This podcast is for injured runners. Those who have been told (or worry) that running is at the root of their trouble.
If you are listening to this podcast you’re probably a runner. And you have probably been told by your friends, your family and maybe even your doctor that running is the cause of your trouble and that you need to run less.
But deep down inside you don’t just like running you feel like you have to run in order to be healthy, fit and sane. This podcast simply helps injured runners understand their condition better, and keep running.
Anything the runners does to heal faster will get the runner back to running faster.
Even simple things you can do at home can help change the course of an injury.
On of the oldest treatments for musculoskeletal injury, and one any runner can do themselves, is massage.
A runner on webcam just asked me whether or not it might help her plantar plate injury recover faster. The short answer is:
Yes, massage can help as along as you do not injure the plantar plate ligament further in the process.
How does massage really help when you have an injury? Yes, there are a couple of ways massage can help, as long as that massage does not make the injury worse.
Today on the Doc On The Run Podcast, we’re talking about the good and bad, or the risk vs benefits of massage with a plantar plate sprain.
Runners who have rolled their ankle often have trouble figuring out when to get back to running.
Mostly they seem to be worried about a subtle fracture or delayed ligament healing.
If you think it is no big deal when you roll your ankle, you might be right, and you might be wrong.
What is the number one most important action you can take when you roll your ankle running?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I know if you call me for a consultation, it is not because you want to talk to me because you watched a YouTube video or listened to a podcast, it is because you have a race and everybody else is telling you there is no way you can do it.
Well, that may be my specialty, but today I am going to help you understand how you can figure this out yourself.
It is not really that complicated, it is just that other doctors do not want to tell you how to do it, so I am going to try to explain it to you.
How can you calculate the amount of rest you really need between your running injury and your race?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I recently posted an episode that was talking about four different kinds of stress and strain that can be applied to the plantar plate ligament that might slow down the healing of that little bitty ligament in runners.
I got a couple of questions about that and one of them was specifically about how to tell whether or not that is really a problem and one person wanted to know if they had a dropped metatarsal if that might be contributing to this issue of compressive stress.
Today on the Doc On The Run Podcast, we’re talking a little bit more about compressive stress on the plantar plate ligament in runners.
If you have a pain in the ball of the foot, underneath the base of the toes, that is right where your fat pad cushioning is located.
There is a lot of misunderstanding about what fat pad atrophy really is, particularly when it is related to something like a plantar plate injury.
Sometimes runners have true fat pad atrophy, but that is rare.
More often runners have fat pad displacement that feels like atrophy.
I think that fat pad displacement is more common than atrophy, and I am going to try to explain why.
What is the difference between fat pad atrophy and fat pad displacement in runners?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I know I talk a lot about how necessary it is to reduce the stress and strain on the plantar plate ligament when you are a runner, especially if you are trying to get ready for a race while healing.
It is really difficult to do, but not impossible.
What are the four forms of stress and strain that can affect runners with plantar plate injuries?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I am going to make a statement and see if you agree with me.
“Rest is bad, and exercise is good.”
Do you agree?
Almost every runner who calls me for a second opinion consultation has been injured, has been told they have to rest, and they have been told they cannot exercise in order to get better.
Sometimes that is true. But 100% rest is rarely the case in runners. Unless you fell off the roof and broke your back and both, then you can probably use one of your legs to exercise and maintain some of your running fitness while your other foot that is injured is resting and recovering.
Today on the Doc On The Run Podcast, we’re talking about single leg exercise benefits for injured runners.
I was just on a call with an injured runner who has been healing from a plantar plate sprain. If you have had one of these, you know they’re problematic.
The thing was that he asked me a question that really made me stop and think.
What he asked was, “Is stress good or bad for the plantar plate ligament?”
Well, that is what we’re talking about today on the Doc On The Run Podcast.
Let me ask you to read 4 words and see how they land on you.
Skinny, weak, atrophy, neglect.
As a runner, would you want any of those words used to describe you?
When the fat pad cushion between the bones and the skin under the heel or the ball of the foot gets thinner, doctors call it “atrophy.” But don’t take it as an insult.
What really causes more atrophy of the fat pad cushion under the ball the foot in runners…inactivity, or too much activity?
Well, that’s what we are talking about today on the Doc On the Run Podcast!
I was just giving a lecture at the 46th annual International Foot & Ankle foundation meeting at the Swedish Medical Center in Seattle.
A foot surgeon in the audience asked a great question during the question-and-answer period following one of my lectures. Specifically, the lecture was medical imaging strategies to avert misdiagnosis in runners.
She asked, “After a runner has been offloaded with crutches and placed in a fracture walking boot or a cast for immobilization, do you incorporate cross training, or only focus on running?”
What is the one biggest mistake any doctor can make with a runner who has been on crutches?
Well, that is what we’re talking about today on the Doc On The Run podcast.
Today, I am at the International Foot and Ankle Foundation meeting in Seattle, Washington and today I was moderating one of the sessions, but I was also giving a lecture on runner’s heel pain and specifically when heel pain is not plantar fasciitis in runners.
At the end of that session, one of the most well-known podiatrists in the world, a guy named Guido LaPorta asked me a specific question.
