Let’s say you’re out on a run and you start noticing this weird aching pain in your foot and so you suspect you have a metatarsal stress fracture. I often get consultation calls and webcam visits, and I even do house calls for athletes who have metatarsal stress fractures.
The good news is that a lot of the times, if you actually do something, when you first notice that aching pain in your foot, when you’re running, it may not actually be a true stress fracture.
Today on the Doc On The Run podcast we’re talking about the five most important things you can do for first aid for a metatarsal stress fracture if you’re a runner.
I often get questions from runners and this is actually a common one that I get from runners when they have either enrolled in the plantar plate sprain treatment course for runners, or if they’ve signed up to do an individual webcam consultation.
Everybody seems to think that an MRI will give you a crystal-clear image of what’s going on inside your body and in some sense, that’s true. It is amazing, the amount of detail you can get when you get an MRI. However, you have to remember that the plantar plate ligament is a very small structure and when you get an MRI, it doesn’t necessarily show everything.
Is it okay to run before I get an MRI of a plantar plate sprain? That’s a great question and that’s what we’re talking about today on Doc On The Run Podcast.
I lecture at medical conferences about stress fractures, trying to teach physicians the difference between a stress response, a stress reaction, which is basically an irritated and inflamed metatarsal bone, and a stress fracture where there’s actually a crack that can cause real trouble.
One of the questions doctors ask me is what’s the best way and the worst way to tell a stress reaction from a stress fracture, because it does make a difference.
What is the worst way to tell a stress reaction from a stress fracture? Well, that’s what we’re talking about today on the Doc On The Run podcast.
If you only get one thing from this episode, let it be this…Thank you!
From the bottom of my heart I am grateful for you as a listener of the show!
More than 10 years ago I started writing a blog talking about running injuries, and the various treatments that we as physicians offer. A few years later, at which point I had actually only listened to a few podcasts myself, I thought it might be useful to start recording a podcast to talk about foot and ankle injuries in injured runners.
Well, its hard to believe but today is episode #500 and that’s what we’re talking about on the Doc On The Run Podcast!
Every time I do a second opinion consultation with a runner who has a plantar plate injury, I hate to tell you this, but I hear the same story over and over and over.
Basically they call me and they say, “Well, I have a plantar plate sprain. I know I have a plantar plate sprain. I went through the plantar plate sprain course and I’ve been doing some of those things to actually try to get it better and it’s starting to improve, but I was misdiagnosed with another condition.”
We’re going to talk about why runners get misdiagnosed so frequently when they have plantar plate injuries and why it can be difficult to figure out whether or not that’s actually a problem in the first place.
Today on the Doc On The Run Podcast, we’re talking about why plantar plate injuries get misdiagnosed so frequently in runners.
Metatarsal stress fractures are one of the most common overtraining injuries afflicting runners. Much of the time the stress fracture is preceded by what we as doctors call a “stress reaction.”
If you ignore the warning signs of a stress reaction and keep on running in the same way, applying the same stress, the stress reaction will advance to a full on stress fracture they can keep you out of training for months. Most people think and X-ray of the foot is the best way to tell the difference between the stress fracture and a stress reaction. But that assumption is false.
If you’re trying to figure out whether or not you’re in the early phases of the stress fracture injury process you have to take action to figure out what is going on immediately. This episode will explain that process.
Today on the Doc On The Run Podcast we’re talking about the difference between stress fracture and stress reaction.
This question came up from somebody in the coaching groups who wanted to make sure that she wasn’t going to get re-injured.
She wanted to know which running shoes she should use to reassess her pattern, and make sure that she’s working her way out of this compensation pattern, where she’s essentially limping because of this prior injury and that’s a really useful thing to do.
Today on the Doc On The Run podcast, we’re talking about which running shoes show running form wear patterns best.
An MRI can be very helpful when you have a strange injury that doesn’t seem to fit in any of the common running injury boxes.
I just had a call from a runner in that very situation. He is someone who has an injury and has something kind of strange going on.
He actually had an abnormal finding on an MRI from a little more than three years ago.
At the time that he had that previous MRI that thing that was a little weird on his MRI wasn’t really causing a problem, but now his pain is in exactly that same spot.
Today on the Doc on the Run podcast, we’re talking about why runners should always get the second MRI at the same imaging facility.
Today’s episode actually comes from a second opinion telemedicine visit with a runner who wanted to know more about a tarsal coalition.
He had an X-ray and the doctor found this thing called a “C-sign.”
The “C-sign” is an abnormal appearance on an x-ray that suggests a tarsal coalition. When you look at the lateral view of the foot X-ray, a bridge of bone can form, partially encircling the talus bone and the calcaneus or the heel bone. It creates a bridging bright white thing that looks like the letter C on your X-ray.
A C-sign is abnormal, and it is one of the classic signs of a tarsal coalition.
How can a tarsal coalition start causing pain in a runner? Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from an injured runner who saw a doctor, got x-rays and found what looked like bone fragments in the peroneal tendons.
We were doing a telemedicine second opinion consultation, and she wanted to know whether or not she should have surgery to take the bone chips out of the peroneal tendon.
That’s a great question!
How did bone chips get in my peroneal tendon? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a second opinion telemedicine call with an injured runner.
She had a recurring injury that was still keeping her from running.
Unfortunately, that injury first started eight years ago.
When you have an injury, and you get x-rays, an MRI or a CT scan, or any kind of medical imaging study that shows more detail than the x-rays, you should always get a copy of that disc.
This runner’s story is a great example of why you need those images.
Today on the Doc On The Run podcast we’re talking about why runners should always get copies of the x-ray or MRI imaging disk.
Today’s question comes from a telemedicine visit second opinion for a runner.
She was asking if she should have surgery to remove bone fragments.
I said, “Well, let’s talk about what’s going on with you first.”
Anytime we see something abnormal on an x-ray or an MRI, we often think that it’s pathologic. We presume something is wrong, just because it doesn’t look right.
We think if something’s wrong, we should go cut your foot open and fix it.
Should a runner have surgery to remove bone fragments? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
The other day I was talking to a runner who had some abnormal findings on the x-rays.
What we could see was calcification in the Achilles tendon that looked like bone chips.
She wanted to know if she should have surgery to remove the calcification or little bony chips that were inside her Achilles tendon.
Now, the interesting part of the story is that the Achilles calcification was discovered from an x-ray where she had a stress fracture in one of the metatarsals….in a completely different part of her foot!
The pain she was having when running didn’t even come from an Achilles tendon problem.
Today on the Doc On The Run Podcast, we’re talking about the difference between pathologic versus abnormal findings on x-rays and MRIs in runners.
Today’s episode comes from a runner who was having some weird aches and pains when running.
One doctor suspected he might have a thing called a “tarsal coalition.”
A tarsal coalition is an abnormal union or connection between two bones.
He was even told me might need surgery to remove the tarsal coalition.
He asked me whether or not an injection, like a stem cell injection, might actually help a tarsal coalition.
You have to think about the runner’s goals, and we expect different injections will actually do to figure out which is best for you.
Today on the Doc on the Run podcast, we’re talking about two opposite ways injections could help a tarsal coalition in a runner.
A podcast listener sent in a great question for the Doc On The Run Podcast.
Sandra asked, “Is there a best way to ascertain if a person has a leg length discrepancy? MRI, measuring, what is it?”
“Limb length discrepancy” just means one leg is a little bit longer than the other.
There are lots of different ways to figure out whether or not you have a limb length discrepancy.
Figuring out how big that difference might be is really important if you want to fix it.
Today on the Doc On The Run Podcast, we’re talking about three different ways to determine limb length discrepancies in a runner.
Today’s episode comes from a discussion in our Monday, Wednesday, Friday coaching group.
This was someone who actually had a metatarsal fracture and had graduated from using crutches to using the boot and was transitioning out of the boot and she asked me a great question.
She said that her foot was hurting a little bit as she was transitioning out of the boot. She wanted to know if that was normal. Or was the aching associated with walking in a normal shoe something to be concerned about.
Today on the Doc On The Run podcast, we’re talking about why healing fractures might hurt after you stop using the boot.
Today’s discussion actually comes from a question from a runner in the Monday, Wednesday, Friday Coaching Group.
This is a runner who has a condition called “hallux rigidus.”
He wanted to understand the best way to assess your running shoes. He also wanted to know whether or not it was possible to identify hallux rigidus just by looking at the soles of a runner’s running shoes.
When you get hallux rigidus, your big toe doesn’t actually “dorsiflex” or come up away from the ground enough to allow you to walk or run without doing something to compensate. That shift in the way you walk creates a characteristic wear pattern on the sole of the shoe.
Today on the Doc On The Run Podcast, we’re talking about running shoe wear patterns with hallux rigidus.
Today’s episode comes from a discussion I had with a runner in person who had some foot pain, it was kind of weird.
He’s an elite runner and he started developing this symptom that he couldn’t figure out and it was in a weird spot.
He got an evaluation and part of his evaluation was X-rays of his foot. When we got the X-rays of his foot and we were looking at him, he had this thing that we call talar beaking and he wanted to know what that was.
What is talar beaking on the X-ray of a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every treatment in medicine has pluses and minuses. Applying ice is no different. Ice can make some things better, and some things worse.
If you ice something, in general it will calm that inflammatory response, reduce the pain and make you more comfortable.
But your goal is to get back to running as quickly as possible, not to just make you feel better.
Today on the Doc on the Run podcast, we’re talking about whether or not an injured runner should ice a broken toe.
Every day I do telemedicine calls with injured runners. They often ask questions that remind me of things learned in the past, that help them understand what to do right now.
