Over a two year period, 52 cases of iliotibial tract friction syndrome (ITFS) in runners were studied (34 males, mean age 30 years; 18 females, mean age 23 years). This represents 5.0% of the total overuse running injuries studied during this period. The purpose of this study was to determine clinical symptoms, etiological factors and appropriate treatment plans. Examination reveals pain on all flexion-extension movements of the knee, focal tenderness directly over the lateral femoral epicondyle and often slight crepitus and/or sharp pain radiating along the tract during a varus stress provocation test with simultaneous fast extension of the knee from a flexion of 45 degrees. The etiology in many cases was multifactorial and included training errors (22 cases), poor footwear and surfaces (4 cases), functional overpronation (47 of 48 cases with abnormal alignment). The treatment protocol consisted of ice massage, local physiotherapy, modified rest and anti-inflammatory medication for initial control of inflammation. Flexibility programmes were initiated as the pain resolved, and, were appropriate, orthotics (42 cases) were used. Evaluation of 48 patients on follow-up showed this treatment protocol to have a 94% success rate. This study illustrates the important role of proper training methods and orthotic foot control in the prevention and care of ITFS.