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Planter fasciitis is a frustrating and relatively common injury in runners. It not only affects your running, but is particularly painful during those first few steps out of bed in the morning. It heals slowly, and can be recurrent.

What is plantar fasciitis?

Plantar fasciitis describes an inflammation of the connective tissue which runs along the bottom of the foot. It is regarded as an overuse injury caused by continual stretching of what is called the plantar fascia. A fascia is a band of tissue connecting the various ligaments and tendons around a muscle.

It is still not know exactly how it is caused, but it seems to be more common in runners who have high arches, who overpronate, or who have muscular imbalances of the lower leg such as tight calves and/or weak shin muscles.

The fascia has a poor blood supply, hence the slow-healing and chronic nature of the condition.

In chronic cases, a bone spur can form where the fascia attaches to the heel. The spur itself does not cause pain, but the fascia rubbing against it can be painful.

How to treat this injury

The first thing to do is to stop the pain, and the best way of doing this is with ice massage. It is also important to continue icing past the point at which your pain is relieved, since this will promote complete healing of the tissue.

Arch supports are another method of relieving the pain, since they take stress off the arch of the foot. Over-the-counter arch supports are generally as good as ones which are made especially for you!

In the early morning, heating the foot in warm water before moving helps relieve the pain. You can then roll the foot over a small ball, such as a golf ball. This will help to stimulate blood flow to the area, and loosen it up after a night's sleep.

Sandals which are contoured to your foot offers support and help with pain and healing.

So far we have only talked about dealing with the symptoms. The injury itself must be treated. Massaging the sole of the foot helps loosen the tissue and promotes healing. Do this before and after you run.

Ultrasound treatment sometimes helps by promoting blood flow to the area. The sound waves also stimulate the underlying fascia and help to break up scar tissue which has resulted from the injury.

Some people advocate a night splint, which keeps the foot stretched overnight. This helps minimise morning stiffness. It seems to speed the healing process as well.

Preventing plantar fasciitis

As with any running injury, the key to preventing it lies in determining what causes it. The first preventative tool involves stretching the calves with straight leg and bent knee stretches - the common wall stretch is good for this. Hold each stretch for 30 to 45 seconds to maximise flexibility.

Strengthen the lower leg muscles using resistance tubing or weight machines. This will help to co-ordinate the movements of the lower leg, support the arch and provide additional strength for absorbing the shock of running. Stretch and lengthen each side equally, starting with 10 to 20 repetitions on each leg. Work up to three sets.

If you can, have your gait and running biomechanics evaluated by someone who specialises in sports injuries to find out what is causing the injury in your case.

You should always try to see a physiotherapist or doctor who specialises in sports injuries, and preferably someone who runs him or herself.

In general

In any sports injury you must try to find the cause, not simply treat the problem as it arises. Some things to consider:

• Have your running gait analysed by a professional.
• Get your muscles tested for strength and flexibility and specific imbalances. This can give a clue to many injuries.
• Check your diet for nutritional deficiencies and excesses. If you are deficient in certain things this can affect your ability to recover from injury.
• Are the over-the-counter medications you are taking simply masking symptoms? If you rely on medication to get you through your training this is the time to seek help.
• Use heat and ice aggressively when injuries occur.
• Add more cross-training to your programme. This gives you more overall fitness and allows your body time to recover from the stresses of running.
• Don't wear your shoes too long before replacing them. It may be an idea to buy two pairs and alternate them.