This podcast is for injured runners. Those who have been told (or worry) that running is at the root of their trouble.
If you are listening to this podcast you’re probably a runner. And you have probably been told by your friends, your family and maybe even your doctor that running is the cause of your trouble and that you need to run less.
But deep down inside you don’t just like running you feel like you have to run in order to be healthy, fit and sane. This podcast simply helps injured runners understand their condition better, and keep running.
Yesterday I called a recovering runner, just to check in and see how he was doing, because he had done the Fast Track Challenge 2 months ago.
He’s doing great. He has recovered and gotten past his injury.
He said he learned a lot in the Challenge and has applied it to his training.
He’s on track for running ultra-marathons this year. He has a coach. Training is in full swing with no limitation from the injury and got him into the Fast Track challenge.
Something he said on that call actually kind of shocked me.
I asked him, “Is there anything that you wish you could have done differently if you went back?”
He answered, “Yeah, I would have called you sooner for a consultation.”
If you ever run into injury many times, your first step is to sit still and wait. Sometimes that’s a problem and that’s what we’re talking about today on the Doc On The Run Podcast.
If you are a runner and you get pain in the ball of the foot, particularly at the base of the second toe right. It could be a plantar plate sprain.
Whenever I see a runner on webcam who has pain that sounds like a plantar plate sprain, the first thing I do is look for any callus pattern in the skin that suggests they have too much pressure and friction at that area that could injure the plantar plate ligament underneath the skin.
This episode will help you understand how certain callus patterns relate to some basic foot mechanics when you’re trying to figure out what is causing your ball of foot pain.
Today on the Doc On The Run Podcast we’re talking about three callus patterns I often see that can suggest you have a risk for getting a plantar plate sprain if you are a runner.
Everybody’s short on time. This is true for runners in training, but it’s also true for injured runners.
If you’re trying to make progress as fast as possible, you really have to do the things that will give you the most progress in the least amount of time.
Many runners I talk to on a second opinion consultation webcam call really want to know which stretches will help them. Specifically, which two or three stretches will help the most.
What are the most valuable stretches you can do after a running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have a condition called “hallux rigidus” or “hallux limitus,” the name tells you what’s wrong.
“Hallux” means big toe.
“Rigidus” means the big toe joint doesn’t move at all.
“Limitus” just means the big toe joint movement is limited and stiff.
There are three problems with hallux rigidus, which are: 1) damage to the cartilage, 2) bone spurs around the joint and 3) restriction of the soft tissues such that the toe doesn’t move up and down the way it should.
Those three reasons that cause the condition are the same reasons that can fail if you have a cheilectomy surgery.
Today on the Doc On The Run Podcast we’re talking about three reasons for cheilectomy failure after hallux rigidus surgery.
Let’s say you have a nagging tendon injury that’s really been painful. It’s been bugging you a lot when you run.
You have had persistent pain either on the side of the ankle that just won’t seem to go away, even if you run less.
You see the doctor and she says, “Look, we tried everything. We should do surgery. Your tendon is not really torn, but we should do this surgical procedure called a “synovectomy” to get it to calm down so it will finally stop hurting.”
What is a tendon synovectomy surgery?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you’re out on a trail run, you roll your ankle and sprain it. So what do you do?
You limp home, you get back to the car, you ice it, you take some pressure off of it, you elevate it, you do all the right stuff. But, it’s really painful and swollen the next few days.
Then, maybe a day or two later, it’s black, it’s blue and swollen. But even worse, you look down and you’re kind of dismayed because your toes are swollen like sausages.
Believe it or not, I have had a number of patients who called me, not because they sprained their ankle, but because they were actually worried they may have broken toes as well.
Is it possible to break your toes at the same time you get an ankle sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a discussion I just had yesterday with an athlete. He had a metatarsal fracture non-union.
A “fracture non-union” can develop when there is a crack in the bone that moving a little bit too much and doesn’t completely heal.
Non-unions can happen if you get a stress fracture, and you keep running on it and you’re tough and you’re strong and it doesn’t really hurt that bad.
If you keep running and repeatedly stress that crack, it can’t heal.
Should I get a CT scan or should I test walking to see if my fracture is healed?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
When you get an injury to a bone like a metatarsal stress fracture, you can develop a thing called a “bone callus.”
You might even see it as a lump visible on the x-ray in your doctors office.
Whether the lump is made up of hard bone, fibrocartilage or something in between, it may help you to understand the significance of that lump in your foot.
When the bone callous appears, and the size of the bone callous itself, can tell your whole lot about your progression of healing, and whether or not you might get other problems in the future.
What is a bone callus in a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On the Run Podcast!
Achilles tendon injury on one leg and a calf muscle strain on the other leg?
Talk about a bummer: 2-for-the-price-of-1 overtraining injuries! Yes, it is possible to get similar running injuries on opposite legs, at the same time.
Today I had a conversation with a runner who has developed both of these injuries from running. These are actually just opposite ends of the same biomechanical spectrum at work. During the call I was explaining to him how it can happen, and how he could make some simple changes to prevent it from happening again in the future.
How can running on the road cause Achilles tendinitis in one leg and calf strain on the other?
Well, that’s what we’re talking about today on the Doc On The Run Podcast!
