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Treatments vary for painful plantar fasciitis, but rest is the best

Judi Briant is now back on her feet after suffering from a condition called plantar fasciitis, a painful foot condition associated with heel spurs that affects more than a million Americans. She was eventually cured after using Extracorporeal Pulse Activation Technology (EPAT) and physical therapy. [Thursday, March 9, 2017] [Photo Luis Santana | Times]
Published Mar. 16, 2017

You might say Judi Briant has spent more than 33 years on her feet. As a teacher with Hillsborough County schools and a professor at Hillsborough Community College, she was always standing or walking.

"That's the way I work," said Briant, who retired from Armwood High but still teaches at HCC. "I can't sit down and teach, I'm always on my feet in the classroom."

On some days she'd put in another 3 miles at home on the treadmill.

About seven years ago, it caught up with her. Briant developed pain in her right foot and started limping through her day. Then one evening while teaching she tried to stand up and collapsed in her chair.

After a trip to the ER and an appointment with a podiatrist, Briant learned she had one of the most common, but painful conditions: plantar fasciitis.

The plantar fascia is a flat band of tissue that runs from the heel to the base of the toes. Certain problems — an unstable ankle or weak arches, even just the way you walk — can put extra stress on the plantar fascia, causing heel pain.

The condition is most common in runners and other athletes who have lots of starts and stops and quick changes of direction, as in tennis and basketball. But it's also common in people who are on their feet for much of the day — teachers, cooks, hairdressers, restaurant servers and those who work in retail sales.

Over time, tension on the plantar fascia causes tiny tears in the tissue, leading to inflammation. The easiest remedy is to stay off your feet. But most people can't or won't do that for the time it takes for natural healing.

So, they take over-the-counter anti-inflammatory medications and keep their normal pace, causing more tears, more inflammation and more pain. Scar tissue builds up, blood flow to the area decreases and the plantar fascia becomes weaker, resulting in a chronic injury.

"It's the micro-tears and inflammation that are causing the pain," said Dr. Joshua Bernard, a podiatrist and assistant professor at the University of South Florida College of Medicine. "No one, especially athletes and physically active people, wants to hear the prescription for relief is R-E-S-T. They hate to hear, 'Stop running and you'll feel better.' So, you have to work around that."

Most people put off going to the doctor until the pain becomes so severe that it limits their physical activity. Treatment usually starts with anti-inflammatory medication, along with icing and stretching the foot.

"A good way to do that is to freeze bottles of water and roll the bottle on the floor with your foot," Bernard said. "You get the benefits of icing and stretching in one exercise."

Or you can simply roll your foot over a can or a tennis ball. Therapists also offer specialized treatments for plantar fasciitis, so it's worth checking out what practitioners in your area offer. It may be covered by some insurance plans.

Most patients also will be advised to start wearing orthotic inserts in their shoes. That helps take stress off the plantar fascia. The inserts are sold in some pharmacies or you can have more expensive orthotics made for your foot. Cortisone shots in the heel help many people, but usually have to be repeated after a few months.

When Briant developed plantar fasciitis in her right foot in 2010, she tried all the conservative treatments but didn't get enough relief. So, her doctor offered an alternative called extracorporeal pulse activation treatment, or EPAT therapy. It delivers low frequency sound waves to the foot, similar to the shock waves used in a lithotripsy treatment that breaks up kidney stones, but on a smaller scale.

"The treatment only takes about 10 minutes and delivers 3,000 pulses to the affected area," said Dr. Stacie Fessette, a podiatrist at Ankle + Foot Center of Tampa Bay, where Briant was treated. The intensity of the pulses is adjusted to what the patient can tolerate, so a local anesthetic isn't usually needed.

"It increases blood circulation, stimulates tissue to regenerate and gets the healing process restarted in the area," Fessette said.

One of the benefits is there's no downtime following treatment. Most people get one treatment a week for three to five weeks. Fessette recommends that patients limit themselves to low-impact activity for about three weeks; competitive athletes and runners can usually resume their sports after four to six weeks.

Briant remembers feeling better after her first treatment. Eventually the pain went away and has never returned.

Two years ago, though, she developed plantar fasciitis in her left foot. After trying conservative measures, she again opted for EPAT, and the pain went away after three treatments.

About 80 percent of patients report at least some relief from EPAT, but one downside is that insurance companies are reluctant to cover the therapy because of the lack of long-term studies to prove it works. Without insurance, patients pay out-of-pocket for multiple treatments that cost $100 to $150 each.

Another option is acupuncture.

"It's one of the things many people try when all else has failed," said Dr. Xiao Zhang, a licensed acupuncture physician at Tampa Bay Acupuncture Clinic in Tampa. "I probably see at least one or two cases a week in my clinic. I don't help everybody, but a big number of them I do."

Zhang said it takes longer to treat plantar fasciitis than conditions such as migraines or back pain, sometimes up to six once-a- week treatments to get relief.

"It helps with inflammation, can relax tissues and improve blood flow, so acupuncture works in several different ways to ease this pain," said Zhang, who also recommends icing, stretching, rest, and weight loss for overweight patients. The cost is $80 to $100 per session, depending on where you live.

For the most severe cases where the patient is incapacitated and nothing else has worked, surgery may be an option. It involves a small incision on the side of the heel and cutting the plantar fascia to release the tissue, allowing it to stretch.

"People are usually walking in a couple days and fully recovered in about four weeks," said Bernard, the USF podiatrist. "Fifty to 75 percent of patients get relief." And it's almost always covered by insurance.

Contact Irene Maher at imaher@earthlink.net.

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