It’s interesting how many times I actually think of this guy that was my mentor when I was racing motorcycles. His name is Fred Provis. Everyone called him “Motorhead Fred.”
Fred and I raced together and won an endurance championship, and he taught me a ton of stuff about life (not just racing).
Much of what Fred told me, I never would’ve thought about doing on my own.
I did what Fred said, because I trusted him.
Today on the Doc On The Run Podcast, we’re talking about why you need to trust in a real expert.
Ankle sprains are incredibly common in runners.
Sprained ankles account for about 10% of all musculoskeletal injuries that show up in the Emergency Room.
But there is another injury that can seem sort of like an ankle sprain, but doesn’t respond to treatment the same way.
This sprain is not in the ankle. It is a sprain of the joint under the ankle…the subtalar joint.
It’s called a Subtalar Joint Sprain.
What is a subtalar joint sprain in a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you suffer a severe running injury, some doctors will give you crutches to speed up the recovery process.
Healing any running injury is a race against time.
All overtraining injuries will eventually heal.
But if you take a long time to heal, you’re going to lose a lot of running fitness. You will get weaker, stiffer and develop a loss of coordination.
That loss of fitness will make it very difficult for you to achieve your running goals after you fully recover. The goal isn’t to heal. The goal is to run without re-injury.
Today on the Doc On The Run Podcast, we’re talking about the best and worst ways to stop crutches if you’re an injured runner.
This podcast episode comes from a telemedicine visit second opinion with a triathlete and runner who was having pain as he ramped up his mileage.
It turns out he had what we call a limb length discrepancy, where you actually have one leg that is a little bit shorter than the other.
This is something we see a lot in runners who are starting to get problems as they increase mileage during training.
Today on the Doc On The Run podcast, we’re talking about three signs of limb length discrepancies in runners.
This is a great question from a runner I’ve been helping in the Monday, Wednesday, and Friday coaching group.
She had a fifth metatarsal fracture and wanted to know if this could actually cause posterior tibial tendonitis.
Since they’re on the opposite sides of the foot, a lot of people think that it won’t cause the same kind of problem, because you wouldn’t expect to have problems on both the left and right sides of the same foot.
Can a fifth metatarsal fracture cause posterior tibial tendonitis? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A runner in the in the recovering runners coaching group asked a great question.
She had just broken her toe and could barely walk on it. She was really worried that she was going to have to use a fracture walking boot for a month or month and a half to get the toe fracture to heal.
She wanted to know specifically when she could start running.
Today on the Doc On The Run Podcast, we’re talking about what happens if you run on a fractured big toe before it completely heals.
I just got a great question from somebody who said he went rock climbing over the weekend, and he got a huge blister on his big toe from his climbing shoes.
He didn’t really complain that much about the blister, in fact, he’d even been running. But then he said he was getting peroneal tendonitis. He was having this pain on the outside of the ankle where the peroneal tendons go down around the back of the fibula bone.
He wanted to know if it was somehow related to the blister on the big toe.
Can a blister on the big toe caused peroneal tendonitis? Well, that’s what we’re talking about today on the Doc On The Run podcast.
I recently got a great question from a runner who was calling me for a second opinion during a telemedicine visit.
She wanted to run but had a partial rupture in the plantar fascia.
When we were talking about her history, she told me that she had had a couple of corticosteroid injections (or cortisone) injections for the plantar fascia when she had plantar fasciitis.
Is a cortisone injection malpractice if it causes a plantar fascia rupture in a runner? Well, that’s what we’re talking about today on the Doc on the Run podcast.
I got a call from a runner who has a really interesting situation.
He’s been doing lots of running, but he’s been getting pain in his ankle whenever he runs.
He gets a little bit of swelling in the ankle at the end of the day.
But when he wakes up, the swelling in the ankle is completely gone.
The ankle swelling is completely resolved and he seems fine the next morning.
So his question was, “Can I run with arthritis in my ankle?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This is a great question I got from a runner during a recent telemedicine visit and this was a runner who actually called me for a second opinion because she had a tear in the plantar fascia.
She felt like it was healing, and she wanted to get back to running. She was really hoping to get some kind of real positive affirmation or confirmation that she was okay to run and wanted to know whether or not she should get a repeat of the MRI that she had previously that actually discovered she had a partial tear in the plantar fascia and not just plantar fasciitis.
Now, this is a great question and it’s a completely reasonable one. In fact, I just discussed this with doctors last week at the International Foot and Ankle Foundation meeting, where I was actually lecturing on runner’s heel pain.
Should I get an MRI of my healing plantar fascia tear before I start running? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just doing a call with a runner who started running before his fracture was healed on the x-ray.
In fact his regular doctor said he couldn’t run on it until the x-rays showed healing.
I let him start running on it, in a very structured way.
Now he is back to full running.
If the bone is always getting stronger while it is healing, do you really need to wait until the x-ray finally proves it has fully healed?
Today on the Doc On The Run Podcast, we’re talking about whether or not you can run if you fracture is not yet healed on x-ray.
This episode actually comes from a question I got during the live question and answer period at the end of a talk I was giving at the International Foot and Ankle Foundation meeting in Hawaii.
The question was about one of the conditions that can often be misdiagnosed as plantar fasciitis, and that’s a condition called medial calcaneal neuritis.
With this condition a nerve on the inside of the heel becomes inflamed and painful.
In short, the patient had alcohol injection under ultrasound guidance by another doctor, but the condition dod not get any better.
The question from the doctor in the audience was basically asking me what my opinion about that procedure using ultrasound.
Today on the Doc On The Run Podcast, we’re talking about heel neuritis in a situation where a doctor did an alcohol injection with ultrasound and another doctor wanted to know if that was a scam.
A doctor at a medical conference asked me a great question!
I was giving a lecture at the International Foot and Ankle Foundation meeting in Hawaii on runners heel pain, specifically about the differential diagnosis or the things that can cause runners heel pain.
In that talk I was also teaching about the differences in treatments between runners like us, and non-runner patients with heel pain.
At the end of that lecture a doctor wanted to know which kind of imaging study was better for a runner with a suspected small tear in the plantar fascia ligament.
Today on the Doc on the Run Podcast, we’re talking about MRI vs Ultrasound. Which is better for Plantar Fasciosis or Partial Rupture in a runner?
Today I got a question from a doctor who wanted to know what I would do with a runner after surgery to remove non-healing sesamoid fractures in both feet.
You have two sesamoid bones under the big toe joint in each foot. When one of them develops a stress fracture, it can break.
If it breaks into two pieces, it can be difficult to get the broken sesamoid to heal completely.
If it doesn’t heal, becomes arthritic and turns into what we as doctors call a “sesamoid fracture non-union” your doctor may recommend surgery to take it out.
Today on the Doc on the Run Podcast, we’re talking about what to think about when a doctor is trying to rehabilitate a runner after tibial sesamoid non-union removal surgery in both feet.
I was just giving a talk at the International Foot and Ankle Foundation’s 40th Annual Hawaii Seminar.
And at the end of the session, we got a couple of questions from the audience during the live Q&A for the doctors.
A doctor in the audience she had a runner who is one of her patients.
This runner had been basically running on a mild stress fracture, which I would really consider a stress reaction, for a period of about two months but wanted to do a race.
Today on the Doc on the Run Podcast, we’re talking about what a doctor should do when she is helping a runner with a stress fracture who has been running on it for 2 months and still wants to run a race.
IThis episode comes from a question from a runner I saw in person during a second opinion house call.
She had a metatarsal stress fracture and felt like it was more comfortable when she was barefoot.
The more you can reduce the stress and strain to the injured metatarsal bone and the healing stress fracture the faster it will heal.
The types of shoes you wear during the recovery can change those stresses for better or worse depending upon which shoes you are wearing.
You need to focus on protecting and healing that metatarsal stress fracture if you want to get back to running as fast as possible.
Today on the Doc on the Run Podcast, we’re talking about whether or not it is better to go barefoot with a stress fracture.
If you want to get back to running faster after a foot fracture (or any overtraining injury), the whole key is make sure that you are increasing your activity to get stronger, instead of just sitting around and waiting, while you get weaker.
But the only way you can do that is with constant readjustment based on how you feel and what happens in response to that activity during that recovery process.
This episode is about runner with a healing fracture who was told by a doctor, “don’t run.” Instead he was supposed to wait for another x-ray to prove it was healed.
And after I did a consultation call with him, I actually cleared him to start running now.
Today on the Doc on the Run Podcast, we’re talking about a recovering runner with a fracture who wants to ramp up his intensity today.
A podcast listeners wrote in and she asked,
“How long do I need to stop running or take it easy after taking five doses, meaning two and a half days, of Cipro?
I told my doctor I was a runner, so I didn’t trust their opinion on when or how I should run.
I haven’t run since finding out the side effects two weeks ago, and the Achilles feels weak and a little thicker than the other side.”
This is a great question, and she is right to be concerned because the FDA issued a black box warning because of an association between Cirpo antibiotics and Achilles tendon ruptures.
Today on the Doc on the Run podcast, we’re talking about a runner with Achilles tendon worries after taking Cipro antibiotics.
A little over a couple of weeks ago, I was working on my motorcycle, and I accidentally cut myself open.
Long story short…I let a middle school kid put the stitches in the wound.
In this episode we talk about how that turned out.
We also talk about how that story applies to running injury recovery.
Which is more important when you have surgery to heal a running injury?
Is the actual procedure done by the surgeon the most important?
Or is the process of injury recovery after the surgery more important?