What would be worse than not being able to run because you had foot pain that didn’t get better for a year or two?
I know one thing that would be worse… Having foot surgery to treat a problem that was not actually even located in the foot.
Think about that. You had pain in your foot for two years. Then some doctor convinces you to have surgery, only to find out there was no problem with the tendon.
You stop running. You have surgery. You wait for your stitches to heal. You have to stay off your feet until the incision is all healed.
And your foot pain does not change at all.
Sounds crazy, but this can happen. And it’s most likely to occur when you have something called referred pain. The pain in your foot might be actually caused by nerve compression deep to your glues maximus…that’ right…in your butt.
Today on the Doc On the Run Podcast we are talking about foot pain that is truly a pain in the butt!
If you just got injured, your number one goal is to not lose your running fitness as your running injury heals.
If you were diagnosed with a running injury a while ago, you stopped running and now you’re just getting back to running after taking some time off, in that case your primary goal is to resume running without sustaining another overtraining injury. Especially right when you start running again.
What I teach runners in the Fast Track Challenge is how to find their unique fastest path back to running. The process is all about methodical testing.
Methodical testing is the key to running after injury.
And that’s what we’re talking about today on the Doc On The Run Podcast.
This morning, I was on a call with a recovering runner who signed up for a series of coaching calls to get back to running after a long-standing injury.
This is an elite athlete who had multiple setbacks, and encountered difficulty getting over the hump a number of times.
If you’re going to get back your fitness, and if you’re going to get back to training as fast as possible, you’re going to have to endure some discomfort, some risk, and frankly, a little bit of anxiety every time you bump up against your limits. But that is part of the recovery process.
Are you scared of re-injury after trying to build strength when you’ve had a running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you have been injured. You’ve been a good little patient. You waited around, you have done nothing. You have endured a frustrating period of boredom. And you finally started running again. That’s great!
Today’s episode came from a webcam call I did with a recovering runner. She has a stress fracture but her foot was good enough to run outside.
The question was about whether or not an injured runner should keep using something like an AlterG treadmill to maintain running fitness while continuing to heal and recover from a stress fracture.
After healing a stress fracture, should I use the AlterG treadmill even after I’ve started running outside?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today I was out on a run and I was thinking about treadmills versus running outside. To be fair, I was actually running outside during this run.
It seems like most of the runners who sign up for the Fast Track challenge, or who call me for a second opinion, the majority of them like to run outside.
I have a question for you.
If you got an overtraining injury like a metatarsal stress fracture, calcaneal stress fracture, or a tibial stress fracture, plantar plate sprain, the question is… Are you running on a treadmill to ease back into running, or are you just running outside, to see how running feels after your injury?
Are you using a treadmill for returning to running after an injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you’re out on a run and you start getting some aching pain in the ball of the foot. It persists for a while.
It’s not really that bad. Your foot is not killing you. But it starts to bother you more and more over the course of a few weeks.
Being proactive, you see a podiatrist. The podiatrist tells you that he thinks you have something called a Morton’s neuroma. So he does an x-ray of your foot and what do you see? Well, nothing. Why is that?
When are x-rays useful for a runner with a Morton’s neuroma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Have you ever had black toenails after a long run?
Have you ever lost a toenail after a marathon?
Have you tried using goopy skin lubricants, or worn bigger shoes that make you feel like you’re wearing clown shoes?
If you have, but you’re still having problems beating up your toenails in your running shoes when run, I’ve got a simple solution that may actually help.
Today on the Doc On The Run Podcast we’re talking about the best way to file your toenails if you’re a marathon runner.
If you’re a runner with plantar fasciitis, you probably have heel pain when you get up and step out of bed.
If that’s gone on for months, you tried icing, you’ve tried stretching, and you’ve become frustrated, it starts to become pretty easy for your doctor to talk you into surgery.
If you’ve had plantar fasciitis for a long time and your doctor is trying to convince you need surgery, you should listen up!
When is plantar fascia surgery really necessary for runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get aching pain in your ankles when you’re running, and it seems to lag and doesn’t just go away, you might not have ankle pain at all.
There’s a thing that I see often in runners complaining of ankle pain, but when I actually look at the runner’s feet, it’s a different condition altogether.
That condition is something called “sinus tarsi impingement.”
Today on the Doc On The Run Podcast, we’re talking about ankle pain versus sinus tarsi impingement when running.
Plantar plate ligament sprains are a tough injury for runners. Plantar plate tears can cause a lot of pain in the ball of the foot. Unless you treat them correctly, that pain can persist for a long time. As a result plantar plate injuries can be super frustrating.
Unfortunately, plantar plate tears are often diagnosed when you get an MRI of the foot. I often get questions from runners asking me whether or not they have to wait for another MRI before they can run.
Does the plantar plate ligament need to heal on an MRI before I can run?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question posted as a YouTube video comment.
That video was explaining how using crutches for a short period of time can help injured runners.
I wasn’t talking about months of crutches, not many weeks, but a short period of time to try to accelerate the process of healing over-training injuries.
In the comments someone posted and said, “How long would you use crutches for this…?”
How long should I use crutches?
Well, that’s a million-dollar question! And that’s what we’re talking about today on the Doc On The Run Podcast.
