Low-dose radiotherapy for persistent pain after surgery for plantar fasciitis: an exploratory real-world observational study

Purpose Surgical treatment for refractory plantar fasciitis does not always achieve satisfactory pain relief, and a relevant proportion of patients experience persistent symptoms after surgery. This study evaluated surgical outcomes and the clinical course after low-dose radiotherapy (LDRT) as salvage treatment for persistent pain after surgery. Methods A single-center observational study with a mixed retrospective–prospective design was conducted. In a retrospective phase, surgical outcomes were analyzed in 92 patients treated between 2012 and 2023. Surgical success was defined as pain resolution leading to discharge; persistent pain was considered failure. In a prospective phase, 26 patients with persistent pain received LDRT (3 Gy in six fractions of 0.5 Gy). Pain (VAS), foot function (FFI), and quality of life (EQ-5D) were assessed at baseline and at 3 months, 6 months, 1 year, and 2 years. Response was defined using predefined VAS-based criteria and secondary functional outcomes. Results Overall, 26/92 patients (28.3%) had persistent pain and were classified as surgical failures, with the highest failure rate after open plantar fasciotomy alone. After LDRT, mean VAS decreased from 7.96 ± 0.77 at baseline to 5.69 ± 1.81 at 6 months and 5.08 ± 2.13 at 2 years. Fifteen patients (57.7%) were classified as global responders at 6 months. Descriptively lower FFI pain and EQ-5D pain/discomfort scores were observed during follow-up. No acute or late treatment-related adverse effects were observed. Conclusion Surgery for plantar fasciitis is associated with a clinically relevant rate of persistent pain. In this exploratory real-world cohort, LDRT was associated with descriptively lower pain scores and improvement in selected functional outcomes in patients with persistent plantar fasciitis pain after surgery. No treatment-related adverse effects were observed, although the small sample size and lack of a control group preclude definitive conclusions regarding efficacy or safety.