Today on the Doc On The Run podcast we’re talking about procedure vs process in healing faster.
A new runner was having some aching in pain in the shins and he asked,
“I just started running. I started having shin splints. Some people told me I have to stop. Some people, say I don’t. What do I have to do?”
Obviously, if you started running, you’re starting to develop some fitness and you’re finally getting to the place where you can run consistently, the last thing you want to do is give up your running routine.
The good news is that in some cases you don’t have to stop running just because you have aching pain in your shins. You just have two figure out whether or not it is really a big problem or something that can improve with minor changes in your running routine.
Do I have to stop running to cure shin splints? That’s what we’re talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation over webcam with a runner who had an overtraining injury.
She was really worried that she could to lose all of her fitness while waiting to heal.
It is just not okay for a runner to sit and wait for weeks, or months, to heal an injury.
If you don’t exercise at all, you will lose your base of aerobic fitness, the neuromuscular connections that keep you coordinated and help you maintain good running form.
You start to lose it all at a very fast rate compared to how long it takes to build that running fitness.
Today on the Doc On The Run Podcast, we’re talking about how healing running injuries is a race a against time.
I just did a second opinion consultation with a runner who called and said she was diagnosed with a grade five stress fracture.
The doctor didn’t actually explain what that meant. He just said it was serious.
Stress fracture severity is rated grade 1 through a grade 5. Grade five is obviously the worst to runner.
She wanted to know if she needed a bone stimulator since her stress fracture was serious.
That’s what we’re talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation with a runner who was really stressed out.
She said, “I’m going to lose all my aerobic fitness. I’m going to get weaker. I’m going to get stiff or my running form is going to be terrible!”
There are some mental tricks you can use that will be very helpful anytime you get an over-training injury, whether it’s a stress fracture, Achilles tendonitis, or any injury.
If a doctor tells you, you have to rest and sit still, that can be stressful. But all runners have the tools to navigate it, whether you have ever been injured or not.
Today on the Doc On The Run Podcast, we’re talking about how you should think of your over-training injury recovery, as an extended rest day.
The fifth metatarsal bone goes from your midfoot out to your little toe. And if you break it, it could be one of three things.
You could have a shaft fracture, which heals pretty uneventfully, most of the time.
You could have an evulsion fracture, where it actually rips a piece of bone off when your peroneus brevis tendon tries to pull so hard to keep your foot under you, that it actually cracks the bone.
Or you could get this thing called a Jones fracture. Now, if you have a Jones fracture, that is a bad thing. Out of those three, it is definitely the worst.
But sometimes a doctor will say you have something called a pseudo-Jones fracture, which implies it’s kind of like a Jones fracture, but not really as bad.
What is a pseudo-Jones fracture? Well, that’s what we’re talking about, today, on the Doc On The Run podcast.
This episode actually comes from a YouTube comment. This runner saw an image from when I was running a 50 mile trail race wearing Hoka trail running shoes.
He said, “I would never take advice from a coach, a biomechanics expert, or a running injury expert who was wearing Hokas.”
Would you take your running coach seriously if he was wearing clown shoes?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode actually comes from a podcast listener who had a question:
“I got an MRI just to give me the green light to resume training and it showed a grade three stress reaction of the left tibia. Do you think I can run?”
Deciding whether or not you can run with a stress fracture really depends on understanding how bad it was when it started, and how bad it is right now.
How bad is a grade three stress fracture? Well, that’s what we’re talking about today on the Doc on the Run podcast.
Today’s episode comes from a podcast listener with a stress fracture and wants to get back to running.
Jennifer says, “I went to see my doctor again today for my MRI results.
He told me that I still have a stress fracture.
I was a bit confused, because after 10 weeks without running I thought there would have been more signs of healing.
So I asked if he could see a fracture line and he said, ‘Yes and that I should stop running immediately!’
(I guess my doctor forgot that I had stopped a long time ago).
I want to get back to running and I don’t believe my doctor is truly getting me there. Prior to this appointment, I was feeling confident that I could continue with my walk/jog routine as long as there was no pain.
However, now I am feeling scared because he could still see the fracture.”
In short, it sounds like Jennifer is saying, “I don’t trust my doctor.”
Well, that’s what we’re talking about today on the Doc On The Run podcast.
I had a really great question from a patient on a second opinion webcam visit.
“I have a partially torn plantar fascia. Can I keep running and let it heal later?”
He had purchased The Runner’s Heel Pain course and based on his self-diagnosis, he concluded that he definitely did not just have plantar fasciitis. It was more likely plantar fasciosis with a small tear in the plantar fascia.
Unfortunately, the treatment that we would normally do and normally recommend for somebody with a partial tear in the plantar fascia, well, he just cannot do right now. He does not have time to actually take off of his activity and stop running completely right now.
Today on the Doc On the Run podcast, we’re talking about Torn Plantar Fascia: If I run can it heal it later?
It’s no secret..I like to talk about running injuries!
But after so many years working with injured runners, helping runenrs race after they get an injury, and showing them how to maintain their running fitness while injured: I have uncovered a couple of “secrets” that really help injured runners most.
If you have a running injury and you’re trying to figure out what to do, if you’re confused why the doctors are just telling you to sit around and wait, this episode may help you understand it.
Today on the Doc on the Run podcast, we’re talking about the top three running injury recovery secrets.
Extensor tenosynovitis is one of the running injuries doctors don’t often talk about simply because it’s a relatively rare condition.
But extensor tenosynovitis can be really painful when running.
Sometimes it’s actually misdiagnosed as a stress fracture, both by doctors or by the runners themselves.
Any misdiagnosis can force you to take time off of running unnecessarily.
Today on the Doc On The Run Podcast, we’re talking about three foot types that are prone to extensor tenosynovitis.
Just this weekend, I got a call from somebody who said that she was out on a run, she felt a pop in the back of her heel, she went to the emergency room and she was told that she has a partial tear in her Achilles tendon.
I’m not really sure if they did x-rays or an MRI or an ultrasound or anything to confirm that, but the doctor seemed very confident that she had torn her Achilles tendon.
And so, she said that all they did really was they gave her some crutches and they told her to see a specialist, which is why she called me.
She asked me “I just found out that I tore my Achilles tendon. The emergency room physician gave me crutches. What should I do?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every day I talk to injured runners who ask me to help them recover faster so they can run sooner. Some runners call me for a one-time, one-hour consultation. Some runners call me and hire me to literally coach them day-by-day for a full month.
Others who don’t want to spend that kind of money, simply join a coaching group where they can get advice for an entire month and join group web-cam sessions every Monday Wednesday and Friday for 4 weeks in a row.
In those sessions recovering runners get to pick my brain to see what they might be able to do to recovery faster and get back on course sooner.
Today on the Doc On The Run podcast, we’re talking about why some runners should never pay for advice.
Today’s episode actually comes from a question that is a real-world situation.
Should I take Lovenox after an ankle fracture? I broke my ankle. The doctor gave me a prescription. Should I take this thing or not? Is this appropriate for me?
This is actually a great question and it points out a couple of things I think are worth hearing.
Today on the Doc On The Run podcast, we’re talking about whether or not you should take Lovenox after an ankle fracture.
Most of the runners who call me when they are inured have hired a running coach. Some of them don’t realize they have a running coach.
A coach is someone who one who instructs players in the fundamentals of a sport and directs strategy.
When you sign up for online coaching, and get a marathon training plan, you hired a coach.
When you go to the doctor and ask for help with a stress fracture you hired a coach.
Both of them are supposed to be helping you (in different ways) get to the finish line.
Today on the Don On The Run podcast, we’re talking about how to pick your running coach wisely.
A body at rest remains at rest.
Now that is a law of physics. That’s not something I came up with, but it definitely applies to running injuries.
This is what I see happen over and over and over. Somebody gets a stress fracture, they go to the doctor, the doctor takes an X-ray, they don’t see a crack. They don’t see anything on the X-ray. And they say, “Well, I don’t see anything, but you have a stress fracture.” Here’s a boot, wear it for four weeks, we’ll see you in a month. Come back and we’ll do another x-ray.
You leave there thinking, “Wait a minute, you didn’t see a crack. You didn’t see anything. In fact, I’m not even so sure that you know it’s a stress fracture, because you said there was no crack on the X-ray yet you gave me a boot and you told me to sit around for a month and then do another X-ray. Like, what does that mean?”
Today on the Doc On The Run podcast, we’re talking about running injury truth number five, a body at rest tends to remain at rest.
If you want to get back to running as quickly as possible you need 3 essential ingredients:
Recovery, Strength and Balance
When something is weaker because it is still recovering, this approach is all the more important.
NEWSFLASH: you can work on recovery, building strength, and better balance at any stage of injury.
Get moving now!
Today on the Doc On The Run podcast, we’re talking about the 3 Ingredients required for rapid recovery from running injury.
The action you and ONLY YOU take are all that matters now.
I can show you the way, but I can’t carry you there.
It takes work. Lots of work. It’s like training for a marathon, without cheering crowds or medals.
The speed with which you return to running ONLY depends on how much effort you put into your recovery.
Today on the Doc On The Run podcast, we’re talking about how no one can save you.
There is NO over-training. There is ONLY under-recovering. You did not run too much. You made a mistake in the order of your workouts or the intensity of one workout or in the strategy you used to rebuild tissue.
That is EXACTLY the same mistake runners make when they get injured again after “healing” an injury.
Today on the Doc On The Run podcast, we’re taking about running injuries can happen to everyone.
The premise is that your crazy physical activity is the problem.
The promise is that you will heal if you simply sit still.. long enough.