WARNING: You may not want to listen to this topic while you’re eating.
I’m going to tell you a story that goes along with dinner.
Believe it or not. One time we went out to a restaurant with a bunch of friends.
A member of our dinner party took off his shoes and he said, “Hey, what do you think of this?” He was literally showing me warts on the feet right there in the restaurant.
Plantar warts are on the bottom of the foot. Warts on the feet can be difficult to treat because the skin is so thick.
To make matters worse, he had a more severe type of warts called mosaic warts. They were all over the feet. That makes treatment even more difficult.
Today on the Doc On The Run Podcast, we’re talking about plantar wart treatment options in runners.
Whenever I speak to a runner who wants to know if they can run with a bone bruise, I get confused. If you were “diagnosed” with a bone bruise, you should be confused, too.
A bruise is a very simple thing. You fall down and land on your knee and you get a bruise. You get a bruise because your kneecap crushes the skin against the ground and you get bleeding in the skin that you see as discoloration that we call a bruise.
You can’t see that in a bone. When you get diagnosed with a bone bruise, you have to think of it in terms of bone injury, like a stress fracture. The continuum of bone injury includes stress response, stress reaction and stress fractures.
You have to understand the severity of the bone injury before you can decide whether or not to run.
What is the difference between a bone bruise and a stress reaction in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have pain at the bottom of the big toe joint, up along the arch, just above the plantar fascia, you may have been told that you have this thing called FHL tenosynovitis.
“Tenosynovitis” just means that you have inflammation of the tendon sheath or tube that carries the flexor tendon down to your big toe. It helps you pull your big toe down when you push off while running. When the tendon sheath gets inflamed, it can be painful.
If you have tenosynovitis, your doctor may recommend a cortisone injection, or a Platelet Rich Plasma (PRP) injection.
So what’s the difference between these two injections and why would you want one versus another?
Today on the Doc On The Run Podcast we’re talking about FHL tenosynovitis injections, corticosteroids versus PRP injection.
It’s no secret that I enjoy Ironman triathlons. I did 15 of them, and the last one I did was the Ironman World Championships. That doesn’t mean I’m fast. It just means I’m stubborn.
But when I was a kid, I was obsessed with Ironman Hawaii and I decided that I was going to do Kona.
You never know what good or “bad” things can happen to help you fulfill your dreams.
Long story short, the day before I was going to leave for Hawaii, literally the day before I was getting on the plane, I was in my doctor’s office and he said that I could not possibly do Ironman Hawaii because I had pneumonia.
But it turns out the Universe is always conspiring to make dreams come true.
Today on the Doc On The Run Podcast, we’re talking about how pneumonia made my Kona dream come true.
If you’re a runner you may be wondering what in the world something like “subungual melanoma” has to do with running injuries.
There are a couple of reasons.
Subungual melanoma is commonly mistaken for a bruised toenail. What runner has never had a dark spot under the toenail?
Subungual melanoma is actually extremely deadly. You’re not necessarily likely to get it, but there is a reason that this might be pertinent to you as a runner.
Repeated trauma from running and beating up your toes could possibly increase your odds of getting this form of cancer.
What is subungual melanoma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have pain under the big toe joint, it could be an injury called sesamoiditis. Sesamoid bones are like a pair of tiny little kneecaps under the big toe joint. They are about the size of kidney beans. If irritated enough, sesamoid can develop stress fractures.
Any inflammation of the sesamoid bones is called sesamoiditis.
But pain in the sesamoid area can also result from inflammation of the tendon sheath that goes around the flexor tendon. The flexor tendon sheath is just a tube around the tendon that actually helps the tendon glide as your big toe moves up and down.
The flexor tendon sheath is very close to the sesamoids. Sometimes it is hard for a runner to tell the two conditions apart.
There’s a big difference between the two conditions and a big difference between the way that you would treat them.
What’s the difference between flexor hallucis longus tenosynovitis and sesamoiditis?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I recently got a question on one of the YouTube videos about hallux rigidus.
He gave me a long description about how there aren’t good treatment options for runners with hallux rigidus, and he’s actually starting to have pain when he runs.
His big toe joint is red, it aches, and he knows it’s inflamed. He is trying to choose some different running shoe options.
Today on Doc On The Run podcast we’re talking about hallux rigidus shoe traits for runners.
When you sign up for a marathon, your coach gives you a really clear plan on what to do. All you need to do is complete all of those workouts as scheduled.
You can’t jam them all in at the end, or you will get an overtraining injury.
We all know that and when you have an injury, a doctor tells you to sit still. So, you do exactly that.
You’re a good little patient, so you sit still and you get weaker.
You get stiffer. Bad things that happen that put you at risk of another over-training injury later.
You can work out now, or you can work out more later. Those are your two choices.
And that’s what we’re talking about today on the Doc on the Run Podcast.
In this episode, we’re talking about tibial stress fractures.
Tibial stress fractures can be mis-diagnosed. Sometimes you just think you might have shin splints or ankle pain, or even a sprained knee.
Stress fractures can affect different places in the tibia. But the exactly location of the stress fracture is really the most critical piece when you’re trying to figure out whether or not it’s safe for you to run.
