According to Tim Noakes, author of the Lore of Running, plantar fasciitis accounts for only 5-14% of running injuries. Obviously Tim has not been to the Washington, DC area where it seems to be occurring in much greater numbers.

Plantar fasciitis is an inflammation of the connective tissue which runs along the bottom of the foot attaching at the metatarsal heads and inserting on the underside of the heel. It is noted by point tenderness beneath the heel and/or generalized soreness along the arch.

Running is a bilateral sport where equal demand is placed on both sides of the body. However, most of the time running related injuries occur on only one side of the body. Why, you ask? Good question. Muscle flexibility and strength imbalances along with faulty skeletal alignment cause altered biomechanical function. Altered biomechanics in turn will focus stress unequally on various parts of the body. These areas become the subject of overuse and are ultimately the sight of injury.

Plantar fasciitis is an overuse injury thought to be caused by prolonged excessive stretching of the fascia. Although the exact mechanism of the injury is still debated, it is most common in runners who have high arches, over-pronate, or have a tight calf muscle/achillies tendon complex.

Proper management of the injury includes symptomatic treatment and biomechanical correction. Begin treatment with ice massage (see training tip below) over the affected area, especially after running. In the acute stage, minimize stress to the plantar fascia by wearing arch supports in all footwear. Before you spend hundreds of dollars on orthotics, try a pair of sorbothane graphite arch supports which can be purchased at most reputable running stores for under $20. Modify your training by avoiding hills and speed work and break long runs into two shorter runs. Heel cups and horseshoe shaped pads can provide relief by reducing pressure at the heel. It may be necessary to change to a straight lasted training shoe.

Biomechanically, the entire spine, pelvis, lower extremities and feet should be evaluated for abnormal alignment, muscle flexibility, and strength imbalances. Identifying these discrepancies will help in eliminating the underlying cause.

If the condition continues to worsen, do not try to run through it. Chronic plantar fasciitis can lead to the formation of a heel spur. This will prolong recovery and may require surgery. For the best advice, consult a doctor who has experience in working with and treating runners.

To prevent plantar fasciitis, build up your mileage slowly. Allow enough time to recover from fatigue and micro trauma after long runs and high intensity workouts. Maintain balance between muscle flexibility and strength by using proper stretching techniques and performing resistive exercises with surgical tubing. Also, roll a golf ball under your foot to massage the fascia and relieve fixations. Strengthen your arch by using your toes to pick up marbles and scrunch newspaper. Finally, have your gait and biomechanics checked periodically before problems begin.

Remember, the best way to enhance your performance is to remain injury free!

TRAINING TIP: The best home care for aches, pains, and acute injuries is ice massage. Fill some paper cups with water and put them in the freezer. When needed, take out a cup and peel away the top layer exposing the ice. Apply the ice directly to the affected area in a circular motion. Do this for no more than five minutes. During this time, sensation will progress from coolness, to burning, to aching, and finally numbness. This can be repeated up to once an hour. This method is colder and more time efficient than the traditional ice pack.

With more than 35 years of competitive running experience and over 60 road race victories between them, Dr. Ronald S. Kulik and Dr. Neil P. McLaughlin are among the leading National Capital area physicians who specialize in the drug-free, nonsurgical treatment of athletes and sports related injuries. Drs. Kulik and McLaughlin's medical practice is located at the Commonwealth Chiropractic Center of Reston, where they treat many of the area's top runners. Questions or comments should be sent to:11339 Sunset Hills Road, Reston, VA, 22090 or call (703) 742-7856.