The hope is that recovery will magically take place through sacrifice like a perverse form of penance for your exercise sins…crazy.
But a prescription of 100% Rest only guarantees 100% loss of fitness.
Today on the Doc On The Run podcast we’re talking about the advice to rest is a lie.
If you’re a runner with a running injury, you need to listen up.
The biggest problem with running injuries is not that you have a broken bone, not that you have a sprained ankle, and not that you have Achilles tendinitis.
The biggest problem is that you’re going to lose your running fitness while you recover from that injury, if you’re not really proactive.
Today on the Doc On The Run Podcast, we’re talking about muscle atrophy, and whether or not it’s reversible.
I was recently doing a presentation about how runners go wrong.
They know all of this stuff about training, running biomechanics, running form and nutrition. And that’s not enough.
Runners still get injured and have to call me…even after they’ve seen other doctors.
Today, on the Doc On The Run Podcast, we’re talking about the number one cause of confusion in injured runners.
This episode comes from Amanda who wanted to know how to tell the difference between contact dermatitis and athlete’s foot.
It’s summertime, she’s been running, her feet sweat a lot, and she noticed a bunch of peeling skin on her feet.
She assumed it might be athlete’s foot, but one of her friends said it might be dermatitis.
This is a great question!
How can a runner tell athlete’s foot from contact dermatitis?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
This episode actually comes from a visit with a runner where I was asked to check her foot.
This runner happens to also be a physician.
She assumed that she was having plantar fasciitis because she had some pain in her heel when she was running, and after her run, she would have a little bit of pain when she was just walking around.
Because she was having this occasional weird twinge of heel pain, she asked me to see what I could figure out.
Today on the Doc On The Run Podcast, we’re talking about how you really need to check your shoes whenever you have pain from running.
I know blisters are not really an exciting topic. You probably want to hear something that’s going to make you stronger and faster and finish your marathon better.
But I can tell you one thing for sure, if you’re running a marathon and you get a blister, it is going to wreck your performance. You cannot perform at your best if you’re thinking about some little stinging aching pain that you’re getting because of a blister, and it really can make a real dent in your training too.
Today on the Doc On The Run Podcast, we’re talking about the causes of blisters in runners.
I just spoke with a runner during a telemedicine visit who has been having some pain that is flaring up in a couple of different workouts.
He’s now a little worried that he’s going to wind up with something that sidelines him.
He remembered that he was told he had some kind of “limb length discrepancy.”
Today on the Doc On The Run Podcast, we’re talking about limb length discrepancy compensation in runners.
Today’s episode comes from a recent group coaching call for recovering runners. All of the runners on these calls have been injured and they’re getting back to running, and today’s call will help you understand several things.
Even if you don’t have cuboid pain, even if you didn’t have flatfoot surgery, this will help you think about your pain differently and help you look for opportunities to maintain your running-specific strength as you continue to recover from your overtraining injury.
Today on the Doc On The Run Podcast, we’re talking about cuboid pain with running after flatfoot surgery.
I had a recent group coaching call for recovering runners, and the main point of this episode is that you’ve got to do more frequent follow-up. Even if you manage that follow-up recovery process on your own, it needs to be frequent.
This particular runner was someone who was having an improvement in her injury. She was actually running, but she still had some foot pain when running and she had one of the best and most common questions I get:
“Should I just keep running and see what happens?”
Well, if you’re in that spot, you don’t want to miss this episode.
Today on the Doc On The Run Podcast, we’re talking about whether or not you can just keep running and see if the foot pain gets better.
This episode comes from a live group coaching call where recovering runners get to ask me anything they want.
Today on the doc on the run podcast we’re talking about whether or not you can get a stress response in your good foot when you’re wearing a fracture walking boot on your bad foot to treat a stress fracture.
Today’s episode comes from a live Q&A. We hold these sessions for runners enrolled in the self-diagnosis courses, and those in group coaching sessions, who just want to make sure that they’re staying on track and getting back to running as quickly as possible.
We were talking about why injured runners should ask better questions.
Today on the Doc On The Run podcast, we’re talking about how to ask better questions at the doctor, for an over-training injury.
This episode actually comes from a recent live Q&A I did with recovering injured runners and during these calls you can come on and you can ask me anything that you want about your specific situation.
This was a really great question that came from one of the runners on the call and he was concerned about this discomfort he was getting in his foot a full year after he had a metatarsal stress fracture.
Today on the Doc On The Run Podcast, we’re talking about what can cause aching pain in the top of the foot a year after a metatarsal stress fracture?
I recently did an episode where I was talking about the causes of black toenails in runners after long runs, and I got a lot of comments and questions about, “Well, what should I do?”
We did talk about a couple of different things during that episode, where I was telling you how to check and make sure that you have sufficient space at the end of the shoes, that your running shoes aren’t just too small or how to make sure that if you do have a lot of room in the shoes or if it seems like they’re big enough.
But if those two things are not your issue, then it’s more likely that when you’re swinging your foot through, during what we call the swing phase of gait.
Today on the Doc On The Run podcast, we’re talking about the top three tips to avoid getting black toenails from your long runs.
I just had a discussion with a runner during a telemedicine second opinion.
She rolled her ankle and went to the emergency room. They gave her a brace to stabilize the ankle and an ACE wrap to compress it.
She started some rehab exercises, and frankly she improved a lot.
But when she got back to running, she had intermittent pain in the back of her ankle.
This was not the same spot where she got the sprain.
She called because this pain has now been going on for a long time, and when she got an x-ray someone told her she might have a posterior process fracture of the talus.
She asked me, “What exactly is a posterior process fracture?”
Today on the Doc On The Run Podcast we’re talking about posterior process fractures of the talus.
Today’s episode comes from a discussion during a recent television fitness segment interview where I was actually asked about black toenails in runners.
If you’ve been running for a long time, undoubtedly you’ve had this happen at least once. I’ve had it happen multiple times.
I realized, after many years of racing, that if I did any run longer than about 20 miles, and I didn’t do some specific things to really provide care for my nails and protect them, I would wind up with one of my second toenails bruised, discolored and painful.
Today on the Doc On The Run podcast we’re talking about the top three reasons runners get black toenails after long runs and races.
This was a great question from a runner enrolled in the metatarsal stress fracture course. She wanted to know whether or not a bone stimulator would really be helpful.
Can a bone stimulator help a stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
I was just on a telemedicine call with a recovering runner. He asked me about different forms of training that he could do to maintain his running fitness, while he fully healed the injury.
He asked a question I get all the time, “Is cycling really helpful or not?”
Well, the short answer is yes, it is very helpful for several reasons.
Today on the Doc On The Run podcast, we’re talking about whether or not cycling will help maintain your running fitness while you’re injured and recovering.
This episode actually comes from one of the live Q&As I did with course members who are actually enrolled in courses like the Plantar Plate Sprain Course for Runners or the Metatarsal Stress Fracture Course.
“One of my friends said that I could get an injection to help my planter plates sprain heal faster. What is that injection?”
Today on the Doc on the Run podcast, we’re talking about what kind of injections might help a plantar plate injury.
This is a question sent in by a listener to the Doc On The Run Podcast and this is someone who’s had a stress fracture, and it’s now turned into what the doctor called a delayed union.
She said, “My doctor has told me that my stress fracture is now a delayed union”.
What does that really mean? What is a non-union? What’s a delayed union?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
The anti-inflammatory medications you can get over the counter at the pharmacy do a great job at decreasing musculoskeletal healing, but there is a little bit of a problem.
There’s some research that actually shows that some anti-inflammatories, particularly non-steroidal anti-inflammatories, may slow down healing of tendon to bone junctions.
Today on the Doc On The Run podcast, we’re talking about should I take ibuprofen when I have a plantar plate injury?
I was just having a discussion with a runner about the things that she could do to accelerate her running injury recovery.
She has been yo-yoing through a cycle or workouts and short runs when she feels good, then does a little bit too much.
That’s when she gets re-injured.
She is aggravating the injury over and over. The real problem isn’t her injury. She’s just pushing her recovery too fast.
Today on the Doc On The Run Podcast, we’re talking about how you have to slow down if you want to speed up.
A runner just asked a great question about when runners should get a plantar fasciitis injection so she can run.
If you’ve signed up for the Runner’s Heel Pain Course, or you’ve listened to the podcasts on Runner’s Heel Pain about plantar fasciitis in runners, you’ve probably heard me say that I don’t inject most runners with cortisone when they have plantar fasciitis.
The way I break it down is that it depends on one of three different scenarios.
“Should I get a plantar fascia injection so I can run?”
That’s what we’re talking about today on the Doc On The Run Podcast.
If you get injured, you’re going to need help.
If you want to maintain your running fitness and get back to running as quickly as possible, sometimes you’ve got to talk to an expert.
I’m an expert on running entries. I do telemedicine visits, but telemedicine does not work for everything or everybody.
You don’t have to talk to me. You can find somebody else.
There are several ways to figure out whether or not your local expert might be able to help.
Today on the Doc On The Run Podcast, we’re talking about three tips for finding a local expert on running injuries.
I just did a telemedicine second opinion consultation with a runner over webcam who was worried about fat pad atrophy causing heel pain.
Fat pad atrophy in itself does not cause pain. But the plantar calcaneal fat pad that cushions your skin under the heel bone really does prevent the skin from getting squished. So, yes, you can definitely get pain if your fat pad gets atrophied.
Does calcaneal fat pad atrophy cause pain when running?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This is a great question from one of the people I was just working with on a telemedicine visit.
Does running really make me nicer?
