Plantar Fasciitis is the most common cause of heel pain in the United States. It is related to “heel spurs” and is due to inflammation and irritation of the tissue around the heel. The specific tissue involved is called the plantar fascia. [1, 2]

The diagnosis of Plantar Fasciitis is mainly clinical. This means a combination of history, risk factors, and physical exam. Patients with Plantar Fasciitis characteristically have heel pain and tightness after standing up in the morning and improves with walking. Palpation of a part of the heel will cause a stabbing pain. If there is a question about the diagnosis, either ultrasound or MRI may be helpful.[1]

For most patients, the pain usually resolves within a year with conservative treatment. Conservative treatments include rest, minimizing activity that irritates the foot, nonsteroidal anti-inflammatory drugs (NSAIDS like ibuprofen), corticosteroids, injections, stretching, physical therapy, orthotics and splints.[1, 2]

If the plantar fasciitis pain does not resolve with these conservative treatments within 6 to 12 months, then more involved treatments may be considered. These include shock wave therapy, low dose radiation therapy, and/or surgery.[2]

Low Dose Radiation Therapy (LDRT) is a very localized treatment specifically to the heel for plantar fasciitis based on the anti-inflammatory effects of low dose of radiation. This is in contrast to high dose radiation typically used to treat cancer patients. Low dose radiation therapy for plantar fasciitis starts with a planning session (called a “simulation”). Low dose radiation therapy treatment usually starts within a couple weeks of the simulation.

The measurement unit for absorbed radiation dose is a Gray (Gy). Low dose radiation therapy for plantar fasciitis involves treatment of only the heel to a total dose of 3-6 Gy applied in small fractions of 0.5-1.0 Gy. Low dose radiation therapy treatments are given 2-3 times per week for 2-3 weeks. (This is in stark contrast to the high dose radiation treatments for cancer patients that may involve total doses greater than 79 Gy.)[3, 4]

Each treatment or fraction of low dose radiation take less than 10 minutes to administer and is painless.

In low doses per fraction and low total doses, radiation therapy has been shown to have localized anti-inflammatory effects. This effect has been known for at least 60 years.[4, 5]

Every person is different, but the response rate for low dose radiation therapy for plantar fasciitis has been shown to be as high as 81% in some analyses, though other analyses have had response rates less than that.[3, 6] A recent randomized clinical trial compared low dose radiation therapy (LDRT) with corticosteroid injections and found that low dose radiation therapy had better results than corticosteroid injections for at least 6 months after treatment.[4] Other plantar fasciitis studies have found that the duration of pain improvement with low dose radiation therapy to be greater than 12 months.[6]

Low dose radiation therapy is painless to administer and is most analogous to receiving an x-ray. Given the very low dose of radiation used for plantar fasciitis, the side effects are fairly minimal. Occasionally, some patients may have some temporary redness or dryness of the skin around the heel, but most patients do not notice any side effects. Long-term there is a very small theoretical risk of carcinogenesis within the radiation field around the heel, but we have not found any actual examples or case publications stemming from low dose radiation for plantar fasciitis.

Many surgeons are worried about increased surgical difficulty or wound healing after surgery in an area that has been previously radiated. For high dose radiation typically administered to treat cancer, this is a valid concern. However, given the low dose of radiation used to treat plantar fasciitis, there should not be any clinically noticeable difference. We have not found any reports of surgical complications arising from prior low dose radiation for plantar fasciitis.

The anti-inflammatory effects of low dose radiation therapy have been known for over 60 years.[4] Publications of radiation being used to treat various foot diseases including plantar fasciitis have been around since at least the 1960’s.[7]

Yes, most commercial insurance and medicare should cover the treatment of plantar fasciitis with low dose radiation therapy (LDRT) as long as other conservative treatments have been tried first without satisfactory relief. Prior to the start of treatment, we will obtain authorization and confirmation of coverage from your insurance carrier.

If it has been at least 6 months since you’ve been diagnosed with plantar fasciitis and you’ve tried other conservative treatments for plantar fasciitis without satisfactory improvement, you may be eligible for treatment with low dose radiation therapy (LDRT) for your plantar fasciitis. The first step is to call our office at 706-272-6060 to schedule a consultation with one of our physicians in Dalton, Georgia.

1. Goff, J.D. and R. Crawford, Diagnosis and treatment of plantar fasciitis. American family physician, 2011. 84(6): p. 676-682.

2. Luffy, L., et al., Plantar fasciitis: a review of treatments. JAAPA, 2018. 31(1): p. 20-24.

3. Ott, O.J., et al., DEGRO guidelines for the radiotherapy of non-malignant disorders. Strahlentherapie und Onkologie, 2015. 191(1): p. 1.

4. Canyilmaz, E., et al., Prospective randomized comparison of the effectiveness of radiation therapy and local steroid injection for the treatment of plantar fasciitis. International Journal of Radiation Oncology* Biology* Physics, 2015. 92(3): p. 659-666.

5. Reichl, B., et al., DEGRO practical guidelines for radiotherapy of non-malignant disorders: Part I: physical principles, radiobiological mechanisms, and radiogenic risk. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft...[et al], 2015. 191(9): p. 701-709.

6. Niewald, M., et al., Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose: mature results after 12 months' follow-up. International Journal of Radiation Oncology* Biology* Physics, 2012. 84(4): p. e455-e462.

7. JM, S.M., Radiotherapy in foot diseases. Revista Espanola de Reumatismo y Enfermedades Osteoarticulares, 1968. 12(6): p. 369-371.