Today on the Doc On The Run podcast, we’re talking about how the most important tibial stress fracture detail is location.
Today on the Doc On The Run Podcast, we’re talking with Andrea. She just ran the Tokyo Marathon in 3 hours and 9 minutes.
I know for most people, they’re going to think, “Wow, 3:09 is really fast!”
But what’s really impressive is that Andrea ran a marathon with a calcaneal stress fracture. In case you don’t know what that is, “calcaneus” is a fancy word for heel bone.
Andrea was told she couldn’t run. She was told to wear a boot.
Instead of just accepting that fate, she figured out how to run, went to Tokyo and finished the sixth of the World Major Marathons.
Andrea’s story is going to be really helpful if you have an injury, you’re told you can’t run, or you think you can’t run.
One of the worst questions you can ask any doctor is, “when can I run?”
Believe it or not, I get these questions every single day…from total strangers.
They get injured and go to the doctor. The doctor says, “You can’t run.” Then they will call me and ask, “When can I run?”
Why am I going to give you the magic answer, if I don’t even know you?
There is a better way.
The best questions that you can come up with are the ones that direct your doctor to start thinking about how to help you get back to running a whole lot faster.
If you got a running injury and you’re trying to figure out how to run and you go to the doctor, don’t ask them when you can run, ask them how you can run.
That’s what we’re talking about today on Doc On The Run Podcast.
An interesting runner called me for a second opinion. He had a couple of things going on that created a pretty confusing picture.
He had a plantar plate sprains (at least he was told he had plantar plate injuries) because his MRI showed evidence of injuries to the plantar plate ligaments of toes two, three, and four.
He also had some nerve type symptoms. But on the bottom of the foot, he also had this very interesting ridge of callus.
So what was REALLY causing all of his trouble when he ran?
Today, on the Doc On The Run Podcast, we’re talking about a runner with a plantar plate injury and deep perineal neuritis.
I got a great question from a runner who wanted to start running on an Alter G Treadmill. What she said was:
“I’ve been getting out of the boot. I started running on an Alter G Treadmill, and everything’s been going great. I feel good. I feel like a million bucks because I’m finally moving again. Is it okay for me to run every day?”
What if you had a friend, who was not fit at all, who wanted to run a marathon? Imagine she wanted to do her very first marathon, and you were going to help her train? Would you tell her to run every single day?
Can I run every day on an Alter G Treadmill?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s question actually comes from Elizabeth who explained she rolled her ankle, and sustained a fracture of the fibula bone. She wanted to see if she could get some advice.
She said, “I’m a 27-year-old female. I twisted my ankle and I was rushed off for x-rays and discovered a spiral displaced fracture of my fibula in my ankle joint. I’m dying to get back on the road and going a bit stir crazy. It’s been 10 or 11 weeks post-break now. I want to know if I will do damage by starting to run in increments to gain back some fitness and cardiovascular fitness or if it’ll be okay.”
Can I run after a spiral fracture of the fibula?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
One of the worst injuries you can get when you’re a runner is a plantar plate sprain. It’s a stretching, a straining, a tearing of this tiny little ligament at the ball of the foot called the plantar plate.
Every time I do a second opinion consultation over webcam for a runner with a suspected plantar plate sprain, I ask them to do one simple thing.
I want to look at the insert in their running shoe: “Go get it, right now, preferably one you’ve been running in for a long time, not a brand new one.”
Pull out the insert and let’s see what the wear pattern shows us.
Today on the Doc On The Run Podcast, we’re talking about how your running shoe insert can actually show whether or not you’re at risk of a plantar plate sprain.
During a recent call with a runner who signed up for a series of phone calls, we were trying to figure out exactly what happened to cause his foot pain.
The way that doctors are taught to think goes something like this: Come up with a particular name called a “diagnosis” and then do a “procedure” that the insurance covers.
Doctors focus on making sure the diagnosis code matches the insurance requirements so they will send a check.
This process does not serve runners well. Runners need to focus on how they got injured…so they do not do it again.
How an injury happened is much more important than what happened.
Does that make sense?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
One of the most common nerve related running injuries is a thing called Morton’s neuroma. A “neuroma” is just an irritated nerve.
A “Morton’s neuroma” occurs specifically in the foot between the 3rd and 4th toes.
When a neuroma first starts, the nerve is just a little bit irritated, and it may feel a bit weird.
In one of the original descriptions of Morton’s neuroma, it described a sensation or feeling of wet leather being stuck to the bottom of the foot. That odd sensation is the result of the nerve getting aggravated. It starts to send little erroneous signals to your brain.
If the nerve is getting irritated, you want to make sure your running shoes are not making it worse.
What are the four worst traits of a running shoe if you have a Morton’s neuroma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have a soft tissue injury in your foot related to overtraining, you (or your doctor) may be thinking about getting an MRI.
If you have a ligament injury, plantar plate sprain, partial tear of the plantar fascia, an Achilles tendon partial rupture, Achilles tendinosis, or peroneal tendinitis, the timing of the MRI is extremely important.
MRIs can be really useful tools. They give you over a hundred images of your foot. Because you have so many pictures, the detail can fool you into believing the MRI is a complete picture, but it is not.