She actually said, “It’s been really tough being injured, because it seems like when I can’t run, I’m not nearly as nice as I usually am.”
Well, if you’re anything like me, it probably does and that’s what we’re talking about today on the Doc On The Run podcast.
This is a great question from one of the YouTube viewers.
Can I do calf raises with hallux rigidus?
He wanted to know whether or not calf raises might cause more damage to the big toe joint. He wants to make sure that condition does not get worse.
This runner wanted to know whether or not it was safe.
And that’s what we’re talking about today on the Doc On The Run Podcast.
This morning I was interviewed as a guest expert on a television program for a health and fitness segment. We were talking about how running shoes are really your only piece of injury protection equipment as a runner.
The only thing between you and the ground is your running shoe. When you are training in them just a little bit too long, they start to get worn out.
Today on the Doc On The Run Podcast, we’re talking about the best three ways to tell when to replace your running shoes.
This episode comes from a question on the Doc On The Run YouTube channel.
“Can I do leg presses with a plantar plate sprain?”
Maintaining your running fitness is critical when you get an injury that takes a long time to heal…like a plantar plate sprain.
The 2 keys are consistently decreasing the pressure and tension to the plantar plate.
Today on the Doc On The Run podcast, we’re talking about whether or not you should do leg presses with a plantar plate sprain.
This episode comes from a podcast listener who is training for the High Lonesome 100 mile race.
Kate wrote in to ask:
I rolled my foot at my child’s field day. I heard a crunch and immediately saw swelling and discoloration on the lateral midfoot area of my left foot. An x-ray was negative. A week later there is no change. I have not run but it is not healing. Could it be broken?
That’s a great question and that’s what we are talking about today on the Doc On The Run Podcast!
I was speaking with a runner who had an over-training injury and she wanted a second opinion. And the reason she called was that she went to see a doctor and the doctor recommended a specific treatment for her.
So she went home and she started doing some online research, and she started thinking that maybe this treatment might actually be bad for her as a runner.
Everything in medicine is about risk versus benefit.
We take every treatment that we offer to a patient that we recommend to someone who has an injury or an illness and we have to decide, is this treatment actually going to make the person better as a whole, or could potentially make them worse?
Today on the Doc on the Run podcast, we’re talking about whether or not this treatment is bad for runners.
This episode comes from a house call I just did with a runner who actually has some heel pain. It wasn’t plantar fasciitis.
Haglund’s is a problem where you get inflammation and irritation at the back of the heel. There is a little bursa in between the Achilles tendon, where it attaches on the back of the heel, and that little part of the heel bone that can protrude on the back.
He had a really great question.
If I have bursitis of the heel, should I do aggressive Achilles tendon stretches with wedges for my Haglund’s deformity?
That’s what we’re talking about on the Doc On The Run podcast.
I was just doing a telemedicine visit for a second opinion with a runner who’s had a longstanding plantar plate sprain. These can be very frustrating injuries because if you don’t treat them appropriately or you ramp up your activity too early, well, it can recur and they can go on for a really long time.
It had been a long time since he’s running, he needed a second opinion, he wanted to know whether or not the PRP injection, or a stem cell injection, or dry needling, or some other procedure might actually help him.
I’ve had one myself I was very cautious about reducing the stress and strain to the plantar plate ligament while I continued to maintain my running fitness as I recovered from that injury.
Today on the Doc On The Run Podcast, we’re talking about whether or not you might need crutches after a PRP injection for a plantar plate injury.
What does Goldilocks and the Three Bears have to do with running shoes?
This morning I was doing an interview for a television program explaining some basics about running shoe selection based on your foot type.
There are really three things you need to think about.
It’s a lot like Goldilocks and the Three Bears. You don’t want it to be too hard. You don’t want it to be too soft. You want it to be just right for you, and that depends upon your foot type.
Well, you’re going to find out because today we’re talking about running shoe selection basics and your foot type on the Doc on the Run podcast.
When you’re recovering from a running injury, the most important thing you can track is your pain.
Changes in pain level is what tells you whether or not you should move from one activity level to the next.
Although many doctors will ask you in your initial interview, “What is your pain on a scale of one to 10? How much does it hurt?” They very rarely ask you many more specifics about that pain.
Today on the Doc On the Run Podcast, we’re talking about pain point measurements that are crucial for recovering runners.
How is it that a runner can actually have a stress fracture that was never even broken in the first place?
Well, this is a real-world situation that I had with a runner who called me for a second opinion.
It was a runner who thought he had a stress fracture, who even had an MRI that showed a stress fracture. The doctor said it was a stress fracture. But it wasn’t actually a stress fracture at all.
Today, on the Doc On The Run podcast, we’re talking about a runner with a stress fracture that was never broken.
The number one question I get on social media from runners, whether it’s a direct message or an email, or even a comment on a YouTube video is:
“My doctor said I can’t run. Is it okay for me to run my race this weekend?”
And I’ll always scratch my head a little bit and wonder, “Does this person really think it makes sense to ask a complete stranger, who has absolutely no idea about what’s going on with them, whether or not it’s okay for them to run, particularly when their doctor told them to not run?”
Today on the Doc on the Run Podcast, we’re talking about why I don’t tell runners whether or not they can run over social media.
This episode comes from a discussion I had at a medical conference last week, which was the International Foot and Ankle Foundation meeting in Sonoma, California.
I was asked to give a couple of different lectures on running injuries. One of them specifically was about runner’s heel pain and the differences that I see in those who are actually just normal everyday patients, and those that are runners with heel pain.
Today on the Doc On The Run Podcast, we’re talking about the top five differences between normal patients with heel pain and runners.
No runner wants pain.
However, when injured and trying to recover, pain is actually one of the most useful tools at your disposal.
I often tell injured runners and doctors at medical conferences something you should think about:
Pain is the most abundant and most underutilized evaluation tool available to runners when they’re trying to get back to running.
Today on the Doc On The Run Podcast, we’re talking about how pain is the most underutilized tool for recovering runners.
This episode comes from a lecture I was giving at a medical conference just last week.
One of the lectures was on the differences between stress response, stress reaction, and stress fractures in athletes.
There are really just a few main points doctors need to understand when treating runners with stress fractures.
Today on the Doc On The Run Podcast, we’re talking about the top three stress fracture takeaways from the International Foot and Ankle Foundation meeting in Sonoma, California.
There is no hope on a downward slope.
I know that sounds really negative and terrible, but it’s true.
A recovering runner recently called for a called me for a second opinion telemedicine visit. Her doctor had told her to wait…to wait to get better. In fact, she waited for 12 weeks and she did exactly what she was told: nothing. She did no exercise for 12 weeks.
If you just think about the last time you were really fit, and if you just stopped exercising completely, right then for three months, how fit would you be at the end of that 12 weeks?
Today on the Doc On The Run Podcast, we’re talking about how there is no hope on a downward slope.
In the last week alone I had telemedicine calls with two different runners with different types of stress fractures who asked what it means when they have no pain, but an MRI that “shows a stress fracture, but no crack in the bone.”
It gets really confusing when it comes to classifying stress fractures based only on medical imaging like x-rays or MRI.
If you wonder…
Can I run if my MRI shows a stress fracture, but I don’t have any pain?
That’s what we’re going to talk about today on the Doc On The Run podcast.
This episode comes from a discussion I had recently with a recovering runner during a telemedicine visit. She was asking me what to do.
She is stuck in a cycle of getting frustrated, she gets better, and then gets injured again when she actually gets back to running.
She seems to have a tendency to get re-injured, with different injuries.
To recover from injury, you have to make sure you don’t rot while you wait.
Today on the Doc on the Run Podcast, we’re talking about how to make sure you recover and don’t rot when you have a running injury.
I got a call from a runner who asked me about staying fit while training with a femoral neck stress fracture. What is interesting to me is that this person has seen a qualified sports medicine orthopedist who told her that she should not train or should not run with this femoral neck stress fracture.
I’m a podiatrist, I treat foot and ankle problems specifically in runners, but I do not treat femoral neck stress fractures. However, I can tell you what I would do if I had a femoral neck stress fracture.
How can I train with a femoral neck stress fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Recently I was interviewed on a television program about telemedicine, who it helps and who it doesn’t help. I do a lot of telemedicine visits with athletes.
Meeting with a doctor via telemedicine can be very helpful because you can get quick access. You can get immediate answers from an expert.
There are three kinds of runners for whom telemedicine is actually incredibly helpful.
Today on the Doc On The Run Podcast, we’re talking about the three types of runners who get the most from telemedicine visits.
This episode comes from a question sent in by a runner who was listening to the Doc On The Run podcast.
This is a runner who had an Achilles tendon issue and was recovering and getting back to running.
He has recovered enough that he is back to running, he’s doing better, he’s running without any pain, but he wanted to incorporate some strength training in the form of either hill repeats or running stairs.
He wanted to know…
Which is worse for my Achilles tendon, running hills or running stairs?
Today on the Doc On The Run podcast, we’re talking about which is worse for your Achilles tendon, running hills or running stairs.
I was just doing a telemedicine consult with a runner for a second opinion. He has so much pain in his foot he actually can’t even walk on the foot, much less run on it.
One of the questions I asked him was whether or not he was doing single leg squats to try to maintain some of the strength in his non-injured foot.
He actually said he wasn’t doing any single leg strengthening because he didn’t want to get “wonky.”
Today on the Doc On The Run Podcast, we’re talking about why wonky is better than weak in a recovering runner.
A bunion deformity is a really common problem.
When a runner develops a bunion, the big toe moves over and starts pushing against the second toe. Over time that can get bad enough that the big toe actually sits on top or underneath the second toe.
