**5. Conclusions**

In radiotherapy of another benign disease (endocrine orbitopathy) a 1 Gy per week over 20 weeks schedule was more effective than the standard schedules (10 × 2 Gy or 10 × 1 Gy every working day) [84]. Although other immunological mechanisms cause endocrine orbitopathy in comparison with plantar fasciitis, there is sufficient clinical evidence to test in a random‐ ized trial different fractionation schedules (twice a week vs. once a week, possibly thrice a

Other therapies than LD‐EBRT have been applied in painful heel spur. In the following, just

Different kinds of insoles and foot orthoses have been developed. The goal was to reduce plantar contact pressure and to distribute the pressure uniformly over the whole rearfoot [63]. Magnetic insoles do not seem to provide additional benefit [64]. As a short‐term treatment, low‐Dye taping techniques are often used. However, in a randomized trial only a modest

Manual stretching is often recommended. A systematic review of six studies found only sta‐ tistically significant differences in comparison with the control in one study combining calf

Several trials have investigated acupuncture. A systematic review from 2010 showed (limited) evidence for the effectiveness [67]. A randomized trial published in 2014 recruited 84 patients [68]. The authors concluded, that "dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the fre‐

Ultrasound therapy has led to questionable results [69], but a randomized trial on cryo‐ultra‐

Low‐level laser light (635 nm), given twice a week for a total of six applications, reduced in a ran‐ domized trial VAS scores significantly after 8 weeks in comparison with placebo [71]. However, the study comprised of just 69 patients; other similar studies have not been reported so far.

Extracorporeal shock waves are widely applied. Three metaanalyses comprising at least five randomized trials found significant short‐term pain relief and improved functional outcomes for this therapeutic option [72–74]. Another study compared the analgesic efficacy of ultra‐ sound and shock wave therapy in 47 patients [75]. The results suggested that the shock wave

Another basic approach is the oral administration of nonsteroidal anti‐inflammatory drugs (NSAID) to achieve a symptomatic relief. Injections into the painful area are also recommended. A recent review summarized ten randomized trials on corticosteroid injections into the plantar fascia [76]. A significant effect of the steroids on the pain has been shown. However, it was usually short‐term, lasting 4–12 weeks in duration. No advantage of ultrasound‐guided injec‐ tion techniques in comparison with palpation guidance was found, and no superiority of one type of corticosteroid over another was seen. A longer lasting pain relief has been suggested

sound with about 100 patients published in 2014 showed good effectiveness [70].

improvement in 'first‐step' pain was seen in comparison with sham‐intervention [65].

week).

162 Radiotherapy

**4.3. Comparison of LD‐EBRT with other therapies**

a rough overview can be given.

muscle and plantar fascia stretches [66].

quency of minor transitory adverse events."

therapy had greater analgesic efficacy.

LD‐EBRT for painful plantar fasciitis/heel spur is an effective and safe treatment option for patients over 30 years of age and after exclusion of pregnancy. A fractionation of 6 × 0.5 Gy twice weekly up to a total dose of 3 Gy is currently recommended. In the case of an insuffi‐ cient response a second course can be offered to the patient.

Randomized trials on target volume definition and further optimization of LD‐EBRT fraction‐ ation are currently in the process of planning. Further trials to compare the different conserva‐ tive therapies for plantar fasciitis with each other are necessary to allow the development of an evidence‐based treatment algorithm.
