beam radiation therapy (EBRT) during 2005-08. The dose of EBRT was 6 Gy in 6 fractions over 2 weeks (1Gy per fraction, 3 fractions per week), given on Telecobalt. Assessment was made for response – at completion of radiotherapy, after six months and one year following radiotherapy. Response was evaluated using Objective (Calcaneodynia) pain score and Subjective (von Pennewitz) pain score. Acute skin reactions were noted at completion of radiotherapy. Late event as radiation induced malignancy was noted after at least 6 years following treatment. Results: Six months following EBRT, complete/ excellent response (CR) was observed in 62.5% heels, both by objective and subjective scores. Partial/ good response (PR) was 16.1% on objective score and 23.3% on subjective score, minor/ fair response (MR) was 12.5% & 7.1% and no/poor response (NR) was 8.9% and 7.1% respectively. One year after radiotherapy, Calcaneodynia objective score revealed CR, PR, MR and NR respectively were 80.4%, 7.1%, 8.9% and 3.6%. No progressive disease was found in any of the heels treated with radiotherapy during treatment or follow-up. No significant acute skin reaction was observed. None of the patients has reported with radiation induced or second malignancy so far. Conclusion: External beam radiotherapy offers very good treatment option for management of plantar fasciitis pain refractory to medical treatment. EBRT may be offered to patients, particularly older, without the historical fear of radiation induced malignancy. Though, equally effective in young patients, conclusive words regarding risk of long term side effects still need longer follow up.

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