Many runners get a bump of any kind around the base of the big toe and mistakenly think they have a bunion. That’s exactly what happened with this runner when I did his second opinion consultation.
Today on the Doc On The Run podcast, we’re talking about a runner who said that he thought he had a bunion, but his big toe was straight.
I just did a telemedicine call with a runner who had a very interesting complaint.
Many runners with heel pain have plantar fasciitis, but this was one of those cases where somebody had heel pain that was not plantar fasciitis, and was definitely something else.
He said he was at a standing desk conducting Zoom meetings all day long.
In this case, the runner’s heel pain came from simply standing at a desk all day during webcam calls.
Today on the Doc On The Run Podcast, we’re talking about aching pain in the heels from standing at a desk during the pandemic.
I was doing a telemedicine, second opinion consultation with an elite triathlete who got a stress fracture.
This is actually a very common sort of discussion that I have with runners who schedule telemedicine visits, who call me for coaching calls and second opinion advice.
This guy has been athletic his entire life and he was ramping up for an event and then he got a metatarsal stress fracture and you would think that it’s pretty simple.
In this particular case, the doctor looked at his x-rays and told him that she thought she saw a crack in the x-ray and so she thought there was a crack in the bone but she wasn’t really a hundred percent sure. Now he asked me a really great question.
He said, “Well, if it doesn’t really hurt that much, is it okay if I walk on it?”
Today on Doc On The Run Podcast, we’re talking about if your hand was broken, would you walk on it?
A question came up during a recent telemedicine visit I was doing with a runner who has hallux rigidus.
He wanted to know whether or not it was a good idea or a bad idea to inject the big toe joint with cortisone to treat his hallux rigidus.
Now, there is nothing free in medicine. For every good thing, there’s a bad thing. For every risk, there is a benefit. And everything in medicine, the doctor is basically looking at your circumstances, trying to figure out what you really want short-term and long-term, and then figuring out whether or not that treatment is actually appropriate and really best for you given your circumstances, given your condition, and your goals.
There is nothing that is risk-free in medicine. So when you have a cortisone injection in the big toe joint for hallux rigidus, what’s happening is you’re doing the corticosteroid injection to reduce the inflammation. It’s very effective at that. Corticosteroids, however, are also very effective at breaking up collagen bonds.
Today on the Doc On The Run podcast, we’re talking about whether or not cortisone injections are good or bad for hallux rigidus.
This episode comes from a question sent in by one of the Doc On The Run Podcast listeners, and she wanted to know whether or not it was okay to jump rope if she has shin splints?
Well, the short answer is, is you can do whatever you want. You just have to be willing to pay the consequences and you can have a couple of different consequences from jumping rope with shin splints.
But if you’re sure that you just have shin splints, if you’ve done a telemedicine consultation with an expert on running injuries, or if you’ve seen your doctor and your doctor poked around on you and was sure that you really and truly only have shin splints, then in that case, it is probably safe for you to do it and just see what happens.
Today on the Doc On The Run Podcast, we’re talking about whether or not it’s okay to jump rope with shin splints.
I was just doing a telemedicine call with a runner with a long history of plantar fasciitis, that has not been getting better. She had been doing stretches, icing, and even an injection of corticosteroids around the plantar fascia.
We were doing a second opinion telemedicine call to talk about what’s really going on. We talked about her whole history. She had been keeping track and has kept a pain journal.
During this one hour second opinion call, we figured out that she had been misdiagnosed.
We figured out she actually had bursitis on the bottom of the heel.
Today on the Doc On The Run podcast, we’re talking about plantar heel bursitis, misdiagnosed as plantar fasciitis.
Just this morning I was interviewed on a television program about telemedicine. Since I have been doing telemedicine for a little more than 10 years they invited me to come on as an expert to talk about the changes in telemedicine resulting from the pandemic.
During the interview, we were discussing all the different ways telemedicine can be more helpful than in-office visits. At the end, I was asked an interesting question, and I remembered that I actually created a check-list years ago for runners to actually take to their in-person doctor visits. That same list can help make telemedicine visits more helpful as well.
Today on the Doc On The Run podcast, we’re talking about why you need to make a list for your telemedicine visit.
This episode comes from a discussion I just had with a runner during a telemedicine visit where I was helping her figure out a second opinion and what to do about her hallux rigidus. So she was very confused because she’s been diagnosed with hallux rigidus.
She’s been told that that’s what’s causing the pain in her big toe joint when she runs and she was a little confused because she said the doctor explained to her that she might want to get some kind of plate to put in her shoe to make it stiffer.
But at the same time said that she has high arches and because she has high arches and what we call a neutral foot type that have in part, led to her hallux rigidus, that she needs to have more cushioning in her running shoes.
Today on The Doc on the Run Podcast we’re talking about running shoes for hallux rigidus. Should they be hard or soft?
This episode comes from a discussion I just had with a runner during a telemedicine visit. This person brought up a great idea that really seemed like it would make a great episode and something that would be really helpful for you to understand.
When you get injured, your goal is to actually recover as fast as possible and maintain your running fitness while you heal that specific injury.
Now, everybody wants some timeline, like two weeks, four weeks, six weeks, something that says this is how long I have to wait for it to be healed and me to get back to running safely. But it never works out that way consistently. What you have to do is you have to figure out how you can push your timeline and how you can actually speed things up.
Today, on the Doc on the Run podcast we’re talking about how you need to find your line if you want to recover from running injury faster.
On this episode, we’re just giving you a quick tip on how you can actually reduce some of the stress and strain on the plantar fascial ligament when you have plantar fasciitis and you want to keep running.
If you stop running you’re going to lose your running fitness. That’s not really confusing.
But what you really need to understand is that plantar fasciitis is not really self-limiting.
It does not miraculously go away like a cold virus. It hangs around if you continue to aggravate it because the stress and strain to the plantar fascia that makes it irritable and causes this condition called plantar fasciitis, is a consequence of excess stress and strain.
Today on the Doc On The Run Podcast, we’re talking about repositioning your heel bone so you can run with plantar fasciitis.
The number one question I get on social media is can I run with this injury?
So the problem with this is that whenever I get this question, whenever somebody says, “Can I run?” what’s really never disclosed to me in that runners question is how bad is it?
The thing that determines whether or not you can run is whether or not you can reduce the stress and strain on that injured piece of tissue enough that you’re not going to make it worse by running.
I get this same question for people with Achilles tendonitis, with plantar fasciitis, with metatarsal stress fractures, plantar plate strains, you name it.
The thing everybody wants to know is can I run right now or not.
Today on the Doc on the Run Podcast, we’re talking about question number one, how bad is my injury?
I just got off a telemedicine second opinion call with a runner who thought she had a stress fracture. She got an MRI. Then her doctor said she has “fraying” of several plantar plate ligaments. She wanted to know if this was serious.
Part of the difficulty lies in determining the severity of plantar plate injury and making the call on when you can run. Most runners want a clear answer. Often times an MRI is performed in the hopes of getting a clear picture of the plantar plate damage.
Sometimes the MRI report not only suggests damaged to the plantar plate that hurts, but may mention “fraying” of other plantar plate ligaments that don’t hurt at all.
This often creates even more confusion and more frustration in recovering runners.
Today on the Doc On The Run Podcast, we’re talking about plantar plate fraying on an MRI a runner with a stress fracture.
Is there any proof that you don’t have to stop running when you get a metatarsal stress response in your foot?
When a runner gets an overtraining injury and goes to a doctor, the doctor’s only priority is healing the injured tissue. Most runners also think healing the injured tissue is the highest priority.
I just got off a telemedicine call with a runner who wanted to know why she sometimes feel popping and clicking in the ball of the foot after she runs.
She saw a doctor and was diagnosed with a neuroma.
The doctor gave her some metatarsal pads, which made the neuroma feel better.
But she could not figure out why she seemed to only get this weird popping and clicking sensation after she went for long runs and hill repeats.
Today on the Doc On The Run Podcast, we’re talking about why a neuroma will pop or click after you run.
One of my favorite podcasts is called The Not Your Average Runner Podcast.
I recently sat down with Jill Angie, who hosts that show.
Self-criticism heals no wounds!
When you have an injury, and you have been training hard, it is very easy to beat yourself up. Jill is the best person to explain how we can take an injury and reframe it so we don’t beat ourselves up when we are injured.
Today on the Doc On The Run podcast we’re talking about how self-confidence and self-love beat finish times, every time with Jill Angie from The Not Your Average Runner Podcast.
I get questions all the time on social media from people who want to know if they can run, and at the base of their question is really, how long does it take for some particular injury to heal?
There’s actually a wide variety of timelines on how long it takes for all of different injuries to different types of tissues to heal, even depending upon anatomic location.
Your age plays into the timeline for healing running injuries.
Today on the Doc On The Run podcast we’re talking about how long tissue takes to heal so you can run.
This episode comes from a question sent in by an injured runner who was listening to the Doc On The Run Podcast.
“I am 30 with medium arches. No prior injuries. 7 months ago I began having left med ankle pain at the calcaneal insertion.
MRI confirmed a plantar fascia rupture of med cord. I was told to just ice and stretch.
I have a distal 4th fracture on the right. Both feet at once?!
What should I do? It hurts!”
Today on the Doc On The Run podcast we’re talking about what a runner should do when you have a rupture of the plantar fascia and metatarsal stress fractures.
This episode comes from a question from a runner, who wanted to know what it means when calf muscles are tight and you have metatarsal stress fractures.
