Treat the patient, not the MRI: Lessons from low-dose radiotherapy for plantar fasciitis

The recent study by Novo-Rigueiro et al. adds important prospective evidence for low-dose radiotherapy (LDRT) in refractory plantar fasciitis. After failure of conservative treatment and extracorporeal shock wave therapy, patients showed durable improvements in pain, function, and health-related quality of life, yet magnetic resonance imaging (MRI) findings correlated poorly with clinical response. This discrepancy deserves attention because structural imaging does not necessarily reflect therapeutic success. In benign radiotherapy, patient-reported outcomes, functional recovery, and quality of life should remain the primary measures of efficacy, with imaging as a complementary biomarker. This view is consistent with the recently published ASTRO–ESTRO–DEGRO–RANZCR Framework for radiation therapy in nonmalignant diseases, which emphasizes multidisciplinary care, modern radiotherapy techniques, and clinically meaningful outcomes. The study therefore reaches beyond plantar fasciitis. Future prospective studies, international registries, and guidelines should prioritize standardized patient-centered endpoints while integrating imaging into a translational framework rather than using radiological normalization as a surrogate for clinical benefit.