I met with an RO for my Ledderhose today. The disease is present in both feet, but I have larger nodules that are causing mobility problems in my right foot. (Two in the arch, one closer to my toes.) The left foot isn’t causing me problems now, so he’s suggested a wait and see approach. Hoping this is the best way to go. The RO seemed knowledgeable and has many years of experience using RT for the disease. I do have some concerns though. He used an orthovolt which he says gives better results. I know electron beam is frequently used these days and wonder about the advantages/disadvantages of each? More concerning though is his plan to radiate the entire plantar fascia rather than focusing on the nodules with a healthy margin. I worry this might be overkill that risks atrophy of the fat pad of the ball of foot and heel, dryness over the entire sole and limitations on future radiation should it be required. Any thoughts? I’ll be going back for mapping in a couple of weeks, and I want to be prepared to address this with the RO if needed. Thanks for your input!

My 2 cents:

advantages/disadvantages of Orthovolt and electron beam radiotherapy:

Orthovolt is using X-Rays, which have a broad energy spectrum (from 0 to max, whereby max depends on equipment), thus irradiates into various depths in various strengths, and X-Rays cannot be focussed. Lead shields can limit the irradiated area. Benefit: easy to define irradiated area in arbitrary forms. Lower cost equipment. Negative: the energy might not be high enough to reach sufficiently into the nodule and the broad energy spectrum will deposit energy in also in depth that do not need to be irradiated.

Electron beam. Benefit: can be focussed and has a defined energy (not a broad energy spectrum). The depth can easily be adjusted to fully reach the nodule. Negative: Cannot be shielded with lead because of high enrgy that would cause additional X-Rays in the lead. Irradiated size is defined by scanning the focussed electron beam (pretty much like in old TVs), i.e. irradiated area is always a rectangle. Doctors often use a large rectangle to be sure to cover everything but then also irradiate a lot of healthy tissue.

"More concerning though is his plan to radiate the entire plantar fascia rather than focusing on the nodules with a healthy margin." - I tend to agree and would ask whether he could define a smaller irradiated area. Whther that's feasible depends on where your nodules are located. If he would need to irradiate several areas seperately it would be important to avoid overlaps.

Wolfgang

Thanks Wolfgang. I know orthovolt has been used for years on Ledderhose, so hope that will be OK. The field size really threw me though. Are there research papers suggesting radiation causes atrophy on the heel or ball of the foot? Or on the thenar or hypothenar which he says he also radiates when treating for Dupuytren’s. Hoping the RO will be open to adjusting as options for treatment in my area are slim.

wach:

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Hi SAB, unfortunately I am just a patient & phycisist not a MD, so I can't answer that and need to refer you to the RT expert doctor. I am sure he knows what he is doing.

Wolfgang