Aadil Najeed: Low Dose Radiotherapy in Plantar Fasciitis

Aadil Najeed, Senior Resident of Government Medical College Srinagar, shared a post on LinkedIn:

“Low Dose Radiotherapy (LDRT) in Plantar Fasciitis – An underused yet evidence-backed option

Plantar fasciitis is one of the most common causes of chronic heel pain — and while most patients respond to NSAIDs, orthotics, physiotherapy or injections… a subset remains refractory.

This is where LDRT finds its role.

What do major guidelines and groups suggest?

RCR (Royal College of Radiologists)

• Supports RT for benign conditions in **selected refractory cases**
• Emphasis on careful patient selection (typically >40 yrs)

German DEGRO guidelines

• Among the strongest proponents globally
• Recommend LDRT for **chronic plantar fasciitis (>6 months, failed conservative therapy)**
• Standard regimen: **~6 Gy in 1 Gy fractions, 2–3/week**

International data (IORBC and published literature)

• Consistent evidence of **anti-inflammatory mechanism**
• Macrophage modulation and cytokine suppression drive symptom relief

What does the evidence show?

1. Large German series (~8000 patients)
   • Pain relief ≥70%
   • Durable response ~65%
   • Minimal to no significant toxicity
2. Retrospective and long-term data
   • Complete pain relief ~48%
   • >50% improvement in additional ~20%
   • Long-lasting benefit (years)
3. Randomized trials (DEGRO group)
   • Standard dose (6 Gy) superior to ultra-low dose (placebo-like arm)

Why does it work?

• Anti-inflammatory effect (not cytotoxic)
• Downregulation of leukocyte adhesion and cytokines
• Particularly effective in chronic degenerative inflammation

 Practical takeaways

1. Ideal candidate
   • Chronic symptoms >6 months
   • Failed conservative therapy
   • Age >40 years
2. Dose and technique
   • 6 Gy in 1 Gy fractions (most commonly used)
   • Orthovoltage / megavoltage both acceptable
3. Safety
   • Extremely low toxicity
   • Negligible carcinogenic risk in appropriate age group

When to avoid

• Young patients
• Pregnancy
• Early/self-limiting disease

Bottom line
LDRT is not first-line — but in carefully selected patients, it offers a **highly effective, low-toxicity, evidence-supported option** that is often overlooked outside Europe.

Time to reconsider LDRT in benign inflammatory conditions?”

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