He wrote in and said, “Hey doc, I meant to inquire about stress fractures in the metatarsal joints and how you can tell. I have a friend who’s experienced a stress fracture, and he says his calves seemed to tighten up when the pain developed.”
There are really two ways tight calf muscles can be related to metatarsal stress fractures. One is the cause. The other is an effect.
Today on the Doc On The Run Podcast, we’re talking about how tight calves are related to metatarsal stress fractures in runners.
This episode comes from a question from one of the Doc on the Run YouTube channel viewers who wanted to know about “bilateral bipartite sesamoid bones” and what that really means.
I get these kind of questions all the time, when somebody really wants to know what a term means, and what the implications are for them as a runner. Usually the runner is trying to figure out how to keep running while the sesamoid heals.
Sometimes the concern is a sesamoid stress fracture or a condition like sesamoiditis where you start to get pain under the big toe joint.
If you see a doctor, they look at your x-rays, they may tell you, “Oh, you have bilateral bipartite sesamoids.”
I was just doing telemedicine visit with a runner who has a red, painful big toe joint.
Gout is an accumulation of painful sharp crystals in the joint.
Gout certainly can cause your big toe joint to become red, hot, swollen and painful.
But gout is only one of three different conditions that might cause big toe joint pain.
The pattern of redness around the big toe joint can help you decide which condition might be causing the problem if you are a runner.
Today on the Doc On The Run Podcast, we’re talking about whether or not a painful red big toe joint means a runner has gout.
The other day I was doing a telemedicine visit with a trail runner who asked me, “Which is better, soft or hard trail running shoes?”
If you’re thinking about getting some new trail running shoes, you have to really think about what’s going to be best for you.
When comes to how stiff or how soft the shoes should be depends upon three variables:
1. Your foot type.
2. How hard or soft is the trail.
3. How steep is the trail.
If you keep these 3 variable in mind the you go to your local running shoe store, you are much more likely to end up with a very best trail running shoes for you.
Today on the Doc On The Run Podcast, we’re talking about which is better: soft or hard trail running shoes.
A runner with pain under the big toe joint said she was told she had a problem with the sesamoid bones in her foot.
The doctor said maybe it was sesamoiditis, or a sesamoid stress reaction or possibly even a sesamoid stress fracture.
Her question was, “What exactly are the sesamoid bones in the foot?”
Today on the Doc On The Run Podcast, we’re talking about these weird little things called the sesamoid bones in the foot.
A plantar plate ligament sprain can cause aching pain in the ball of the foot when you run.
Plantar plate sprains are caused by excess stress applied to the ligament at the base of the toe.
If you want to heal it and keep running, you have to decrease the stress and strain on the plantar plate, and address the root cause of the injury.
A runner with a plantar plate sprain, and tight calf muscles, had a great question:
Does the plantar plate ligament cause tight calf muscles, or can a tight calf muscle cause a plantar plate sprain?
Today on the Doc On The Run Podcast, we’re talking about whether a plantar plate sprain causes tight calf muscles in runners, or other way around.
Shin splints and tibial stress fractures can feel similar when you run.
Most runners understand there is a huge difference between shin splints and a tibial stress fractures.
I recently did a telemedicine second opinion call with a runner who had a tibial stress fracture.
What she did not understand, and what her doctor had not explained is why some tibial stress fractures are very low risk of breaking, and another is very high risk of landing a runner in the operating room.
Today on the Doc On The Run Podcast, we’re talking about different types of tibial stress fractures in runners.
I was just doing a telemedicine call with a runner with a stress fracture, and he had a really interesting question.
He said, “Look, I just really want to know if I really have a stress fracture because my doctor took an x-ray and there was no crack in the bone. I looked it up myself and the definition of a fracture is a visible crack.”
Do I really have a stress fracture, or not?
This is a great question, it brings up a really interesting point.
Today on the Doc On The Run Podcast, we’re talking about whether or not a runner can have a stress fracture, if there is no crack in the bone.
Raynaud’s Phenomenon is an interesting condition in which spasms of small blood vessels cause changes in the skin color of the hands and feet. Raynaud’s phenomenon can also cause pain in the feet. Foot pain is also very common in runners.
Raynauds is one of those conditions that isn’t typically diagnosed with a blood test or and x-ray. The diagnosis is typically made “clinically” meaning the doctor hears your story, listens to your history and decides you probably have the condition, because nothing else fits.
The question is whether or not a runner who gets an MRI because of foot pain, might have something show up on the MRI images that can indicate Raynaud’s is contributing to the runner’s trouble.
Today on the Doc On The Run Podcast, we’re talking about wether or not you can see see Raynaud’s Phenomenon on an MRI in a runner.
When you get any stage of Achilles injury and you’re a runner, you’re trying to figure out what you can do to get it to heal as quickly as possible.
The biggest concern with runners when they have an Achilles tendon injury is that the tendon is going to continue to degenerate, turn into Achilles tendinosis, and then potentially even rupture.
But the good news is that stress, when actually applied in the right way, can help your Achilles tendon recover faster, become stronger, so you can get back to running, possibly even with less risk of re-injury.
Today on the Doc On The Run Podcast, we’re talking about how stress can actually help your Achilles tendon recover faster.
There are the three forms of stress that can affect you and the injured tissue when you actually get back to running after you’ve been injured and you feel like you’ve recovered.
I was just recently doing a telemedicine visit with someone who had an injury and was getting better. She was told to start running, but she wasn’t really given any specific instructions.
She was told, “You can go and just kind of run a little bit and see how it feels.”
If you’re a runner and you haven’t been running for weeks because of an injury, you’re probably going to feel so good when you start running that you’re going to do too much. If you do too much, and then you start having pain, you’re going to completely freak out because you’re going to be worried that you’ve completely set back your injury.
Today on the Doc On The Run podcast, we’re talking about the three forms of stress when you start running after injury.
Just a couple of days ago I was doing a telemedicine call with a runner who wanted to know what it meant to have “thinning of the plantar plate ligament on his MRI.
He asked, “What does ‘thinning’ really mean? Do I really have a plantar plate tear? Is it a problem? Will I be able to continue to run?”
“What is the issue with this idea of thinning of the plantar plate ligament, and why does it happen?”
Today on the Doc On The Run Podcast we’re talking about thinning of the plantar plate ligament on an MRI in a runner.
When you break down the goal of running a marathon, it really only has 3 key elements.
You are crystal clear on the distance, the starting point and the end point.
All you have to do to compete the marathon successfully is break your training down into the daily and weekly stages of growth to establish the fitness required of your body on race day.
Running injuries are difficult because they lack the clarity and simplicity of training for a marathon. But make no mistake. The process is just the same.
Today on the Doc On The Run Podcast we’re talking about the 3 key elements of marathon training and running injury recovery.
Metatarsal stress fractures are one of the most common injuries in runners. Unfortunately for runners, 4 weeks to 6 weeks in a fracture walking it boot is the common recommendation from doctors.
Part of the reason you get the boot for 4-6 weeks, is that you didn’t give your doctor enough information to recommend anything else. The doctor wants you to heal. The way you tell your stress fracture fracture story leaves the doctor imaging the worst possible scenario and you get the worst possible treatment as a result.
To heal a stress fracture you need to stop stressing the bone. You need to stop causing damage. It is that simple.
Today on the Doc On The Run Podcast we’re talking about why doctors prescribe 4-6 weeks in a fracture boot for stress fractures in runners.
This weekend, I was giving a lecture at a medical conference that was specific to running injuries.
During the question and answer period, one of the physicians in the audience asked a completely valid question.
She asked, “Why wouldn’t you just begin with a prescription medication if you’re 100% sure that medication had the highest probability of reducing the patient’s symptoms?”
The difference between the treatment options really lies in what is best for a runner long-term, versus what may best in the short term.
Today on the Doc On The Run Podcast we’re talking about why runners should not start running injury treatment with prescription medications.
Think back to the last time you really remember getting a second wind. Maybe it was 2 miles into your fastest 5K. Maybe it was mile 18 or mile 22 of a marathon.
Just when you felt you really couldn’t got on, just when you hit an all time low, your energy started to grow. You felt revived. Energized, you pressed on the the finish, thrilled with the boost of energy moving you forward.
Every runner recovering from a running injury will have dark days. The energy vaporizes and is replaced by frustration. If not careful, despair can set it.
On these days in your recovery it is crucial you dig deep.
Today on the Doc On The Run Podcast we’re talking about finding your second wind in running injury recovery.
A few minutes ago I was on a second opinion telemedicine call with runner who was told he had an MRI showing an “osteochondral defect.”
The doctor told him to stop running.
If a joint surface gets damage, you may develop a little soft-spot called an “osteochondral defect.”
Just because you have an osteochondral defect, it doesn’t necessarily mean you have to stop running, but you do need to figure out whether or not it’s actually a problem that could get worse if you don’t address it.
Today on the Doc On The Run Podcast we’re talking about osteochondral defects in runners.
I just got off a telemedicine call with a woman who was an elite runner in college.
She has been having a difficult time getting back to an acceptable level of activity after recovering from her overtraining injury.
When you have been doing a certain run at a certain pace, as a part of your training for years, you always fell like you can do that workout.
But when you get a running injury and take time off, unfortunately, your sense of reality is off in that moment. What you sense about your fitness is off.
Today on the Doc On The Run Podcast we’re talking about how your sensor is broken.
If you over-stretch any nerve it can become inflamed and painful.
If you roll your ankle on a trail you can get a condition called traction neuritis.
Most of the time when I am on a telemedicine or second opinion call with a runner with traction neuritis, they have been misdiagnosed with some other condition.
