Rest is best, but other treatments are available for plantar fasciitis

You might say Judi Briant has spent more than 33 years on her feet. As a teacher and a community college professor, she was always standing or walking.

"I can't sit down and teach," said Briant, who is semiretired. "I'm always on my feet in the classroom."

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. 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 to heal.

"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."

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."

Most patients also will be advised to start wearing orthotic inserts in their shoes. That helps take stress off the plantar fascia. 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.

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