Cancer therapy rays that blast away... heel pain

IT MAY not be a medical term than rolls off the tongue but for an estimated six million Britons plantar fasciitis – pronounced fash-ee-eye-tis – is impossible to ignore. It’s the most common cause of heel pain, responsible for at least 80 per cent of cases and can leave sufferers unable to walk or even stand.

But increasing numbers are now benefiting from a most unlikely treatment – radiotherapy, which is normally associated with blasting away tumour cells in cancer patients.

Although the option is still not in widespread use, one pioneering NHS doctor is offering it to patients in much lower doses than is used to attack cancer.

Research suggests the ten-minute targeted treatment soothes discomfort in 80 per cent of patients with plantar fasciitis, which is caused by a ligament running along the bottom of the foot becoming inflamed. It has been discovered that the X-rays used in radiotherapy – at a tenth of the strength used to treat cancer – dampen down these swollen tissues.

About one person in ten develops plantar fasciitis at some time in their life and, although it is most common in people aged between 40 and 60, it can occur at any age.

Now, Dr Richard Shaffer, consultant clinical oncologist at the Royal Surrey County Hospital, has become the first specialist in the UK to offer radiotherapy to patients with the condition, with ‘outstanding results’. He says: ‘Radiotherapy is a good treatment. We use it for cancer at the moment but there are other things we can use it for as long as we are very aware of the risks versus benefits.’

About eight in ten heel-pain sufferers get better using ice, heat or over-the-counter anti-inflammatory medicines, creams or gels.

A fifth have injections of the steroid cortisone, although any relief they get from this lasts only a couple of months.

Surgery to slice through the plantar facia ligament to ease pain has a success rate of only about 60 per cent.

Dr Shaffer first used radiotherapy to treat more than 400 patients with Dupuytren’s contracture, also called ‘trigger finger’ or ‘claw hand’. This condition leads to one or more fingers becoming permanently bent in a flexed position due to problems with the hand ligaments. Later, he came across research on the role of X-rays in treating plantar fasciitis.

A 2016 study in Radiation Oncology, by scientists at Saarland University Hospital in Germany, found that patients experienced significantly lower pain after radiotherapy. On a scale of one to 100 – where 100 is the maximum pain they could feel – most saw scores decline by over 40 points in the three months following treatment.

Guidance from the Royal College of Radiologists says radiotherapy can be used in plantar fasciitis if patients have had it more than six months and not got better with standard treatment.

DR SHAFFER, who carries out the treatment privately at a cost of £3,000 per foot at clinic chain Genesis Care, says: ‘Ideally we will have patients approaching us at an earlier stage when radiotherapy will be even more effective.’

Kathy Lloyd, 62, had the treatment after years of foot and ankle problems. The financial services worker from Surrey ended up with agonising plantar fasciitis after five bouts of surgery for a broken left ankle.

‘I could only get around with crutches or a mobility scooter – even lightly pressing my left foot on the ground left me in pain.

‘For the first three weeks after treatment, I was actually in more pain than ever because of the healing process,’ she explains.

‘By week seven the pain started to lessen, and after six months, it had almost completely gone. I had to pinch myself that it was real.

‘Now I can walk with just one stick and feel like I have my life back again.’

Plantar fasciitis is often known as policeman’s foot because it is traditionally associated with lots of walking and standing. Putting too much strain on the ligament over an extended period is the most common cause and pain is often felt just forward of the heel.

Dr Shaffer says: ‘The problem is that once the ligament inflames and starts to break down, it can quickly worsen until walking or standing is unbearable.’

Despite fears that radiotherapy can cause cancer, Dr Shaffer insists: ‘People worry about the cancer risk but that is so small.

‘Current evidence shows using low doses in peripheral areas such as the feet or hands doesn’t pose a significant risk.’

Dr Tom Roques, a cancer specialist at Norfolk and Norwich University Hospitals and spokesman for the Royal College of Radiologists, says although there is a lack of evidence to support widespread use of radiotherapy in non-cancerous conditions, the risk to patients is low.

‘The doses are very small and side effects are minimal. Research suggests well under one in 1,000 patients is at risk of developing cancer as a result.’