Low-dose Radiation Treatment for Painful Heel Spur: a Highly Effective Therapy With Little Side Effects

Aim: Evaluation of pain reduction using orthovolt or cobalt-based radiation treatment for painful heel spurs and determination of long-term response as well as prognostic parameters.Methods: 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. Pain reduction was scored using the modified Rowe-Score prior therapy, at the end of each treatment series as well as after 6 weeks and at the time of data collection. Long-term outcome was evaluated in patients with a follow-up period of longer than three years. Results: Before 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. Hier noch etwas über die Nebenwirkungen schreiben? Darauf gehen wir in der Conclusion ja ein.Conclusion: Radiotherapy of painful heel spurs 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.

Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in calcaneal spur treatment: A prospective, randomized, clinical study

Objectives: In this study, we aimed to evaluate and compare the efficacy of low-level laser therapy (LLLT) and extracorporeal shock wave therapy (ESWT) in the treatment of calcaneal spurs. Patients and methods: A total of 62 patients (14 males, 48 females; mean age: 47.6±11.7 years; range, 18 to 70 years) who were diagnosed with calcaneal spurs based on clinical examination and plain radiography between April 2019 and September 2019 were included in this study. A total of 15 sessions of plantar fascia gastroc-soleus stretching exercises and cold pack treatments were given to both groups. The LLLT (904 nm wavelength, 3,000 Hz, 8 J/cm2 dose to the painful heel area and insertion of the plantar fascia on the medial calcaneal area, five points for a total of 5 min for three weeks) was applied to the first group (n=31), whereas ESWT (10 Hz, 2,000 shock waves with a 2.5 bar pressure into the areas of the painful heel, insertion of the plantar fascia on the medial calcaneal area) was applied the second group (n=31). All patients were evaluated using the Visual Analog Scale (VAS) and Foot Function Index (FFI) before and after treatment. Results: In both groups, the median VAS and FFI scores after treatment showed a significant improvement, compared to pre-treatment scores (p=0.001). There was no significant difference between the groups in terms of the median post-treatment VAS scores (p>0.05). In the ESWT group, the median FFI pain and total scores after treatment were significantly lower than in the LLLT group (p=0.033). The change in the median FFI pain and total scores were significantly higher in the ESWT group (p=0.046). Conclusion: Both treatment modalities are effective and not superior to each other in terms of disability and activity limitation reduction, although a greater improvement in the FFI pain and total scores can be achieved with the ESWT. Based on these findings, we recommend both non-invasive treatment methods to be used in the treatment of calcaneal spurs in the clinical practice.

Vatakantaka and its management through Ayurveda- A Case review.

Vatakantaka is characterized by pain in the heel region and included in Vatavyadhi by Acharya Sushruta. It causes due to silent and repeated injury resulting into inflammation of plantar fascia which results in the painful heel. It is a common cause of heel pain occurs in about 10% of the general population. Women are twice more prevalent than men. Vatakantaka is mainly caused due to vitiation of Vatadosha and continuous pressure on the heel region. It can be correlated with Chronic planter fasciitis or Calcaneal spur. It is more prevalent in female gender and having Sthul akruti (obesity). Various chikitsa measures for management of Vatakantaka are given in classics of Ayurveda. Here bahya and abhyantar chikitsa with Agnikarma gives improvement in subjective criteria like vedana (pain), stambha (stiffness), shotha (swelling) and kriyahani (restricted movements) in short duration of time.

Radiation-induced DNA double-strand breaks in peripheral leukocytes and therapeutic response of heel spur patients treated by orthovoltage X-rays or a linear accelerator

Purpose Biodosimetric assessment and comparison of radiation-induced deoxyribonucleic acid (DNA) double-strand breaks (DSBs) by γH2AX immunostaining in peripheral leukocytes of patients with painful heel spur after radiation therapy (RT) with orthovoltage X‑rays or a 6-MV linear accelerator (linac). The treatment response for each RT technique was monitored as a secondary endpoint. Patients and methods 22 patients were treated either with 140-kV orthovoltage X‑rays (n = 11) or a 6-MV linac (n = 11) with two weekly fractions of 0.5 Gy for 3 weeks. In both scenarios, the dose was prescribed to the International Commission on Radiation Units and Measurements (ICRU) dose reference point. Blood samples were obtained before and 30 min after the first RT session. γH2AX foci were quantified by immunofluorescence microscopy to assess the yield of DSBs at the basal level and after radiation exposure ex vivo or in vivo. The treatment response was assessed before and 3 months after RT using a five-level functional calcaneodynia score. Results RT for painful heel spurs induced a very mild but significant increase of γH2AX foci in patients’ leukocytes. No difference between the RT techniques was observed. High and comparable therapeutic responses were documented for both treatment modalities. This trial was terminated preliminarily after an interim analysis (22 patients randomized). Conclusion Low-dose RT for painful heel spurs with orthovoltage X‑rays or a 6-MV linac is an effective treatment option associated with a very low and comparable radiation burden to the patient, as confirmed by biodosimetric measurements.

Role of Agnikarma in the management of Calcaneal spur: A Case Report

Vatkantaka (Calcaneal spur ) is common source of heel pain causes excruciating type of pain in the heel and disability. Vatkantaka is one of the vatvyadhi. During walking or running on uneven road if the foot landed improperly, the vata ceases in khudukapradesh or gulf sandhi produces as if prick by the thorn hence it termed as a Vatkantaka. Calcaneus is the heel bone. When it is met with constant pressure, calcium deposition occurs beneath this bone and if the pressure continues, the deposition takes the shape of spur, causing pain. Pain on standing or while walking is the characteristic feature. People who need to stand for a long period of time, or those who walk on uneven surfaces tend to cause pressure beneath the heel bone, triggering calcaneal spur. Calcaneal spur condition of painful heel can be understood under the term Vatkantaka. In Ayurvedic literature. Acharya Sushruta has advised Agnikarma as a treatment modality for the management of Vatkantaka. This Agnikarma therapy is local management which relieves pain instantly I.e Sadyafaldayi chikitsa.

The Role of Agni karma in the management of Planter Fasciitis

Planter fasciitis is commonly found in 80% population in the society which is caused due to the affection of calcaneum. It is often seen in females and individuals over 35 years. It is one of the most troublesome complaints affecting the individuals in their routine work. Acharya Sushruta suggests the disease planter fasciitis can be correlated with Vatakantaka which is caused by vitiated Vata dosha due to constant standing and walking. Planter fasciitis can develop due to walking on uneven roads with ill fitting footwear which causes silent and repeated injury resulting into inflammation of planter fascia which results into painful heel, tenderness, early morning stiffness & restricted movements of heel. Sushruta has mentioned different methods of management of diseases, such as Bheshaja karma, Kshara karma, Agni karma, Shastrakarma and Raktamokshana. Aim-To study the role of Agnikarma in the management of Planter Fascitis. Objectives: To study planter fasciitis.To study the role of Agnikarma in planter fasciitis. Results and Discussion: Chronic Planter fasciitis can develop due to use of walking on uneven roads with ill fitting footwear which causes silent and repeates injury resulting into inflammation of planter fascia which results into painful heel, tenderness, restricted movements of heel, During the use of Agnikarma chikitsa, we take the Agni in the shalaka by making it Red Hot on fire. The Agni from shalaka is to be transferred to the diseased part, the dhatoo (twacha). The Dhatu Agni gets utkleshit (Activated). The activated dhatoo Agni use to produce Dosh Pachan.