Low-Dose Radiation Therapy for Foot Osteoarthritis

Foot osteoarthritis most often affects the big-toe joint (the first metatarsophalangeal joint), which troubles an estimated 7.8 percent of people over 50, and the midfoot joints^[1]. When orthotics, footwear changes, medicines, and injections have not helped enough, some programs discuss low-dose radiation therapy (LDRT) for foot joints. US radiation oncologists report that hands and feet are among the most common areas they treat, because orthopedics has few good options for small painful joints^[2].

What the Evidence Shows

The largest published study followed 196 foot-and-ankle osteoarthritis patients treated at the University Hospital Erlangen in Germany between 2004 and 2019. Nine in ten received 6 sessions of 0.5 Gy (3 Gy total). The majority reported less pain afterward, younger patients responded better, and the midfoot improved less than other foot regions^[3]. In the study itself, 75 percent of patients reported a meaningful pain improvement, meaning more than 20 percent better^[3].

A second German study of 66 ankle and tarsal joints with osteoarthritis found the median pain score fell from 7 before treatment to 4 at the 12-month follow-up^[4]. A 2025 US retrospective study of 59 patients and 94 joints, including 5 feet, reported significant pain and function improvement in 89 percent, with the average pain score dropping from 7.27 to 1.84; small joints (hands and feet) did no worse than large ones^[5].

Be aware: this evidence is thinner than for the knee or hip. No randomized, sham-controlled trial has studied foot-only osteoarthritis. The Erlangen authors write that foot and ankle osteoarthritis is "rather seldom subject to intensified clinical research," and most studies bundle the foot with the ankle^[3]. No published study isolates toe or forefoot outcomes specifically. The American Radium Society rates LDRT for foot and ankle osteoarthritis as "may be appropriate," with moderate strength of evidence, for patients who have not responded to conservative measures, medicines, and injections^[6].

Typical Schedule

• Total dose of 3 Gy, split into 6 treatments of 0.5 Gy each; the guideline rates 3 Gy and 6 Gy regimens similarly^[6]
• Treatments given 2 to 3 times per week, over about 2 to 3 weeks^[6]
• Outpatient visits of roughly 15 minutes each^[2]

Who May Be a Candidate

Programs generally consider adults whose foot osteoarthritis has not responded enough to conservative measures, medicines, and injections, which matches the American Radium Society's "may be appropriate" rating for exactly that situation^[6]. German guidance recommends LDRT for osteoarthritis only for patients aged 40 and above, to keep the long-term radiation risk as small as possible^[7]. A radiation oncologist weighs age, the joints involved, and overall health together.

What to Try First

• Foot orthoses and footwear changes: a randomized trial in big-toe osteoarthritis found prefabricated orthoses and rocker-sole shoes similarly effective for pain, with orthoses better tolerated^[1]
• Anti-inflammatory medicines and injections into the joint, before considering radiation^[3]
• Note: the 2019 American College of Rheumatology osteoarthritis guideline covers only the hand, hip, and knee, and gives no foot-specific recommendations^[8]

References:
1. Menz HB, et al. Foot orthoses and rocker-sole footwear for first metatarsophalangeal joint osteoarthritis. Background and trial in BMC Musculoskeletal Disorders. Full text
2. Low-Dose Radiation Therapy Making a Comeback for OA. Medscape. 2025. Article
3. Weissmann T, et al. Low-Dose Radiotherapy Leads to a Systemic Anti-Inflammatory Shift in the Pre-Clinical K/BxN Serum Transfer Model and Reduces Osteoarthritic Pain in Patients. Frontiers in Immunology. 2022. Full text (PMC)
4. Hautmann MG, et al. Radiotherapy for osteoarthritis of the ankle and tarsal joints: analysis of 66 joints. Strahlentherapie und Onkologie. 2020. Journal page
5. Shah N, et al. Low Dose Radiation Therapy (LDRT) for Osteoarthritis: A Retrospective Study of 59 Patients and 94 Joints Treated. International Journal of Radiation Oncology, Biology, Physics. 2025 (ASTRO meeting abstract). Abstract
6. American Radium Society Appropriate Use Criteria for Use of Radiotherapy for Treatment of Osteoarthritis. Expert Panel for Use of Radiotherapy in the Treatment of Arthritis. 2026. Full guideline document. Full document (PDF)
7. German Society for Radiation Oncology (DEGRO) guidance on LDRT for osteoarthritis, as summarized in The Emerging Use of Radiation Therapy for Benign Conditions. Summary (PDF)
8. Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis and Rheumatology. 2020. PubMed