Foot pain

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

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. The intensity of the pulses is adjusted to what the patient can tolerate, so a local anesthetic isn’t usually needed.

One of the benefits is there’s no downtime following treatment. Most people get one treatment a week for three to five weeks.

About 80 percent of patients report at least some relief from EPAT, but it is not always covered by insurance. Without insurance, patients pay out-of-pocket for multiple treatments that cost $100 to $150 each.

Another option is acupuncture.

Tampa Bay licensed acupuncture physician Dr. Xiao Zhang says 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. 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.

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