He said, “What percentage of runners do you recommend have endoscopic plantar fascia release surgery for chronic plantar fasciitis?“
Do I often recommend endoscopic surgery for plantar fascia problems in runners?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
I was recently working with a runner who had really bad sesamoid issues.
She was taping it to try to decrease some of the motion around the big toe joint that could have been irritating the sesamoid bones.
She had a bunch of tape around the forefoot holding everything still. Weird thing was, she did not have swelling there. She had swelling elsewhere.
Is taping the sesamoids good or bad if you have swelling in the foot?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
I was on a call with a runner, and he has had a long history of plantar plate trouble. He had a whole bunch of different treatments, done time in a fracture walking boot and then got worse when he started running a number of different types.
He was very frustrated.
Over the last month since we started working together, he has been doing significantly better than he ever has in a year and a half.
I had him do a couple of things over the last week. It made a huge difference for him that he noticed right away.
Do I need to do ankle exercises if I had a plantar plate sprain?
That is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
If you get an aching pain under the big toe joint, it might be an injury to one of the two little bones called the sesamoid bones.
The sesamoid bone injuries make me super nervous. If you are a runner and you start getting pain and irritation if the sesamoids, you do not want to ignore it.
I just got off a call with a woman who had sesamoiditis. She wanted to make sure that she was not doing anything to slow the recovery of her sesamoid stress fracture.
With summer coming up, she wanted to know what kind of sandals she might be able to wear.
What summer sandals should I wear if I have sesamoiditis?
Well, that is a good question and that is what we’re talking about today on the Doc On The Run Podcast.
I was just on a second opinion call with a runner. He is a triathlete, and he has had a long course of foot trouble. He was diagnosed with a plantar plate injury, but was not getting better.
We figured out some missing pieces of his recovery puzzle and developed a plan of action.
Well, he acted on that game plan and turns out he had been misdiagnosed. What he has is a neuroma (not a plantar plate sprain).
He went back to his doctor and she then wanted to inject his foot with cortisone, but he had a race coming up.
And then he said, “Well, this is the problem. This is why I am calling you again, is that when I saw her, she said you have a neuroma so let’s go ahead and inject it with cortisone.”
Can I run a race after a corticosteroid injection for a neuroma?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
If you get a sesamoid fracture, you are probably worried. This is a scary injury if you are a runner.
Since stretching is one of the main components of physical therapy after many running injuries, you may think about stretching and why it might help your injury recover faster.
What is the single most important stretch if you are a runner who has had a sesamoid fracture?
Well, that is what we are talking about today on the Doc On The Run Podcast.
One of the most difficult running injuries is a plantar plate injury.
I know, because I have had a plantar plate sprain myself.
Plantar plate sprains are really frustrating because the plantar plate is a very small ligament. It takes very little to aggravate or stress the plantar plate, to irritate it, to stretch it, strain it, or injure it further when you are running.
I had a patient who asked a really interesting question. He said:
“Should I expect to have pain as soon as I start running?”
I basically said, “Well, if you do, you are doing it wrong, because if you are having pain, you are stretching and straining the ligament in the way that is predictably going to re-injure it.”
Should I expect to have some pain when I return to running after healing a plantar plate sprain?
Great question and that is what we’re talking about today on the Doc On The Run Podcast.
If you have a fractured sesamoid bone, the biggest concern is that the sesamoid fracture will turn into a fracture nonunion.
“Non-union” means it did not unite. The two broken pieces did not get back together, and the fractured sesamoid bone did not heal.
I was talking to a runner who had a sesamoid injury and she wanted to know whether or not surgery was a good option in her case.
We talked broadly speaking about three different possible kinds of sesamoid surgeries.
Today on the Doc On The Run podcast, we’re talking about surgical options for sesamoid fracture nonunion.
I got an interesting question from a runner who had a plantar plate injury.
This runner had a long course of sort of misdiagnosis, mistreatment and various plantar plate “misadventures.”
But when we started working together, he started to do some specific things to improve quickly, and he is doing great now.
He asked:
“Which comes first after my plantar plate sprain heals, will I be running, or will I be wearing dress shoes?”
Well, that is a good question and that is what we’re talking about today on the Doc On The Run Podcast.
I had a call from a patient who wanted to know about surgical removal of Morton’s neuroma.
She said she went to the doctor. The doctor said, “Well, we can just take the nerve out. It is not a big deal. We do this all the time.”
The reason she called me for a second opinion was because the doctor told her we have to cut a ligament to take the painful nerve out.
She wanted to know if that was true, and whether or not that could cause a problem later.
Do you have to cut a ligament in the foot to remove a painful neuroma?
That is what we’re talking about today on the Doc On The Run Podcast.
I got a comment from a runner who posted this question on one of the YouTube videos on the Doc On The Run YouTube channel.
He says he had plantar fascia surgery just over 3 months ago.
He said that following the operation, he followed all of the surgeons post-operative instructions “to a tee.”
He was feeling great, until he started developing a small pain at the back of the arch right where the heel starts.
He said:
“My whole arch is in pain. Do you think I could have a torn plantar fascia? It was tolerable but in hindsight this has not been ignored.”