If you understand how to tell the difference, you can understand how to get back to running sooner.
Today on the Doc On The Run Podcast we’re talking about traction neuritis in a runner and what it really means.
If you hire a running coach, your coach is going to design a program that is going to actually test you physically and mentally, and push you to your physiologic limits on a regular basis to make you stronger.
Any running coach will give you a series of workouts to execute.
And when you do runs correctly then what happens is that you do the maximum amount of tissue damage that your body can sustain and rebuild before your next workout.
Today on the Doc On The Run Podcast we’re talking about why runners need to flirt with overtraining injury.
Osteophytosis is a common finding on foot and ankle x-rays of runners.
Bone spurs can form anywhere bone is irritated or otherwise aggravated by jamming, jarring motion.
Most often, osteophytosis is found in the heel, big toe joint and ankle joint.
The real is question is whether or not the osteophytosis a problem that needs to be removed, treated, or even prevented.
Today on the Doc On The Run Podcast we’re talking about osteophytosis in the foot and ankle in a runner.
The biggest mistake any runner can make when seeing a doctor for a running injury is leaving the office without a clear picture or how bad the injury actually may be.
If you don’t have a clear idea of your state of injury, you (or your doctor) are only guess- ing at how long it will take to get better and return to running. Part of the lack of clarity is your fault.
You have to communicate what really happened when you got injured, what happened between the injury and the day you show up in the doctor’s office, and your running goals.
Without doing all of that, you cannot get an accurate baseline on your injury or expect to use it for comparison as you maintain your fitness now and ramp up your running later.
Today on the Doc On The Run Podcast we’re talking about the 3 most important days in healing any running injury.
The chances are good a lot of your friends secretly admire your ability to run. Unfortunately it seems a lot of people who want to start running, but don’t think of themselves as runners find it very difficult to start.
Sooner or later one of your friends is going to call you or talk to you and ask for some advice.
The real challenge and helping one of your friends begin running is to get them to go for the initial run, and be proud of themselves for doing it.
I really believe that we as runners to understand how good it makes us feel have an obligation to be as encouraging as possible to our friends, when they want to start running as well.
Today on the Doc On The Run Podcast, we’re talking about the 3 steps you can give to any friend who wants to start running.
I am sure that you have heard your running buddies use an analogy:
“We just banked another long run.”
“We got another hard workout in the bank.”
All these efforts and investments in our training add up. They create this great store of energy for us. The accumulation of fitness is what prepares us for a marathon an Ironman, or an ultra-marathon.
Today on the Doc On The Run Podcast we’re talking about how running injuries are a lot like a savings account.
.
Snowboarder’s fracture is a small fracture in your foot that is often misdiagnosed as an ankle sprain.
The injury occurs when you break a portion of the talus bone called the lateral process.
The lateral process of the talus sits at the outside of your foot and ankle.
You break it when you roll your ankle running on a trail or stepping in a pothole while running on the road.
These fractures are much more common that previously taught.Not surprisingly, if you think you have an ankle sprain, but you really have a lateral process fracture, it won’t get better.
Today on the Doc On The Run Podcast we’re talking about what a snowboarders fracture really is, and why runners need to know about them.
Many times doctors look at you cross-eyed when you tell them how much you run, how far you run and how much you want to run now. They tell you that you ran “too much” and got injured. The snap recommendation is to stop running.
Doctors want you to heal your running injury. Many times doctors recommend the “safest” path…stop running. Be patient. Wait for healing.
Slower treatment is not always better, and isn’t even always safer.
The goal for most injured runners is not to just heal the injury.
The goal for most recovering runners is to get back running.
The critical piece is to not lose sight of what “not running” does to your longevity as a runner. Time is of the essence.
Today on the Doc On The Run Podcast we’re talking about how the safest path to healing is the slowest.
A runner with a stress fracture called me for a telemedicine visit because she was confused. The doctor told her that she has a stress fracture. But there was no crack on the x-ray.
The doctor said she only had a “periosteal reaction” which suggested she had a metatarsal stress fracture. She wanted to know if a periosteal reaction meant the foot was really broken, or not.
The periosteal reaction is one of the earliest findings that you can see on your x-ray when you have a stress fracture in one of the metatarsal bones in your foot, before you even see a crack.
Today on the Doc On The Run Podcast we’re talking about periosteal reaction in a runner with a stress fracture.
If you’re not actually healing as fast as you want to it is just not a priority.
I talked to a runner who said that he was trying to lose some weight, but he already felt like he was off track, yet it’s only a couple weeks into the new year.
The fact is that if you can’t get up and exercise, if you can’t take the time to prepare meals and eat food that is not junk food or whatever, it’s just not a priority for you. That’s not a judgment, it’s just a fact.
Whatever we prioritize gets priority in our lives.
If we are not really taking the time to pay attention to how we sleep, how we eat, how much stress we have applied to the injured tissue, for not doing all of those things it’s because it’s not a priority.
The sesamoid bones are two little bones that sit under the big toe joint. Interestingly, when I show X-rays to someone who has a stress fracture many times the first thing they say is “what are those two things” and they’re pointing to the sesamoid bones.
Sesasmoid bones very small and they don’t have a great blood supply. So if you get a problem with the sesamoids and you get sesamoiditis, it gets flared up and gets worse and worse and worse.
A lot of times it’ll turn into a sesamoid stress fracture which is very serious because it can actually crack and break.
Today on the Doc On The Run podcast we’re talking about why sesamoiditis is so serious in a runner.
The sesamoid bones are two little bones that sit under the big toe joint. Interestingly, when I show X-rays to someone who has a stress fracture many times the first thing they say is “what are those two things” and they’re pointing to the sesamoid bones.
Sesasmoid bones very small and they don’t have a great blood supply. So if you get a problem with the sesamoids and you get sesamoiditis, it gets flared up and gets worse and worse and worse.
A lot of times it’ll turn into a sesamoid stress fracture which is very serious because it can actually crack and break.
Today on the Doc On The Run podcast we’re talking about why sesamoiditis is so serious in a runner.
I recently got a great question from a runner…
Why are flat feet less stable when you run?
Pronation of the foot happens as your arch collapses and the foot elongates. You do that every time you land as you run. You need pronation to absorb impact and decrease forces.
Supination is the opposite of pronation. Supination transforms your foot from a flexible, force-absorbing adapter to a rigid lever to propel you forward as you run and push off.
One of my best friends has pain and swelling in his Achilles tendon, right in the watershed region that we know develops Achilles tendinosis and can even rupture.
He was understandably worried. He asked me, “Does my Achilles tendon need a PRP injection or Stem Cell injection?”
I explained to him that he was asking the wrong question.
I said, the right question is, “Do I need an injection at all.”
Next I gave him access to the Achilles Tendon Course where he could go through the 5 step process I teach in the Achilles Tendon Course for Runners so he could figure out how serious your Achilles tendon really may be.
Problem solved…no stem cell injection no PRP injection. No stem cell injection. No fracture walking boot. No cast. No surgery. Today he is running.
When you get any kind of over-training injury, something also incredible happens. You limp.
You compensate to remove all of the pressures and forces and friction that goes through that injured structure by “compensating.”
But the reason compensation is a problem is that if you think about holding your foot in an uncomfortable and natural position, what you’re doing is you are strengthening one thing and you’re stretching and weakening something else.
I was recently doing a call with an athlete who has a sprain of the plantar plate ligament. Now there are a couple of problems with this because he went and got an MRI. In fact, he got a couple of MRIs. The MRIs were different. They may have been done in different facilities. But the problem is that you don’t get a clear comparison on the healing that’s happened in the months that happens in between those two imaging studies.
The other thing is that when you get an MRI and you see a tear on the MRI you assume a couple of things. The first thing you assume is that the tear on the ligament was not there before your foot started hurting. You have to think about that for a minute because one of the things that happens all the time with runners is we get an MRI, we get a study, sometimes just for what we suspect is a plantar plate sprain.
We always want obvious signs when we are healing form something like a metatarsal stress fracture, Achilles tendinitis or peroneal tendinitis or any injury that is keeping his from training as much as we would like.
But the results aren’t always obvious.
Think about your pace, what it feels like.
Think about how those feelings of pace, perceived exertion and heart rate keep you on track.
These are are performance clues when training and racing. We also have to look for performance clues when recovering.
I was just talking to a runner in one of the sessions where people call in who are taking the One Run Away challenge.
In that challenge course, I’m helping you try to figure out what is the step that you’re not taking that is holding you back from recovering as quickly as possible.
This is the thing that goes on and every few days I do calls and let people ask questionsdirectly to me over webcam.
I 
was just doing a telemedicine visit with a runner who has had an injury to the plantar plate ligament with pain for months.
He’s been getting better slowly, but he was trying to figure out how bad it really is. And one of his first questions he asked me was what I see on the x-rays.
Can you see anything about the plantar plate where it’s torn, where it’s injured or anything else?
Most of what doctors see on a foot x-rays are changes that imply ligament damage.
But there is really only one thing on an x-ray that truly indicates that you probably have a tear or rupture of the plantar plate ligament.
I was just doing a telemedicine visit with a runner who has had an injury to the plantar plate ligament with pain for months.
He’s been getting better slowly, but he was trying to figure out how bad it really is. And one of his first questions he asked me was what I see on the x-rays.
Can you see anything about the plantar plate where it’s torn, where it’s injured or anything else?
Most of what doctors see on a foot x-rays are changes that imply ligament damage.
But there is really only one thing on an x-ray that truly indicates that you probably have a tear or rupture of the plantar plate ligament.