When is an MRI most reliable for a soft tissue running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who has a plantar plate sprain. A plantar plate sprain is an injury to a very small ligament right at the base of the toe, usually the second toe, right where it attaches to the metatarsal at what we call the metatarsophalangeal joint.
That sprain typically causes aching in the ball of the foot.
These are tough injuries to get better.
I have had one myself, and when you get them, they’re really annoying.
It seems like they get better very, very slowly, but you can make them worse very, very quickly.
It’s really important when you get a plantar plate sprain to identify the one thing that caused the injury so you stop doing it.
Today on the Doc On The Run Podcast, we’re going to talk about my advice for a flat-footed runner who has a plantar plate injury that started from running on a treadmill.
I just got off the phone with an elite athlete recently who asked a great question.
He called me and said, “I have custom orthotics and I know they support my foot better. So the question is, can I use a broader range of shoes?”
What he really wants to know is whether or not he can ONLY use motion control shoes.
He was really asking, “Since I have an unstable foot that’s now stabilized by the custom orthotic supporting the foot, does that mean that I can wear shoes other than something like a true motion control shoe?”
Can I wear softer shoes when running with a custom orthotic?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
One of the things about getting an MRI has to do with timing of the injury.
What do I mean by that?
Well, it means timing in terms of when the MRI is done relative to how long it has been since you actually beat it up and injured that structure.
When is an MRI most reliable for a bone running injury like a stress fracture?
Well, that’s what we’re talking about today on the Doc The On Run Podcast.
Every time I talk to a recovering runner who is trying to figure out how to run, and help figure out what’s causing all their trouble, I ask them to keep a pain journal.
Why do you think that is?
Pain is the lowest cost, most abundant, and most underutilized diagnostic resource available to help an injured runner guide the recovery.
Imagine a contest between doctors trying to get injured runners back to running faster.
If I could only use pain as a diagnostic tool, but other doctors could use MRIs, X-rays, CT scans, and all the medical imaging they wanted (but could not track the runner’s pain), I bet I would get runners back to running faster.
Find the one thing that causes the most pain when you’re running.
That’s what we’re talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you have to remember that it is a stress related injury.
That’s why it’s called a “stress” fracture.
It is not a “run-too-much” fracture. It is not a “ran-too-far” fracture. It is a “too-much-stress” fracture.
So, if you want to know whether or not you’re at risk of getting one as you ramp up your training, one of the simplest things you can do is look at your running shoes. More specifically, your running shoe insert.
How can your running shoe insert show you whether or not you’re at risk for a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get an overtraining injury and your doctor tells you to stop running, so you sit still doing nothing, lots of bad things happen.
If you stop running, you will feel terrible physically. Zero exercise makes athletes feel worse.
Additionally, you’re probably going to get super grumpy.
Don’t be surprised if your spouse, your kids, and your friends start to think you’re being a little bit of a jerk. That is because you’re in a really terrible mood all the time… because you’re not running.
You also start to lose your identity as a fit runner.
We all feel good when we run. We feel good when we accomplish goals. We feel good when we do a long run at a good pace.
But all that gets washed away when you’re sitting around recovering from an injury.
Your identity needs to be that of a recovering runner.
That’s what we’re talking about today on the Doc On The Run Podcast.
A runner with a calcaneal stress fracture has a problem. So we got on a call.
The problem with calcaneal stress fractures is not healing. The heel bone “heals” fast!
Runners with calcaneal stress fractures really have 2 problems:
1. How do I let the heel bone heal fast
2. How can I fix the scarring that happens during step 1?
I was recently doing a call with a real runner who had a calcaneal stress fracture. She was having some issues because she was returning to running. The problem was not the heel bone.
She noticed a lot of stiffness and irritation around the ankle joint, because she’d been immobilized and off of the foot for quite a long time. Anytime you use a boot or crutches, you get lots of indiscriminate scarring. You can’t run unless you fix that.
Is stretching safe with a calcaneal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you recently got an MRI and then looked at the MRI report, it may seem like a bunch of gibberish.
What you really want to see is a picture of the actual injury.
So you do the most reasonable thing…you try to look at the actual MRI images to see if you can see the stuff mentioned in the report.
You put your MRI disc in your computer, or you go on an online viewing portal and you pull up your MRI images to try to make sense of it.
You’re trying to figure out if it really picked up your injury or not.
Did the MRI miss my plantar plate sprain?
Can the MRI show me the actual crack in the bone?
Where is the tear in the tendon or ligament?
This episode on the size of the slices might help you. It will also help you a lot if you’re going in to get an MRI because you have an injury and your doctor is going to order an MRI.
Today on the Doc On The Run Podcast, we’re talking about MRI essentials for runners, slice size matte
Let’s say you’re out on a run and you start feeling some aching pain in your foot. The next day you wake up, it really hurts when you step out of bed.
You go see a doctor and you’re told you have a stress fracture.
Being told you have a stress fracture is a real bummer because the doctor will probably tell you it will take about six weeks to heal. Then things get worse…
You are told you need to wear a fracture walking boot for about four to six weeks, and of course, you can’t run during that time.
After you wallow in tears, you decide to be a “good patient.” You go with the plan.
You sit around in the boot.
You don’t do anything.
You don’t take the boot off.
