MRI Archives - DOC

#671 Value of getting an MRI on both feet

There are only a few occasions when you might want to get an MRI on both feet.

Truthfully, getting an insurance company to agree to pay for an MRI on both feet is not easy to do.

A few years ago I helped a runner who was training for marathons when he got injured. He was super fit. But on a long, super steep run in Yosemite he did some damage to tendons in both of his feet.

He really needed an MRI on both feet. So, I wrote an order for his MRI’s. But, when the MRI facility tried to get prioritization, the insurance company denied the MRI request.

That just didn’t make any sense to me.

Is it valuable to get an MRI on both feet?

That’s what we’re talking about today on the Doc On The Run Podcast.

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#660 You’ll have to wait 6 months before you can have an MRI

I just got a call from an ultra-marathoner I have seen a number of times over the years.

He is not a wimp. He’s a tough guy. He’s very smart. He knows his body really well, and he got what we suspected was a partial tear in the plantar fascia.

He didn’t get better. He took weeks off. He couldn’t run. He couldn’t even hike! it was killing him, so I ordered an MRI.

I diligently prepared the order for his MRI. I sent it to the facility. I wrote up all the various details which basically proved that his MRI study is medically necessary and completely justified…and they should pay for it.

Well, the insurance company denied prior authorization for his MRI.

You won’t believe this, but the insurance company said he had to have heel pain FOR 6 MONTHS before they would allow him to get an MRI.

What would you do if you’re a runner and you were told you’re going to have to wait six months to get an MRI in order to make a decision about what you would do for treatment?

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

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#653 Is an MRI best way to check for a tendon tear in a runner?

If you are a runner who thinks you have a tendon tear, ligament tear or other overtraining injury, you may want an MRI. In fact, you may be convinced an MRI will give you a crystal clear picture of what may be wrong inside your foot or ankle.

But, I believe many many runners and doctors rely way to heavily on MRI for running injuries.

Today we are going to talk about a study published in Foot and Ankle International in 1998.

The research study was led by Dr. Matthew Rocket (a well-respected foot and ankle surgeon) in Houston Texas.

This was a great study comparing the effectiveness of MRI and diagnostic ultrasound when trying to decide whether or not there is an actual tear in a tendon around the foot and ankle.

Is an MRI best way to check for a tendon tear in a runner?

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

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#636 Plantar Plate Imaging: MRI vs. Ultrasound

Every time a runner calls me who has a plantar plate sprain, they’re trying to figure out how they can know for sure they actually do have a plantar plate sprain. They often also want to know how bad the plantar plate injury really is.

When you’re a runner, the problem with plantar plate sprains is that many doctors will offer a standardized cookie cutter approach.

I most often help runners get better without surgery.

That’s not because I’m a better doctor. It is because I really put a lot of attention into educating injured runners about how to do all of the additional things to get the injury to heal quickly…so that they can skip the surgery.

One way to start healing faster is by imaging the plantar plate to determine the extent of tissue injury.

Plantar plate imaging, MRI vs. Ultrasound.

That’s what we’re talking about today on the Doc On The Run Podcast.

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

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

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

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

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

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

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

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#557 4 Things you need for a running injury second opinion

I do lots of running injury second opinions and I do most of those over webcam. Sometimes I do them over phone, but webcam’s way better because I can see you, we can talk, I can show you some stuff on screen, share if I need to, and I can look at stuff that you have that might be really useful for me to help you figure out what’s going on. Whether you’re seeing me for a webcam visit or if you’re seeing your doctor in your neighborhood, there are four things that you really should make sure that you have together and that you take to get your most valuable running injury second opinion. Today on the Doc On The Run podcast, we’re talking about the four things you need for a running injury second opinion.

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#540 No Proof No Permission to Run

I get questions all the time, daily almost, where somebody will send me a message and they’ll say, “Well, I saw a doctor and they said I had this injury, and they said that I couldn’t run for six weeks. Would you let me run?” Well, the answer is no. There’s a reason doctors don’t give you permission to run, and there are really four ways that you can tell, ways you can get permission. I think it’s important to talk about these four ways that you can actually get permission to run. No proof, no permission to run. That’s what we’re talking about today on the Doc On The Run podcast.

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#511 Can a stress fracture spread from one metatarsal to the bone next to it?

One thing that’s really demoralizing if you get a stress fracture is to spend a bunch of time in a fracture walking boot and then go get something like an MRI and be shocked and horrified when the doctor says, “Well, not only do you have a stress fracture in that bone, it looks like you’ve got a stress fracture in another bone as well.” If you think this stress fracture might have spread well, it could. But not the way an infection would spread. There is a way that stress related inflammation in a neighboring bone can spread after getting the original stress fracture. Can a stress fractures spread from one bone to another? That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.

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#502 Is it okay to run before I get MRI of plantar plate sprain?

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.

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#496 Why runners should always get second MRI at the same facility

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.

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