Numerous retrospective trials have shown that low-dose radiotherapy for painful heel spur has a good analgesic effect, pain relief has been noticed in 65–90% of the patients [
17,
20,
33-
36]. However, a certain placebo effect is still under discussion [
33]. Goldie et al. examined this effect in 399 patients with painful conditions of the locomotor system. They found a response in 60% of the patients whether irradiated or not; these results made the effect of radiotherapy questionable [
37]. The trial, however, has been criticized because of missing clearly defined endpoints: furthermore the therapy was started in an acute stage of the diseases and the authors did not wait for spontaneous pain remissions. In the meantime, several more modern trials have shown the analgetic effect of radiotherapy. Seegenschmiedt et al. [
2] performed a randomized trial treating 141 patients (170 heels) for painful heel spur using orthovoltage, comparing three radiotherapy schedules: 1 Gy/fraction up to 12 Gy, 0.3 Gy/fraction up to 3 Gy and 0.5 Gy/fraction up to 5 Gy. The overall complete pain relief was reported in 67–72% of the patients. The best results were seen after a total dose of 5 Gy. These results were confirmed by Schäfer et al. using a telecobalt machine, they achieved a complete pain relief in 58% [
33]. Heyd et al. used 6 MV photon beams of a linear accelerator, they noticed a frequency of pain relief of 69% [
4]. The same author group published a prospective randomized trial recently [
38] comparing the effect of a total dose of 3 Gy (single fraction 0.5 Gy twice weekly) to that of a total dose of 6 Gy (single fraction 1 Gy twice weekly). Radiotherapy was reported very efficient however a dependency from dose could not be noticed. Mücke et al. looked for prognostic factors for pain relief in a multicenter trial [
39]. They found an overall response in 60.9%. Significant favourable prognostic factors for pain relief were a patient's age over 58 years, the use of megavoltage techniques and the number of therapy series required. Niewald et al. showed in actual prospective study that a total dose of 6 Gy with single doses of 1 Gy twice weekly is much more effective than a total dose of 0.6 Gy with single doses of 0.1 Gy concerning analgetic effect and showed that a total doses of 6 Gy makes this effect durable for at least 1 year [
40]. After the start of this trial, Ott et al. [
41] published their trial comparing the effect of six single doses of 1Gy (total dose 6Gy) to six single doses of 0.5Gy (total dose 3Gy). They found no difference between the arms.