You don’t run.
You don’t exercise.
And a month or two later…you finally get clearance to run!
But when you first go for your run, everything feels super stiff!
Your running form is terrible. You feel really slow. But more than anything else, you really notice how super stiff everything feels around the ankle.
Today on the Doc On The Run Podcast, we’re talking about how ankle stiffness can lead to another stress fracture in a recovering runner.
An injured runner called me with a problem. “I rolled my ankle and it hurts HERE. The explanation from my doctor didn’t make any sense, because the pain on the top of my foot is not where the trouble was on the X-ray.”
I asked for some pictures showing where he felt the pain. And then it started to make sense.
Ankle ligaments are not the only structures that get injured when you roll your ankle!
If you are a runner with an injury and you want to get back to running you really need to understand what structure could be damaged. Then you can decide whether or not it’s dangerous for you to ramp up your activity.
If a doctor gives you a vague answer that usually tells me that the doctor doesn’t know what’s going on.
But if you really think about where the pain is, AND the mechanics of rolling your ankle during an ankle sprain event… you can figure it out!
I rolled my ankle and my foot hurts here. What is it?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner who got injured and got an MRI, I’ll bet that you’ve already tried to look at it…but you have simply no idea what you’re looking at.
You see there are more than a hundred images of your foot on the MRI. So, you’re not even sure where to start. MRI’s can be really overwhelming!
But MRI images are not really that complicated.
In this series on how to read your own MRI, I’m going to break it down and help you understand your own MRI images, especially if you want to see what was in the MRI report from the radiologist.
Today on the Doc On The Run Podcast, we’re talking about MRI Essentials for Runners, T1 versus T2 Images.
If you’re injured, you really need to have a goal.
If you were to call me for a private consultation or a house call, I would not accept “I want to get over my foot pain” as a goal.
But interestingly, when injured runners call me, that’s often what they say.
Think about this. When you sign up for a race, it’s really easy to get motivated. It’s easy to decide on your training plan and just get to work.
But when you are injured, you think the process has to stop.
Today on the Doc On The Run Podcast, we’re talking about why injured runners need a goal race.
Today’s episode comes from a recent question from a runner who I advised to begin running on this thing called an AlterG treadmill.
First of all, I do not own an AlterG treadmill. I do not own the company. I don’t own stock in the company. I do not get paid a referral fee or anything else if you use one.
I’m not pitching the AlterG treadmill because I get paid for it.
But the AlterG treadmill is a tool that I not only use frequently with athletes who are returning to running, but it is a tool that I teach physicians at conferences to use with their patients as well.
How can you get access to an AlterG treadmill when the physical therapy place says no?
That’s what we’re talking about today on the Doc On The Run Podcast.
You and your brain are supposed to be on the same team. You work hard with long runs, tempo runs and speed work to get your brain used to the idea of letting you run fast.
But sometimes your mind can work against you. This is especially true when you first return to running after a foot injury.
Your brain remembers your pre-injury ability. If not restrained, your brain instinctively wants to get you back to running at that same pace.
If you just started running post-injury, a little more detail may help you avoid a common trap.
You need to understand how powerful your mind is when it comes to your pace, your return to running and staying below your threshold for re-injury.
Your brain can be your adversary when you first start running after an over-training injury.
That’s what we’re talking about today on the Doc On The Run Podcast.
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.
When you’re trying to get back to running, you have to think about all of the variables that can increase the stress and strain to your injured tissues.
Your “threshold for recovery” or your “threshold for re-injury,” are really the same.
When I lecture at medical conferences, I always tell doctors there are 3 variables you have to play with.
And you do have to play with the variables if you want to get an athlete back to running as quickly as possible.
What are three variables you can modify when you’re starting to run after you’ve had an injury?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
Yesterday it started to snow. So I decided to go out on a trail run on the trail in this picture.
I only saw one deer and two people.
As I ran around a corner under a cliff two climbers approached wearing jackets, with fleece hats under their helmets and all their climbing gear.
I stopped, looked at them and I asked, “Isn’t it too cold for climbing?”
One of the climbers smiled and said, “Isn’t it too cold for a trail run?” We all started to laugh.
The reality is that it is never too cold to go for a trail run. But excuses for getting stronger abound.
This is true when you are injured, too.
You got injured because you were too weak.
That’s what we’re talking about today on the Doc On The Run Podcast.
One of my Elite Access patients sent me a message. He was having pain from an inflamed Tailor’s bunion bursa at the base of the pinky toe.
He got a bigger shoe with a wider toe box that decreased the pressure. But when he was running, his foot was sliding around in the shoe, and it was still causing a problem.
He asked me if there was any solution. And yes, there is…
Today, on the Doc On The Run Podcast, we’re talking about how you can lace your running shoes differently when you have bursitis pain from a tailor’s bunion.
When you get injured, a lot of things go wrong.
1. Because you have pain, you suspect you have to stop training.
2. When you see a doctor, they confirm your fear and tell you that you really need to rest.
You translate that into really strict rest, doing nothing basically. You stop exercising. You stop training.
All kinds of bad stuff starts to happen. It is a lot more than just losing aerobic fitness.
