Heel spur treatment with X-ray therapy

Treatment of plantar fasciitis with X-rays or x-ray therapy of the calcaneal spur is an effective method of significantly reducing the symptoms of pain, and often - and completely getting rid of it.

Numerous randomized clinical trials conducted by European specialists over the past three decades have shown that 68-82% of cases after this treatment are marked by significant pain relief, and in 27-36% of patients for at least two years the pain completely ceases.

Indications for the procedure

Treating the calcaneal spur with X-ray therapy, as well as some other enthesopathies and articular diseases, caused by degenerative and dystrophic processes in the structures of the musculoskeletal system, has strict indications for conduction: intense pain that can not be overcome and problems with movement.

The main criterion for the appointment of radiation therapy of  plantar fasciitis  is the ineffectiveness of the standard methods used for at least six months: local injections of glucocorticosteroids, analgesic ointments, massage, exercise therapy, and physiotherapy equipment (provided that the insteps and orthopedic insoles are used).

[1], [2], [3], [4], [5], [6], [7]

Preparation

Since patients with a calcaneal spur are treated by an orthopedist or a podiator, all the necessary examinations, which include the preparation for X-ray therapy, are appointed by the attending physician. The main thing is the presence of an X-ray (in two standard projections) and / or the results of the last MRT of the affected foot.

It is necessary to give a general blood test. And in unclear clinical cases, it may additionally require scintigraphy of the bone structures of the foot.

10-12 days before the start of the X-ray sessions, any physiotherapy procedures are canceled and local means are no longer used.

[8], [9], [10], [11]

Technique of the radiotherapy of the heel spur

X-ray therapy with a calcaneal spur can be short- and long-focus. The technique of short-focus X-ray therapy consists in exposing the spurs generated by the X-ray therapy device (penetrating through the skin) to the spur by no more than 60-70 mm deep into the tissues of the plantar fascia.

In this case, the choice of voltage and current strength of the X-ray unit (i.e., optimal technical parameters), the focal distance, the size of the irradiated area, the value of the single-shot focal and cumulative absorbed dose of ionizing irradiation is carried out by specialists taking into account the depth of location of the marginal plantar osteophyte and the condition of the surrounding its tissues.

The fractionation regime is individually determined: the number of sessions, the duration of one irradiation and their frequency.

There can be only one irradiation (if the anesthetic result is achieved quickly), two procedures (with a long interval) or 5-10 exposures (every two to three days).

According to the recommendations of the Society for Radiation Therapy and Oncology of Germany (DEGRO), updated in 2013, treatment of calcaneal spur with X-ray therapy should be carried out with two or three fractionations with a single focal dose of 0.5-1.0 Gy and a total absorbed dose within 3.0- 6.0 Gy.

In the case of persistent pain or inadequate anesthesia, repeated exposures may be recommended - 6-12 weeks after the first treatment.

Contraindications to the procedure

X-ray therapy of the calcaneal spur is absolutely contraindicated with the general poor health of patients: severe cardiological, vascular and pulmonary pathologies (including thrombophlebitis of the lower limbs and pulmonary tuberculosis); hematological diseases; oncology; immunosuppression; pregnancy and lactation.

Also, temporary contraindications for this treatment are associated with the presence of acute inflammatory processes or infectious diseases.

It is undesirable to use orthovolt radiation therapy in patients younger than forty.

[12]

Consequences after the procedure

It is believed that such consequences after the procedure of irradiation of the foot area, like the development in the long-term period of cancer (skin or bone marrow) are unlikely. At least, according to the European Journal of Orthopedic Surgery & Traumatology, the risk of developing oncology as a result of this treatment is very low, and there have been no documented cases of radiogenic acute or chronic side effects among patients of Western European medical institutions.

But the complications after the procedure can be manifested by local skin hyperemia (immediately after irradiation), its swelling and some soreness. Radiation therapy can cause an increase in dryness and flaking of the skin on the sole of the foot (as an exfoliative dermatitis), thinning of the epidermal layer of the skin and reducing its elasticity, cracking the skin at the site of exposure to radiation - with the release of exudate.

[13], [14], [15], [16]

Care after the procedure

X-ray therapy of the heel spur is performed on an outpatient basis, so patients do not need to be monitored in hospital, and special care is not needed after the procedure.

[17], [18], [19], [20], [21]

Reviews

Although in Russian orthopedics, in contrast to foreign orthopedics, x-ray treatment of calcaneal spur is not widely spread (due to the lack of a single protocol for its conduct and irrefutable evidence of safety), the reviews of most patients after such therapy are evidence in favor of this method.

However, it should be borne in mind that acute pain in the foot may resume after a while, since low doses of ionizing radiation do not destroy the plantar osteophyte and are symptomatic treatment.