Koca Timur, Aydın Ayşen, Sezen Duygu, Başaran Hamit, Karaca Sibel
Regional Training and Research Hospital Radiation Oncology Department, Caykara caddesi, Erzurum, 25200 Turkey.
Springerplus. 2014 Jan 10;3:21. doi: 10.1186/2193-1801-3-21. eCollection 2014.
Painful plantar heel spur (PPHS) is a benign disorder with painful heels as a result of plantar calcaneal bone spur. Exact etiological factors are still unclear. Treatment typically consists of osteoarthritis tretment schedules and surgical techniques. External radiotherapy is another treatment option. This study is aimed to determine effectiveness and treatment outcomes of external radiotherapy in patients with PPHS.
Sixty-two patients with PPHS were analysed for radiotherapy success and other possible prognostic factors. All patients were treated with Co-60 units from parallel opposed lateral portals, to a total dose of 8 Gy. Responses to radiotherapy was assessed by visual analogue scale (VAS) of pain. Follow-up completed in December 2012 with 28 months median duration (range 22 to 35 months). Age, sex, patient number, spur settlement site, prior treatments, time interval between diagnosis and radiotherapy, pain scores (before and after radiotherapy), plantar fat-pillow thickness (PFPT; thickness of the plantar fat pad) and Böhler's angle estimations were analysed.
Study included 53 female and 9 male patients with median age 57 (range 43-70). Time interval between PPHS diagnosis and radiotherapy were median 33 months (range10-60). Radiotherapy response time interval were 6 months (range 3-10 months). Responses to radiotherapy were no response in 13 patients (21%), partial response in 13 patients (21%)- pain relief below 50% and complete response - no pain in 36 patients (58%) respectively. Median PFPT of patients were 3.5 cm (range 1.20-4.50 cm). Complete response rate was statistically significant in patients whom PFPT is greater than 3.5 cm. The Böhler's angle range is about 20-40 deg. Complete response rates were higher in patients with degree of Böhler's Angle 30 and below.
Simplicity of treatment, lack of acute adverse effects and low cost, seem to make radiotherapy one of the safest, cheapest and also an effective treatment modality for PPHS.
疼痛性足跟跖侧骨刺（PPHS）是一种因跟骨跖侧骨质增生导致足跟疼痛的良性疾病。确切病因仍不明确。治疗通常包括骨关节炎治疗方案和手术技术。体外放射治疗是另一种治疗选择。本研究旨在确定体外放射治疗对PPHS患者的有效性和治疗效果。
分析62例PPHS患者的放射治疗成功率及其他可能的预后因素。所有患者均采用60钴源从双侧平行相对野照射，总剂量为8 Gy。通过疼痛视觉模拟量表（VAS）评估放射治疗反应。随访于2012年12月完成，中位随访时间为28个月（范围22至35个月）。分析年龄、性别、患者数量、骨刺位置、既往治疗、诊断与放射治疗之间的时间间隔、疼痛评分（放射治疗前后）、足底脂肪垫厚度（PFPT；足底脂肪垫厚度）和跟骨角测量值。
研究纳入53例女性和9例男性患者，中位年龄57岁（范围43 - 70岁）。PPHS诊断与放射治疗之间的时间间隔中位值为33个月（范围10 - 60个月）。放射治疗反应时间间隔为6个月（范围3 - 10个月）。放射治疗反应分别为：13例患者无反应（21%），13例患者部分反应（21%） - 疼痛缓解低于50%，36例患者完全反应 - 无疼痛（58%）。患者的中位PFPT为3.5 cm（范围1.20 - 4.50 cm）。PFPT大于3.5 cm的患者完全缓解率具有统计学意义。跟骨角范围约为20 - 40度。跟骨角为30度及以下的患者完全缓解率更高。
治疗简单、无急性不良反应且成本低，似乎使放射治疗成为PPHS最安全、最便宜且有效的治疗方式之一。
