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#616 What is a “bone bruise” at an old fracture site?

I was just giving 3 lectures on running injuries at a medical conference in Las Vegas.

As is often the case, after one of my lectures one of the physicians in the audience approached me in the hallway to ask a question.

What do you do with activity level when somebody has an old fracture where the bone was broken long ago?

The runner recently had a re-injury at that spot. It has been painful, it’s been swelling, and he’s trying to figure out what to do.

What’s a bone bruise at an old fracture site? Is it a big problem or a little problem?

Well, that’s what we’re talking about today on the Doc On The Run podcast.

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#615 Runner has a neuroma and bursitis, which is worse?

When you have two painful problems in different parts of the same foot, things can get complicated.

I recently had a call with an injured runner with a couple of different problems.

On the outside of his foot, between the third and fourth toes, he has a painful neuroma. The other problem is that he’s got bursitis. The inflamed bursa is in a completely different place, no where near the irritated nerve.

When a runner has two injuries, like a neuroma on one side of the foot and bursitis on the other side of the foot, which one is worse?

Which one should you pay attention to first?

Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.

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#614 Got clearance to start cycling, should I stop icing?

I just got off a call with a runner who needed a second opinion with his running injury recovery.

He had a fracture and it has been improving. But because it was painful and swollen, he was still icing it daily.

At his last follow-up appointment, the doctor actually said, “I think you’re good enough to actually start cycling at this point, to get back a little of your running fitness.”

So, the question is, should I stop icing?

Do I need to keep doing that? If my injury is good enough to start cycling can I stop icing?

Does a release to cycle mean you’re good enough to stop icing your foot?

Well, that’s what we’re talking about today on the Doc On The Run podcast.

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#613 When is a web-cam second opinion just as good as in person doctor visit?

Sometimes a doctor really needs to touch your foot to make the diagnosis. But not always with runners.

Since the pandemic pushed so many of us into Zoom meetings, we all know it’s pretty easy to get on a web-cam call when it’s really difficult to meet someone in person.

There are a couple of times when webcam second opinion visits can be almost as good as meeting in the doctor’s office.

There are lots of benefits to the webcam calls that do make them almost as valuable as in person visits.

When is a webcam second opinion just as good as an in-person doctor’s visit for runners?

Well, that’s what we’re talking about today on the Doc On The Run podcast.

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#612 Dry Needling vs PRP injection in Runners

Today’s episode comes from a great question I got during one of the Runners Aid station calls.

This was someone who had a plantar plate sprain and had talked to a doctor about a couple of different procedures that might actually, potentially, speed up the healing.

He wanted to know about the difference between these two things called dry needling or a PRP injection.

Today on the Doc On The Run podcast, we’re talking about dry needling versus PRP in runners.

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#611 What if stress fracture still swells and hurts a lot?

Ivan has a great question. After watching the watching the video “Can I Run After Wearing a Fracture Boot?” he wanted to know: “It still swells and has a lot of pain what do I do?”
Anytime a runner gets a stress fracture, the main goal is to confirm the foot is healed enough to withstand the forces and stresses applied to the injured bone.
In the episode we are going to talk about:
• 3 indicators of ongoing tissue damage when you have a stress fracture.
• 3 strategies used to decide when it’s safe to run after stress fracture.
• Questions I would ask you if you called me for a stress fracture second opinion consultation.

Today on the Doc On The Run Podcast we’re talking about What to do if a stress fracture in the foot still swells and hurts a lot after wearing a fracture walking boot.

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#610 Find your target when you are not getting better

Let’s say you’ve had an aching pain in the ball of the foot that’s been going on for several weeks.

You’ve tried lots of stuff. You tried icing it. You tried some over-the-counter inserts that you got.

Maybe you stopped running all together. Maybe even used a fracture walking boot.

But after weeks, you’re not getting anywhere.

Today on the Doc On The Run Podcast we’re talking about how you need to find your target when you’re not getting better.

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#609 How can a 2nd metatarsal stress fracture cause a 5th metatarsal stress reaction?

I was just on a call with a cross-country runner who had had a second metatarsal stress reaction.

A stress reaction is basically like a mild stress fracture, but without any crack in the bone.

She was doing well and her foot had been getting better.

But then when she went for her first run, she had pain in her foot.

The pain during that first run was in a completely different bone. The new problem was not in the second metatarsal, it was in the fifth metatarsal on the outside of the foot.

Let’s talk about how that happens.

Today on the Doc on the Run podcast we’re talking about how a second metatarsal stress fracture might cause a fifth metatarsal stress reaction.

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#608 The benefit of your radiologist being clueless

The radiologist reading your MRI knows nothing about your problem.

The only clues a radiologist gets about your injury are described in the clinical history section of the MRI order from your doctor.

I just got off a call with a runner who had gotten an MRI order from his doctor. He had a long history of injury but the only description on the MRI order was “Concern for fracture.”

This runner had more than just a concern for a possible fracture.

But because there was such a limited description for the radiologist, the injured runner was understandably irritated and frustrated that the radiologist didn’t have the full information.

I will admit that I also get very upset about this when I’m looking for something obscure that the radiologist is likely to miss, unless it’s on their radar.

But there is an up-side to everything!

Today on the Doc On The Run podcast, we’re talking about the benefit of your radiologist being clueless.

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#607 How can sinus tarsi syndrome cause FHL Tenosynovitis

This episode has a whole bunch of complicated-sounding terms that you may have never heard before.

One of them is sinus tarsi syndrome, and the other one is FHL tenosynovitis or flexor hallucis longus tenosynovitis.

Sinus tarsi syndrome is often confused with ankle pain.

FHL tenosynovitis is often confused with plantar fasciitis.

These conditions affect opposite sides of the same foot. Yet, one can lead to the other.

Today on the Doc on the Run podcast, we’re talking about how sinus tarsi syndrome can cause flexor hallucis longus tenosynovitis.

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