Did I tear my fascia after plantar fasciitis surgery?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who had a plantar plate injury that has been bothering him for about a year and a half.
We did a series of calls to talk about some changes in his treatment that could get him moving in the right direction.
He asked me a great question when I was on a call with him this morning.
He said:
“Can I run in zero drop shoes once it is really healed? Not today, but like when it is really, really healed and it is stronger and all that kind of stuff.”
I said, “You can do whatever you want, you just have to be willing to pay the consequences.”
Can I run in zero drop shoes after a plantar plate sprain heals?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcas
When you have hallux rigidus, the problem is the big toe joint does not want to move.
Many doctors will simply tell you that your big toe joint, or the “first metatarsal phalangeal joint” is getting progressively stiffer and developing arthritis.
If you wear shoes that irritate the joint more, the condition will only gets worse. The question is what sandals won’t make hallux rigidus worse?
What sandals can I wear with hallux rigidus?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a comment on one of the YouTube videos on peroneal tendinitis. A limping runner asked the question:
“Can peroneal nerve tendinitis cause fifth metatarsal to be tender to the touch and when walking, I am not sure if I have a stress fracture.”
When I read this comment, I became confused because I am not sure what is going on with this runner, but I am going to try to explain and answer the question as best I can in this episode.
Can peroneal nerve tendinitis cause fifth metatarsal pain?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I got a great question from a runner with a sesamoid fracture that turned into a “non-union.”
The sesamoid bones are two tiny little bones under the big toe joint. When you break one of the sesamoids, if two pieces of bone do not heal back together, we call a “sesamoid fracture non-union.”
In this runner’s case, she used a bone stimulator. She wore a fracture boot. She used crutches. But after a year of treatment, the doctor looked at her X-ray and said, “You have a non-union, we should take it out.”
Is it possible to run if you have a sesamoid fracture non-union?
That is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
The primary way I help runners is through telemedicine second opinions.
I help runners who are not running, who have not been getting better, who are frustrated, and help them figure out what they need to do to get past the injury and back to running.
Once they are on track and have made lots of progress, they want to know “When should we check in for our next call?”
I feel like I am on track with my running injury, should we book another consulting call or a series of calls to talk about it?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
I saw a runner today and I did a cortisone injection to treat her sinus tarsi syndrome. She asked me a great question.
She said, “Is the cortizone injection something I am going to need to do every three to six months?”
She had been reading up on corticosteroid injections and had found that some athletes with certain conditions may have injections scheduled every few months.
Should I have serial injections for sinus tarsi syndrome?
Well, that is a great question and that is what we are talking about today on the Doc On The Run Podcast.
The most important first step with any athlete who signs up for a webcam second opinion or series of coach coaching calls is to ask, “What is your goal?”
I was lecturing at a medical conference in Wisconsin where I was doing a whole morning session on running injury talks and diagnosis of subtle fracture patterns in athletes.
What I told those doctors is they have to ask the athlete, “What is your goal?”
Without understanding your timeline based on your running goal, you cannot make a useful recommendation on treatment on any running injury.
Sitting in that conference room I realized…
Your goal that you have right now could tell me how chronic your running injury really is.
Don’t believe me? Well, that is what we’re talking about today on the Doc On The Run Podcast.
Today, I had a final follow-up call with a runner who did a series of consultation calls with me to get advice every week. After the series of calls he had improved and was better, but disclosed to me that he felt like he had been depressed.
He thought he might have depression because he realized something had significantly changed in his goal setting.
He said, “I can’t even imagine myself doing races anymore.”
Are you depressed because of your running injury?
Well, maybe you are, maybe you are not. I am not a psychiatrist. I am not a psychologist, but that is what we’re talking about today on the Doc On The Run Podcast.
This morning, I was on a second opinion call with a runner who had a couple of different injuries in his foot.
The main problem keeping him from running was an injury to the collateral ligaments in one of his toes.
“The toe feels weak and unstable.” He is understandably worried that the instability is going to cause a problem if he runs.
He was asking me:
“Well, can we surgically repair the ligaments?”
Should I have surgery to repair the collateral ligaments in my toe if I am a runner?
Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
This morning, I had a conversation with a runner who had an injury. He has been getting a lot better and one of the things that really seemed to help the injury improve was wearing compression socks.
His question was a really good one. He said:
“I had so much improvement with wearing compression socks, but with the injury I have, every time I take the socks off and on, it feels like I am moving the injured tissue now. I am not really sure if I still need the compression.”
Do I need to keep using compression socks until my injury is really healed?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
If you get an overtraining injury like a metatarsal stress fracture or a plantar plate sprain or Achilles tendonitis, or peroneal tendonitis, a doctor might prescribe a fracture walking boot.
Well, it is designed to hold you still so that you can hopefully walk on something like a fracture and still let it heal.
The reason for this episode is this morning I was on a call with someone who has been wearing a boot and he is curious why all of a sudden, he is starting to have some aching pain in the boot in the morning when he first gets up and steps on his foot while wearing the boot.
What are the two reasons you might get pain when you have been wearing a fracture walking boot for a running injury?
Well, that is what we’re talking about today on the Doc On The Run Podcast.
I was doing a second opinion webcam consultation with a runner who noticed a lump in the calf muscle.
