Radiotherapy in the low-dose range with total doses of 5-6 Gy is in Germany an established method for the treatment of the pain symptoms in existing painful heel spurs. Most known results were achieved with orthovolt radiation. The answer to this question today is whether the use of high-voltage linear accelerators for therapy can further improve these results. From 06/99 to 12/2001, we irradiated 287 patients with painful heel spur in a consecutive series. 137 patients were irradiated with Orthovolt device (200kV), 151 with the linear accelerator (6MV). Before and after the therapy as well as in the follow-up the pain profile was recorded in 274 patients with 311 localizations in a questionnaire. For the determination a pain sum score was used. 9 patients could not be followed-up and 265 patients with 300 heel spurs were evaluated. The time from onset of pain to treatment, pain intensity and duration of pain were the same in both groups, as was the dose applied. 111 patients (79.3%) of the orthovolt group (O) were painless after radiation treatment, 126 patients (78.8%) of the accelerator group (L) achieved the same result. The outcome of the treatment in both groups was not affected by gender, site location, duration of pain, or previous treatment. 19 patients (13.6%) in O and 22 patients (13.8%) in L reported a noticeable decrease in pain symptoms and did not want further treatment. 8 patients (5.7%) in O and 8 patients (5%) in L were unable to change their pain symptoms. Only 2 patients (1.4%) in O and 4 patients (2.5%) in L reported an increase in pain after completion of treatment (3 series). The results of this work show no influence of the radiation quality on the pain profile after radiotherapy of the painful heel spurs. The number of pain-free patients after treatment was the same in both groups, the same number of patients experienced pain relief, and the number of therapy-resistant locations was equal. The low-dose irradiation of the painful heel spur is an effective and inexpensive method, which should be used much more frequently in the daily practice of the pain therapy of benign diseases. The use of linear accelerators for the treatment of benign diseases such as heel spurs is not necessary, the same effect can be achieved with Orthovolt irradiation. Conventional orthovolt radiation units are sufficiently usable for these indications and show identical results.
Frau PD Dr. med. G. Hänsgen & Herr Prof. Dr. med. Hildebrandt