Can the Effect of Radiotherapy on Painful Plantar Fasciopathy Be Objectively Measured Using Static and Dynamic Pedobarography

Objective: This study was about evaluating a new method of objective measuring the effectiveness of the radiotherapy for the painful plantar fasciitis. In this case we tried to elaborate a new, more objective method using the dynamic and static pedobarography. Until now the only way of disclosing the effectiveness of the radiotherapy of the plantar fasciitis was the subjective perception of the patient telling the investigator if he has recovered from the pain after the radiotherapy or not and if he did how much benefit he would get out of this therapy due to the decrease of the pain and the gain of functionality of the effected foot using the C´VAS-Scale as well as the Calcaneodynia-Score according to Rowe [31]. Imaging processes are not indicative of the local conditions, for the persistence of symptoms and the morphology of the plantar fasciitis do not correlate with the results of the diagnostic imaging. Patients and methods: 30 patients with clinical and radiological diagnosed plantar heelspur and therefore indication for radiation were included in this prospective and consecutive study after obtaining their written consent. Exclusion criteria were previous medical conditions of the effected foot, trauma, rheumatic diseases, periphery artery occlusive disease or severe chronic venous insufficiency. Besides obtaining medical history, physical examination and using semiquantitative parameters such as the Visual-Analogue-Scale and the Calcaneodynia-Score in order to graduate the state of the foot functionality and the baseline pain levels, the dynamic and static gait analysis by means of dynamic and static pedobarography was used for examination. Collected parameters were “Cadence”, “Average Total Force”, “Double Support Time” and others. The radiotherapy took place with the overall dose of 3Gy, split up in single fractions of 0,5 Gy applied two times a week using photons with 6 MV border energy of a linear accelerator. The patients were investigated and measured by the consistent protocol three month after radiotherapy. The assenting opinion of the ethics commission of the medical chamber of Saarland, Germany (178/16) were given, the requirements of the declaration of Helsinki were respected. Results: Indeed, there could be shown a statistically relevant correlation between the parameters of the gait analysis and the patient’s statement regarding pain history or foot functionality (e.g. “Cadence” and VAS-Scale, “Average Total Force” and Calcaneodynia-Score) pre-radiation. Furthermore, there can be found a tendency of correlation between “Double Support Time” and VAS-Scale. Three months after radiotherapy most of the patients experienced a significant reduction of pain and gain of foot functionality (the mean of VAS-Scale reduced from 61 to 28 points, the mean of Calcaneodynie-Score increased from 48 to 68 points). Unfortunately, a correlation with the results of the pedobarography at the same time were not found. Conclusion: The sensitivity of the used system of pedobarography is currently not sufficient to conclude to the clinical parameters pain and functionality of the effected foot after the radiotherapy of the plantar fasciitis in a reliable modality. With further investigation in terms of sensitivity of the gait analysis instrument there may be a chance to get more detailed information and find some more useful parameters to use to objectify the effectiveness of the radiotherapy of the plantar fasciitis.