The knot in the leg wasn’t limiting his running. In fact, when he was running, this lump in the calf muscle felt better, not worse.
So, you have to wonder, could the knot “not” be a big deal?
There are really 3 things a runner can do immediately after noticing a bump in the leg.
Today on the Doc On The Run Podcast, we’re talking about the three steps you should do as the very first thing when you feel a weird lump in your calf muscle.
Today I am about to drive to the airport, get on a plane, fly to Wisconsin to give five lectures on running injuries at a medical conference.
As I was finalizing that talk on medical imaging strategies for athletes, I was thinking about a conversation that I had yesterday with an athlete who had a very frustrating course and actually called me for a second opinion.
He had an injury that hass been going on for a long time. In short, he is trying to get a second opinion from me specifically because I have worked with runners.
Today on the Doc On The Run Podcast we’re talking about three things you should not tell your new doctor.
This episode comes from a question posted by one of the Doc On The Run YouTube viewers as a comment on the video “Where to run with plantar fasciitis.”
In the video, I was trying to explain which surfaces can help you the most when you’re trying to run with plantar fasciitis. The only way to do that is to make sure you are decreasing the stress and strain on the plantar fascia ligament.
But the question was…
Is the plantar fascia really a ligament?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
There are three ways that a doctor might convince you that it’s really time to have surgery and fix that plantar plate ligament that’s been making you miserable when you’ve been trying to run.
To you, it may not seem that bad. It kind of aches. It kind of swells. It kind of bugs you. But then the doctor suddenly says, “Look, it’s not getting better, let’s have surgery.”
Well, how does the doctor convince you that it’s time for surgery? What are the things a doctor does, that might actually lead you to believe that it really is time to have surgery?
What are the three ways that a doctor might convince you that you need surgery if you’re a runner with a plantar plate injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from one of the YouTube videos and it was specifically a comment that someone posted on one of the videos that was called “Five worst exercises for hallux rigidus”.
This came from Matt and he asked:
“When can you start doing push-ups again, if you have hallux rigidus?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I know. You don’t want plantar plate surgery.
But if your plantar plate ligament doesn’t repair itself, or your doctor doesn’t help it repair itself, you might get talked into surgery.
If you have plantar plate repair surgery, you may spend a lot less time running over the weeks following surgery…because you have to let it heal.
There are really three mistakes that I see runners make when they’ve had a plantar plate injury. This episode will help you avoid them.
What are 3 big mistakes runners make that lead to plantar plate surgery?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I’m not going to tell you that any runner should want to use crutches. I’m also not going to tell you that you will enjoy wearing a fracture walking boot.
But there are reasons that you may want to do things a little differently if you’re a runner.
The critical issue is that runners must really try to speed up the healing process as much as possible, so that you can avoid losing your running fitness.
What are the three time-sensitive problems solved when you use a fracture walking boot and crutches at the same time?
Well, that’s what we’re talking about today on the Doc On The Run Podcast!
Most of the runners I see who have pain in the ball of the foot from a plantar plate sprain rarely start out with a completely torn plantar plate tear.
More often, runners ignore the pain from the plantar plate sprain and it evolves into a full thickness plantar plate tear.
Surgery is only needed when the plantar plate is torn in such a way that the plantar plate ligament cannot be expected to heal without surgery.
But there are some mistakes that could lead a runner to the operating room.
Plantar plate surgery is a failure to act quickly.
That’s what we’re talking about today on the Doc On The Run Podcast.
Sometimes when you get injured and have to stop running, you start to lose your identity.
One of the things that I notice most in runners who have gone weeks or months without running, is they are really bummed out.
These runners seem really grumpy. In some cases, they don’t even view themselves as a “runner” anymore…well, because they’re “not running.”
If you want to heal and get back to running as quickly as possible this can be a real problem.
How can self-judgment actually slow down your injury recovery when you have an overtraining injury as a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just had a consultation with a runner who had foot pain that she thought might be a stress fracture that had been coming and going for about a month.
She had been increasing her training volume and doing strength exercises that are supposed to build her running fitness.
The pain seemed to be volume related. The more training she did, the more she would notice the discomfort in her foot.
But when we x-rays of her foot, the radiologist suggested this could be an “acute on chronic” stress reaction.
What does that mean?
What is the difference between a chronic stress reaction, or an acute on chronic stress reaction in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Just this morning, during the live Stress Fracture Masterclass I had an interesting question.
The story went like this. An athlete who is a State ranked high school cross country and track, had to suddenly stop running due to intense pain that started about 15 days ago.
He went and saw a doctor. He got x-rays. He got an MRI, had a physical exam where the orthopedic doctor poked around and tried to figure out what was going on. The Orthopedist gave on diagnosis, but the Radiologist suggested a different diagnosis.
This is where the trouble comes in.
So, the runner was told a couple of different things, 1) a stress reaction, or 2) stress fracture, possibly of A) the third metatarsal or B) intermediate cuneiform bone, at the base of the third metatarsal.
Confused yet?
So was this runner!
What do you do if you think you have a stress fracture, you see an orthopedic doctor and the radiologist who reads your images s disagrees about your diagnosis.
