Runners, particularly distance runners, commonly suffer from plantar fascitis, an inflammation of the plantar fascia of the foot. The plantar fascia helps hold up the arch along the inside of the foot. When running, we strike the ground with 2 to 5 times our body weight at approximately 1500 foot falls per mile. With every foot strike the arch drops, which stretches the plantar fascia. The hallmark symptom of plantar fascitis is sharp pain underneath the heel, especially during the first 10- 20 steps out of bed in the morning.

Plantar fascitis may have intrinsic and extrinsic causes, or a combination of both. Extrinsic causes are training errors, such as too much mileage or speed work. Intrinsic causes are related to faulty foot biomechanics, resulting in overpronation.

SYMPTOM RELIEF
1. Icing the painful area will reduce inflammation more efficiently than oral anti-inflammatories. Apply ice after a run while tissues are recovering.
a. Ice packs - 20 minutes on, 40 minutes off. Repeat 3-5 times a day.
b. Ice massage - fill a paper cup with water and freeze it. Peel back the cup and massage the ice directly on your skin for 8-10 minutes, off for 40 minutes. Repeat 3-5 times a day.

2. Compression Massage: Rolling your foot back and forth over an object like a golf ball helps break up adhesions and disburse swelling. Try an empty glass soda bottle, stick it in the freezer and use for massage as necessary. Perform several times a day for 5-10 minutes.

3. 90 degrees Night Splint: Sleeping on our stomachs causes our toes to point down, shortening our plantar fascia. The first few steps in the morning stretches the fascia, tearing the scar tissue. Splinting the ankle at 90 degrees while sleeping keeps the fascia from healing in a shortened position at night and decreases healing time.

CORRECTING TRAINING PROBLEMS
4. Active Rest - Cross training will allow you to train while taking the pounding stress off your injured fascia. It will also enable you to maintain your aerobic base and prevent you from driving your significant other crazy with your grumpiness!

5. Frequency - Recovery time increases with age, so you may need to take more days off than you used to.

6. Intensity - Try not to follow a speed session with long or steep downhills, which increase stress at heel strike.

7. Duration - A general rule is not to increase your long slow run by more than 1-2 miles per week, or your total weekly mileage by more than 10% per week.

8. Type - Softer surfaces like packed dirt are a good alternative. Running on packed dirt trails is the best, let's give it a factor of 1, asphalt would have a factor of 2, concrete a 3.

CORRECTING FOOT BIOMECHANICS
8. Stretch!!: I've been treating runners for over 13 years now and I have yet to meet a runner that says "I think I stretch too much." Stretching your calf muscles should always follow your runs, but as the most dense muscle tissue in your body, they should be stretched frequently throughout the day.

9. Strengthen: Heel raises are the only exercises that have been shown to strengthen the structures that support the arch.

10. Proper Footwear: Overpronation can often be corrected by changing to a "motion control" or "stability" shoe. These shoes commonly have a "dual density midsole". The sole will have cushioning along the medial side (inside) and under the arch of the shoe that is stiffer than the cushioning towards the lateral (outside) of the foot.

11. Orthotics: Orthotics are foot beds placed in the shoe that are designed to reduce or eliminate overpronation and the stretch it places on the fascia. These can vary in price from $15.00 to $500.00 and are beyond the scope of this article. As a provider of custom orthotics, I will give you the following advice:
a. Not everyone needs orthotics.
b. All orthotics are not the same.
c. Your orthotics are only as good as the casting procedure used.

Plantar fascitis can be a complex problem not often resolved simply by rest. Early evaluation and proper treatment are beneficial. Prevention through stretching and strengthening are invaluable.

Dr. Ken Sheridan is a local runner who practices at ActiveCare Chiropractic & Rehab in Golden, a clinic specializing in sports injuries. To read more on plantar fascitis, log onto www.getactivecare.com.