Thursday, May 24, 2018
Health

Another nonsurgical option for plantar fasciitis

Whether your goal is to run a marathon, take up yoga, get serious about your heart health, or anything else you've been putting off, you'll likely hear this piece of encouragement from some well-meaning person: • Just take the first step. • But what if the first step you take every day has you hobbling in pain?

Back in October, we devoted our cover story to common foot problems that keep athletes and exercisers sidelined.

Plantar fasciitis — an inflammation of the ligament that supports the foot arch — got a prominent mention. But to judge from what sufferers have told me since, we could have done the entire story on it.

The classic symptom: Stabbing pain in the heel and/or arch as you get out of bed. It tends to ease up a little as you hobble around, but stay still for any length of time, and the pain returns with your next step.

Not only is plantar fasciitis a common condition, but it afflicts an amazing array of people. Check out a few risk factors:

• Flat feet — or high arches

• Running, high-impact aerobics — or obesity

Doesn't seem fair that the same problem can be traced to excess weight — or to the activity that keeps weight off.

In our October story, we offered what is pretty universal advice: stretching, anti-inflammatories, rest, orthotic devices, ice, night splints. If all that fails, cortisone injections and physical therapy. Last resort: surgery.

I had an interesting conversation the other day with a local physician whose practice offers another option.

Dr. Bruce Levine, the senior partner at Foot & Ankle Specialists in Pinellas and Pasco counties, explained that conservative therapies work for a good 80 to 90 percent of sufferers.

In the past, the other 10 to 20 percent of patients would be recommended for surgery, but for more than two years he's been suggesting another therapy to try first.

Extracorporeal Pulse Activation Technology (EPAT for short) is a treatment that delivers shock waves to an injured area to help stimulate blood flow and healing. The device is FDA-approved, but has been used for other conditions outside the U.S., Levine told me.

For plantar fasciitis, coupling gel — like that used in ultrasounds — is applied to the heel, and then an activator delivers the shocks. You feel a pounding sensation, which can be made more or less intense depending on your comfort level, he said.

"We're taking a chronic condition and making it more acute,'' Levine explained. The idea is to stimulate blood flow — and healing. Patients may feel discomfort during the treatment, but it doesn't linger.

The standard therapy is three treatments spaced a week apart, but don't expect quick results.

"It takes time,'' he said. "This is a process where the body takes over the healing.''

He tells patients to give recovery eight to 12 weeks, though some notice improvement after one or two treatments.

Best part: The potential for relief without surgery.

Worst part: It's not covered by insurance. Foot & Ankle Specialists charges $500 for a course of three treatments, each administered a week apart.

Although helpful to most, some may require other treatments, such as surgery, Levine told me. The medical journal articles I found on the therapy agreed, also noting that even if it doesn't help, it won't hurt.

Our conversation left me grateful not to have this problem, and wondering whether I ought to just stay off my feet. Nothing doing, said Levine, who advises that if high-impact activities aggravate injuries, there are gentler options like cycling and elliptical machines.

Which just goes to show that your first step doesn't have to be a literal step, as long as it puts you in motion.

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