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you had an ankle injury a long time ago.
You sprained the ankle when you were out on a trail run, it got better , and you went right back to running.
But over time, you slowly got more and more pain in the ankle.
In that case, you doctor might order an MRI of your ankle, or a similar imaging study called an MRA (instead of MRI).
What’s the difference between MRI or MRA in a runner with an old nagging ankle injury?
That’s what we’re talking about today on the Doc On The Run Podcast.
I recently saw a runner who thought that he might have a tibial stress fracture. But it turns out, it was just shin splints, which of course is good news. Because you don’t really want a tibial stress fracture. Shin splints is much easier to treat.
One of the questions he asked me was about the best running shoes based on his foot type.
This runner really needed more stability than got from the running shoes that he was wearing.
What are two different ways shoes can actually cause shin splints in runners?
That’s what we’re talking about today on the Doc On The Run Podcast.
If you got pain on the ball of the foot, at the base on the 2nd, and you have been running in a minimalist shoe, running uphill, doing lots of calf raises, or running on steps, you could have an injury to a little bitty ligament called the plantar plate ligament.
If you get an injury to the plantar plate, sometimes your second toe will drift toward your big toe or away from your big toe. The toe drifting sideways can happen for two different reasons.
They are very different causes and so they are treated differently.
Why does the toe drift sideways when you have a plantar plate injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you roll your ankle on a trail run and it turns black and blue and swollen, you may think you just have to take a few days off.
In fact, if you research how long it will take to get back to running, you might find a study that says that if you do early range of motion after an ankle sprain, it only takes 4 days to get back to pre-injury levels of activity.
However, if you do that, you can wind up with a lot of trouble later.
When I lecture at medical conferences on how doctors should treat ankle sprains in runners, I teach 3 phases of ankle sprain injury recovery.
If you are a runner with an ankle sprain, and you understand them, it’ll help you get back to training and running without another ankle sprain.
What are the three phases of ankle sprain recovery in runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Last night, I was doing a consultation with an athlete who had a fracture when she accidentally kicked a piece of furniture.
Her foot was swollen, it was black and blue. The foot was really painful and she couldn’t walk on it.
She went to urgent care and they took x-rays. She was a little concerned that they told her that it wasn’t broken.
So, she called me for a second opinion.
My doctor missed a fracture on my x-rays. What should I do about that?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
My doctor missed a fracture on my x-rays. What should I do about that? Well, th
If you’re out on a run, and you have heel pain that suddenly hurts a lot, you may have a calcaneal stress fracture, especially if you see bruising and swelling.
If you go see a doctor, they take an x-ray, and they don’t see anything at all but they squeeze your heel and it hurts. The suspicion goes up.
If your doctor gets an MRI that shows a calcaneal stress fracture, the doctor is probably going to tell you, “you can’t do anything until the stress fracture heels.”
Today on the Doc On The Run Podcast, we’re talking about calcaneal stress fractures in runners and I have some good news and some bad news.
Last night, I was doing a consultation with an athlete who actually broke one of her toes and her main question was:
Can I compete in four weeks? I have a competition in four weeks, I want to compete. Do you think I’ll be ready?
Well, I actually told her, no joke, I actually said, “I’m very sorry, but my crystal ball is broken.”
However, I can tell you how to figure that out because that is what I teach athletes to figure out when they do the Fast Track challenge.
I have a broken toe and I want to compete in four weeks. Is it possible?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Yesterday, I went to an appointment with a friend who had an appointment with an orthopedist.
She had 3 fractures. She wanted to know what she could do in terms of activity while she’s healing and recovering from these different injuries.
I just went with her, not as her physician, but to serve as a friend and advocate for her at her appointment. This episode is going to explain why you really need to take an advocate with you to any doctor’s appointment.
I went to an orthopedic appointment yesterday and they told me to come back in four weeks. What do I do now?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Yesterday, I was doing a consultation with an athlete who broke one of her toes when she accidentally kicked a piece of furniture.
If you fracture your toe, and you just run and ignore it, it can turn into a painful nonunion (non-healed fracture).
As a runner, you want to speed the healing as much as possible. One of the ways to stimulate fracture healing is with a thing called a bone stimulator.
This particular athlete actually happened to already have a bone stimulator. Her question was pretty obvious:
“Can I just use that bone stimulator for this broken toe since it’s a different kind of fracture?”
Well, that’s what we’re talking about today on the doc on the run podcast.
If you’re a runner with heel pain you may think you have plantar fasciitis. But if it is not getting better, your heel pain may be caused by “neuritis.”
I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe.
I was giving a lecture called “When Heel Pain is NOT Plantar Fasciitis in Runners.” One of the conditions I was talking about was “medial calcaneal neuritis.”
One of the doctors in the audience asked a really great question…
He said, “I see a lot of people that have Baxter’s neuritis, and it’s down on the bottom of the heel it’s plantar , it’s not on the side of the heel, it’s not medial neuritis, it’s different. What would you do to tell the difference between these two conditions in a runner, given the circumstances you just explained in the talk?”
Today on the Doc On The Run Podcast we’re talking about medial calcaneal neuritis versus Baxter’s neuritis in a runner.