Today on the Doc On The Run Podcast, we’re talking about how it is that the longer you wait, the more pain you can expect when you actually return to running after you get an over-training injury.
Today we’re talking about metatarsal fracture, nonunion surgery versus no surgery.
I know some people will think that I probably should have gone straight from #665 to 667 because frankly, there are some negative connotations surrounding those three letters, 666…the number of the beast.
But I decided to do this episode anyway. And, I decided to dedicate this one to a buddy who is a beast.
He’s tough, he’s active, and he happens to have a metatarsal nonunion that hasn’t stopped him from doing a whole lot of fun, active things.
I’m hoping in this episode you can learn a little bit about the different options you have when you get a metatarsal fracture nonunion.
Do I need surgery if my nonunion starts hurting?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
A calcaneal stress fracture is a terrible injury.
What is a calcaneal stress fracture?
“Calcaneus” is the medical term for heel bone. When you get a stress fracture in the heel bone, doctors call it a calcaneal stress fracture. When you run with a calcaneal stress fracture there is a risk the bone can actually shatter and break apart.
That obviously would be bad.
But there are three really interesting facts about the heel bone that you should think about.
Is a fracture walking boot the best thing when you have a calcaneal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today I went out for a run, but truthfully I wasn’t really excited about it. It was cold, it was pouring rain, and I had a lot of stuff to do. I could have easily justified not putting on my running shoes, not going out and slogging through a bunch of mud puddles.
I also hate to admit that part of the truth is, I had new running shoes. I just didn’t want to get them all nasty and dirty running in the rain, because they were brand new.
But I did run.
I enjoyed that cold wet run more than I thought that I would. But that’s almost always the case when you’re not really wanting to go out and workout, but you do anyway. Right?
When you’re injured, and you’re not exercising, you may wonder, “When should I start to exercise?”
Remember, the best time to plant a tree was 100 years ago.
Today on the Doc On The Run Podcast, we’re talking about how runners who recover faster workout before the perfect time.
I just got a great question from a runner who had been using a thing called a dancer’s pad.
A dancer’s pad is sometimes used to help an injury to these little bones under the big toe joint called the “sesamoid bones.”
If one of the sesamoids is painful and irritated and you’re trying to take the pressure off of it, an easy way to do that is to place a dancer’s pad in your shoe.
How can a dancer’s pad lead to a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you are listening to this, you probably have some kind of injury that’s doing one of two things.
Either it’s keeping you completely off of your feet and you’re not running at all, or you are basically running in a halfway fashion.
You are not really doing your full workouts. Your workouts are not really gratifying. And you don’t really feel like you’re making progress.
You have to remember here, the enemy is time.
Today on the Doc On The Run Podcast, we’re talking about how uncertainty costs injured runners.
In this episode of the Doc On The Run Podcast we have a real treat for you. Kate is someone I met through the Grand Canyon R2R2R Run Group and she has an amazing story!
If you are not familiar with what running the Grand Canyon entails, you start at one side, run from the rim of the Grand Canyon Down treacherous trails all the way to the bottom, then run across the bottom of the canyon and back up out of the canyon on the other side. Then you turn around and run back.
Kate has agreed to come on the show today to talk about running the Grand Canyon.
More specifically she is here to talk about running Rim-to-Rim-to-Rim with a calcaneal stress fracture!
Today on the Doc On The Run Podcast we are talking with Kate Stopa, about calcaneal stress fractures, running the Grand Canyon Rim to Rim to Rim, giving up a kidney.
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.
Imagine this scenario. You are out on a long run. You have been training hard for your race. But near the end of your run, your foot starts to ache a little bit.
The next day when you wake up, it hurts. So maybe you take a day off, you don’t run that day, and you skip a workout.
The day after that, you go for a run and predictably it gets worse.
You call your local podiatrist. You make an appointment and when you’re in the doctor’s office, the doctor hands you a pre-written sheet (that is not designed for runners,) but designed for anybody that comes in with a metatarsal stress fracture or with plantar fasciitis or with Achilles tendonitis, or whatever. Those instruction sheets are not written for runners.
They’re written for anyone and everyone who has that injury. It’s supposed to fit everybody. Does that make any sense?
Today on the Doc On The Run Podcast, we’re talking about how to get tailored treatment instead of some cookie cutter treatment plan when you go to the doctor with an overtraining injury.
Achilles tendinosis is one of the worst injuries you can get as an injured runner. It is chronic, it’s hard to get rid of, and the tendon feels noticeably different.
The tendon gets thicker and it becomes constantly painful. Every time you run on it, you may worry that it might rupture or rip apart.
There are lots of different ways to treat Achilles tendinosis. Two of those options are PRP or platelet-rich plasma injection or a procedure called “dry needling.”
Yesterday in a live Runner’s Aid Station call, an injured runner asked me to explain the specific differences between these two treatments. I thought it might be helpful to try to explain it to you the way I explained it during that call.
What’s the difference between dry needling and PRP injection when you have Achilles tendinosis and you’re a runner?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
If the top of your foot hurts because you have extensor tenosynovitis, it can cause a lot of pain. But the condition is not complicated.
The extensor tendons run down across the top of your foot. The extensor tendons continue all the way out to the toes. The function of the tendons is to pull your toes up when you swing through in the swing phase of gait, so you don’t trip over your toes when you run.