I recently did a consultation with a runner who had gotten a plantar plate injury. He had been getting better by using some of the tricks I teach in the Plantar Plate Course For Runners.
He got better, he was protecting it, he reduced the stress and strain on the ligament, and he got back to running. He was doing great.
But then he had a setback when he went to the synagogue. He was dressed up and wearing some fancy dress shoes, and he started to get plantar plate pain again.
Today on the Doc On The Run Podcast, we’re talking about how dress shoes with a long toe box can actually work as a lever against your plantar plate.
I was just at the International Foot & Ankle foundation meeting in Lake Tahoe listening to a lecture given by a Professor of Biomechanics and Podiatric Medicine at Barry University.
He said that a cortisone injection can be used as a “stop gap treatment” in heel pain caused by plantar fasciitis.
The idea is that some runners may need pain relief sooner than would normally be expected. It is true that corticosteroid injections can reduce the inflammation in and around the plantar fascia and quickly reduce pain.
When I had “normal practice” with “normal patients,” I used to treat plantar fasciitis with corticosteroid injections pretty much daily.
But I almost never do plantar fascia cortisone injections now.
Can a corticosteroid injection serve as a stop gap for runners with heel pain?
That’s what we’re talking about today on the Doc On The Run Podcast.
I just had a conversation with a runner who has a plantar plate injury.
He got the plantar plate sprain trying to build his uphill running strength in preparation for a trail race.
This is no rookie mistake. He is a longtime ultra marathoner with lots of experience. But he made a common mistake determined runners can make.
Today on the Doc On The Run Podcast, we’re talking about one of the worst exercises you can do if you have a plantar plate sprain and you’ve been trying to build your uphill running strength for a trail race.
Taping is one of the oldest and simplest ways to treat foot pain and injuries to the toes, feet and ankles.
There is a specific way to take your ankles after an ankle sprain so you can start running earlier.
If you have a plantar plate sprain you might try taping the toe to decrease some of the stress and strain on the plantar plate ligament when you run.
If you have a broken toe, buddy-splinting with tape can really help hold the broken bone still so it can hurt less and heal faster.
But if your skin gets irritated, and you are forced to stop using it, the tape can’t help you at all.
Today on the Doc On The Run Podcast, we’re talking about how to patch test for tape allergy.
I recently saw an elite runner who had what he thought was shin splints. One of the findings on the MRI report was something called “hyperemia.”
He asked me:
“What does that mean? Does that mean I have a stress fracture? Does that mean I have shin splints?”
What does hyperemia mean when you see it on an MRI report or an ultrasound report and you have something like shin splints or a tibial stress reaction?
Well, good question and that’s what we’re talking about today on the Doc On The Run Podcast.
I believe the most commonly prescribed and most overprescribed treatment for injured runners is probably a fracture walking boot.
The big question for your doctor is…
Is the fracture walking boot really necessary or not, given my stage of injury recovery?
When is a fracture walking boot really necessary for a metatarsal stress fracture?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
When you get an overtraining injury from running, it’s not because you did too much, because you were too strong or too motivated.
You got injured because you were too weak.
You were too weak to sustain the stress applied to that piece of tissue, that one injured piece of tissue that got injured when you did one workout.
That’s what really happened.
If you get injured, you have to understand how to correct that specific weakness.
Understanding this is crucial.
Overtraining injuries in runners are actually caused by weakness.
And that’s what we’re talking about today in the Doc On The Run Podcast.
There are a lot of confusing things you can see on an MRI report, on an x-ray report or an ultrasound report when you’re a runner with pain that you think might be a stress fracture.
One of those findings that may be reported on your medical imaging study is a thing called “cortical thickening.”
I want to explain what that is so you can better understand it in case you happen to see it on an MRI report, x-ray report or in your doctor’s notes.
What is cortical thickening that precedes a stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just had an interesting call with an elite runner, who’s a high school cross country runner.
He developed a tibial stress fracture, or stress reaction.
But he thought it was shin splints.
When I looked at it with ultrasound, I saw some stuff that made me really worried about it. So, I got an MRI to confirm.
The first question he had was, what’s the grade?
Grading scales cause confusion.
Today on the Doc On The Run Podcast we’re talking about why stress fracture grading is BS for runners.
When you get a stress fracture, one of the earliest visible indications on an X-ray or an MRI or a CT scan is a thing called periosteal elevation. Your doctor might see it on ultrasound, x-rays or MRI studies….way before your ever see a crack in the bone.
Since it’s one of the earliest changes in the bone when you start to get a stress fracture, I thought it might be useful to talk about the term “periosteal elevation” really means.
What is periosteal elevation in a stress fracture in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I got an interesting question in the Injured Runners Aid Station, “Should I run without my custom orthotics to strengthen my feet?”
It seems logical that stronger runners are less prone to injury. The premise behind this question is whether or not orthotics may cause weakness in your feet or legs.
Never ignore your doctor’s advice. But you have to ask your doctor the right questions about treatments like custom orthotics. You also have to understand when a little variety might help you become a stronger runner.
Why variety makes you stronger as a runner?
That’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you get a stress fracture, the number one most important thing that you do is get it to calm down while you maintain your running fitness.
Based on those ideas, I built a framework that I’ve been using for years with injured runners who want to heal and want to get back to running.
In this episode we will go through my stepwise process of how I do it.
Today on the Doc On The Run Podcast we’re talking about my stress fracture framework simplified.
The most common medical advice for a runner with a stress fracture, is to stop running, rest, let it heal and then wait to start training after it heals.
But as a runner, you need the stress fracture to heal as quickly as possible so you can get back to running as quickly as possible.
In the Injured Runners Aid Station, I got a question from a runner who asked me about the “most important ingredient for healing a stress fracture.”
What is the most important ingredient for healing a stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Pain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run.
How you track your pain is important.
One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue.
You cannot run without understanding the difference, at least not safely.
Is the pain from injury or just inflammation?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a plantar plate sprain, it can take a long time to heal, particularly if you’re not paying close attention.
And because of that, many runners get frustrated.
I see 2 responses to that frustration:
1) go to the doctor and hope for some kind of quick fix.
2) just ignore it and run on it because it doesn’t really hurt that bad.
Both of those are bad ideas with plantar plate injuries in runners.
What are two ways capsulitis can actually lead to a plantar plate rupture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you need the little bitty crack in the bone to heal.
How do you do that?
First, you have to stop bending or torquing or twisting the bone in a way that led to the crack in the first place.
Second, you have to let the healing process take place.
After the inflammation goes away, and after you get some collagen sealing up the healing crack, you start to get “ossification” of the bone where it turns into hard solid bone that you can run on.
That happens through a combination of two different types of cells in the bone called osteoblasts and osteoclasts.
Osteoblast versus osteoclast, the battle that’s rebuilding bone after a stress fracture.
That’s what we’re talking about today on the Doc On The Run Podcast.
How long does it take you to get fit enough to run a 3 hour marathon?
Well, that depends on what? It depends on what you would actually do. Not how long you wait.
How long it takes for you to heal your overtraining injury all depends on what you do, and which variables you choose to control. Not how long you wait.
Believe it or not, every injured runner who calls me for a consultation has control over far more of these variables than they think.
How long will it take my overtraining injury to heal?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner with a plantar plate sprain, I can understand why you’re frustrated.
You have some minor vague aching pain in the ball of the foot, and you’re trying to get back to running, but you’re getting lots of conflicting advice.
In my experience, it’s very rare that a runner gets a plantar plate injury from what I call “overtraining.”
Plantar plate ligaments don’t get sprained because you ran way too much, or ran too many miles. It doesn’t really happen that way. But they do get injured by workouts designed to support your running fitness.
What are three running drills that might lead to a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re trying to improve and you don’t improve, whose fault is it?
Before we talk about running injuries, let’s talk about when you’re not injured. You hire a coach. You know the coach is qualified, You know your coach has given you a valid training plan, and you know that you can execute.
But then something goes sideways. Your baby gets sick. You get an additional work project. You are sent away out of town on work. Something happens, and you miss some workouts.
If you don’t communicate that to your coach, and you just skip workouts, or inadvertently stack workouts together to make up for missed workouts, and then you get injured, whose fault is that?
Whose fault is it if an injured runner is not getting better?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I often get nutrition questions from runners who have overtraining injuries involving tissues made of collagen like the plantar plate ligament.
At the heart of these questions is what is the most important ingredient to add in their diet to speed recovery.
In this episode we are briefly discussing the key ingredients your body needs to repair collagen. If you are missing these, you might have a slower repair process if you have a partial tear of the plantar plate ligament itself.
What is the most important ingredient to a runner after a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
In the Injured Runners Aid Station, I get questions from injured runners that stop me in my tracks.
“I got this injury while running. I had a stress fracture. It was grade two stress fracture. It’s been six weeks. How much longer will it be before I can run?”
Every injured runner wants to know when it will be safe to run. But, I cannot make that decision based on that information. It seems crazy, but “how long until you can run” is never just about “how long since the injury started.”
Do not ask me if you don’t know your pain numbers.
That’s what we’re talking about today on the Doc On The Run Podcast.
It’s no secret that I truly believe fracture walking boots are overprescribed, overused and used for way too long for many injured runners with many different kinds of overtraining injuries.
But sometimes I recommend runners use a fracture walking boot for a short period of time. Then teh question becomes which kind? Short boot or Tall boot?
A tall fracture walking boot versus a short fracture walking boot. Which one is better if you’re an injured runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just saw a woman with an extremely painful callus on the bottom of her foot. She got a type of callus doctors call an “intractable plantar keratosis.” When you get one of these calluses, it turns into a tiny rock hard callus embedded deep in the skin on the bottom of the foot.
It hurts. It’s like having a little rock taped to your foot. In theory, you can start running as soon as the callus is removed.
But the real question is whether or not running right away will increase the probability of getting the same callus again.
Do I have to wait for my callus to go away before I can run?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a fracture in your big toe joint it can be easy to get talked into surgery. Especially if you see fragments on an X-ray.
Your doctor may call old broken bone pieces by a number of terms:
“Osteophytes”
“Fracture fragments”
“Loose bodies”
“Surgical targets”
If your doctor points them out and starts talking about surgery, the chances are good that you’re going to want to have them removed. But there are times when surgery is totally unnecessary.
How can I tell if I really need to have surgery to remove a fracture fragment in my big toe joint?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a metatarsal fracture and it does not heal, doctors call it a “non-union.”
Sometimes, even if you have a non-union you can still run. Maybe without surgery.
The single most important consideration with a non-union is stability.
The more stable the bone is, the more likely the fracture will heal.
The more stable the bone is, the less likely it will cause pain.
The more stable the bone is, the sooner you can start running.
The more stable the bone is, the less likely you will need surgery.
One of the keys to deciding when it’s actually healed enough has to do with that stability. When it comes to assessing it, everybody wants an imaging study.
What’s the best imaging study to assess non-union stability when you have a fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just got a great question from a runner with a tibial stress fracture that had been misdiagnosed with shin splints.
She wanted to know how long to use the crutches.
Is two weeks on crutches better than one week when I have a tibial stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode applies to any injured running pondering surgery.
I just spoke to a runner who was told she might need surgery to fix a non-union of a metatarsal fracture.
I said, “Look, you have two choices. You can have surgery or not have surgery.”
We talked about what it meant if she did have surgery in terms of her recovery. And we also talked about how she could potentially get it to heal without having all the risk associated with surgery.
What is the very last option you can do as a runner to avoid surgery?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you are an injured runner, you are probably limiting your activity.
Doctors who don’t understand how important it is for you to get back to running tend to limit runner’s workouts more than necessary. They’re more restrictive than necessary. And it costs you.
You lose more fitness, you get weaker, you get stiffer, you get neuromuscular changes that damage your running form, and disrupts your coordinated firing of muscle units that makes you efficient.
All of that gets damaged over the weeks that you’re not running. So, it’s really important that you maintain your fitness.
Today on the Doc On The Run Podcast, we’re talking about how the minimum restrictive intervention should always be the goal with injured runners.
I had an interesting question from an athlete who asked,
“I had an injury, I went to see the doctor and got an X-ray. There was no crack on the X-ray, but my doctor called it a stress fracture. So, I’m confused.”
“I thought that a stress fracture happens when you run too much, too far, too soon, it overloads the bone, and you get a little crack in it. I didn’t do that. It was trauma, a sudden injury, not a bunch of force applied over a long period of time. I wasn’t training for anything. I don’t get it. Why is my doctor calling this a stress fracture?”
I had a sudden injury, but my doctor called it a stress fracture.
That’s what we’re talking about today on the Doc On The Run Podcast.
I recently did a webcam consultation with an athlete who has had a lot of trouble for a long time. He was very, very athletic. He started having pain and a whole lot of trouble that ensued afterwards that severely changed his athletic picture in only a couple of years.
After years of seeing experts and not getting any better, he asked me to help him to do a second opinion and help him reassess where he was and what he might be able to do.
The way I think about this is really simple. Many of the bad things that happen after the original injury are because of compensation or your body trying to keep pressure off of that worst injury that happened first.
So, I always tried to address that first injury, first!
Today on the Doc On The Run Podcast we’re talking about why you need to fix the original pain first.
It’s important to understand they were talking about similar cracks in similar bones that remain in a similar position. We’re not talking about broken bones that are displaced.
If you jump off a ladder, you break the bone and it’s moved out of position, that is a completely different story. Stress fractures don’t generally get displaced as much as traumatic fractures.
If there’s a crack in the bone because of a stress fracture, the bone is not displaced. But how does that compare to similar (non-displaced )traumatic fracture?
Is there any difference in healing between a stress fracture versus a traumatic fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A metatarsal fracture “non-union” is what doctors call it when you broke the bone, it started to heal, but then the fracture kind of quit healing. Usually it means you got a bunch of scar tissue between the ends of the bone.
Sometimes that happens without you or your doctor realizing it. The problem gets worse if you start running on it.
The question is, “should I take non-steroidal anti-inflammatory drugs (or NSAIDs)?
NSAID’s are medications like ibuprofen and naproxen. These drugs are not steroids, but they stop inflammation.
Many runners take them for all kinds of aches and pains after training. The question is, is it a good idea or not when you may have a metatarsal fracture non-union?
Should a runner take non-steroidal anti-inflammatory medications for a non-union?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a metatarsal stress fracture, the first thing that you’re going to notice is not that you have a broken bone in your foot.
You are going to notice pain.
Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it.
The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs.
As I explained this to a runner in the Injured Runners Aid Station, she asked “What really causes the pain?”
What causes most of the pain when you have a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A stress fracture in your tibia, or shin bone, is a bad injury. You definitely don’t want the crack to grow to the point where it could break.
The big question is what will make a tibial stress fracture better, faster…crutches or a fracture walking boot?
When is a fracture walking boot better than crutches for a tibial stress fracture if you’re a runner?
That’s what we’re talking about today on the Doc On The Run Podcast.
This episode comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery.
I was looking at her CT scan and she asked me an interesting question.
She said,
“Does it look stable?”
And I said, “Can’t tell.”
It looks like a non-union. It looks like it’s broken and never healed.
What are the three ways you could tell whether or not a metatarsal fracture non-union is stable without getting an imaging study?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.