If you start running and your shoelaces actually push on the tendons with just a tiny bit too much force, the tendon sheath surrounding the tendons can get irritated. With continued aggravation, you get inflammation within the tendon sheath. A big painful spot right on the top of your foot is the result.
So, there’s a simple way you can decrease the irritation of the tendon sheath when you have extensor tenosynovitis.
Today on the Doc On The Run Podcast, we’re talking about how you can alter your running shoe lacing pattern if you have this condition called tenosynovitis.
All of us want to get better when we have a running injury.
We just want to run. But when you go to the doctor, things can start getting confusing. The doctor may tell you what you need to do, but it doesn’t always jive with what you really want to do.
I thought it might be helpful for you to understand a little bit about the difference between true wants and needs when you go to the doctor. This may help you get your doctor to focus on what you really do need so you can get back to running sooner.
Today on the Doc On The Run Podcast, we’re talking about distinguishing your wants from your needs and your running injury recovery.
Maybe you had to take some time off because you were injured.
Maybe you had a big break from running just because pandemic race cancellations got you out of the swing of things.
Or maybe a holiday festivities got the best of you.
No matter what the reason, if you gained a few extra pounds (or more than a few extra pounds) you are going to really enjoy this episode!
Today on the Doc On The Run Podcast, we’re talking about How Running Can Help Us Go From Fat to Fit with Nick.
Any time you get a running injury you are facing a tremendous task.
You might think that your job is to get help and heal the injuries quickly as possible.
But that would only be partially correct.
Your real job as an injured runner is to seek the full solution.
Today on the Doc On The Run Podcast, we’re talking about how injured runners need the full solution.
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.
I got a call recently from a runner with a torn plantar fascia. It was a unique situation, but truthfully really not that rare.
Any time you have an injury and you want to run, you have to make some really important key decisions, based on only a few important factors.
This case will be instructive in helping you figure out how you can make that decision, and decide if (and when) it might be safe for you to run.
If you just had an injury, but you have a really important event you want to run, you gotta check out this episode!
“I think I tore my plantar fascia. Can I run this weekend?”
Well, that’s a great question, and that’s what we’re talking about, today, on the Doc On The Run Podcast.
Most runners understandably feel like a victim of an over-training injury.
They say something like, “Well, I was feeling strong, I was feeling ready for my race, I was really feeling great, and then this happened to me. I got a stress fracture, I got Achilles tendonitis, I got peroneal tendonitis, got plantar fasciitis, something happened to me and now I feel like I’ve lost all my fitness and I can’t run my race.”
Well, most of the time we just reflexively think that things happen to us, but sometimes things really do happen for us.
What do I mean by that? Well, sometimes the bad thing actually has a silver lining that you can’t even see.
Today on the Doc On The Run Podcast, we’re talking about how if you PR with an injury, the injury happened for you and not to you.
Today’s episode actually comes from a comment and a question sent in by one of the viewers of the Doc On The Run YouTube channel.
This was Jean, wrote in and she said,
“Hello, Dr. Segler. I had a fifth metatarsal fracture repair surgery five weeks ago. I was started to walk without crutches and a knee walker or a scooter as of yesterday, but my foot feels achy, though. Well, as a runner, when can I possibly resume running after my metatarsal surgery?”
This is what everybody wants to know.
I didn’t do the surgery and I don’t know all the details, but I can tell you that depending upon when you’re going to run after a surgery depends upon several things.
How soon can I run after fifth metatarsal fracture surgery?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
I was just talking to a runner over webcam who had been researching metatarsal stress fractures, but heard something about a “malunion” and knew that a fracture malunion was a really bad thing.
He had been diagnosed with a stress reaction in one of his metatarsals.
If you continue to stress a metatarsal stress reaction enough, it can progress to a full-on metatarsal fracture.
So, he wanted to know, “If I run on my stress reaction, is it going to turn into a malunion?”
How can a bone stress reaction turn into a malunion, from running?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Many years ago when I was first in practice, I met someone who was a doctor, and who was a runner herself. She liked to treat runners and she happened to make a lot of money. A whole lot of money!
I was very impressed with her, so I actually flew across the country to spend one day in her office following her around to see exactly what she does to make so much money working with runners.
There was one particular visit with one runner, which really struck me.
Right before we walked into the treatment room, the doctor spun around, looked at me and said, “Okay, this guy’s a runner. He has plantar fasciitis. I’m going to show you how to treat plantar fasciitis in a runner in under a minute.”
The encounter was nothing like I expected…
Treating injuries is fast, but treating runners is slow.
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from one of the YouTube viewers Doc On The Run YouTube channel who had watched one of the videos on fractures. He asked a great question.
This is from Saif. What he said was,
“Thank you for such a short and effective, informative video. My question was, does displaced fracture heal naturally without medical treatment? And the thought process was that how did our ancestors and primitives heal without medical care or deal with these displaced fractures?”
How does a displaced fracture heal naturally without medical treatment?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode actually comes from a question sent in by Melissa.
She signed up for the Plantar Plate Masterclass and she asked a very specific question.
She asked:
Should I run with a pad for a plantar plate sprain?
Great question! And that’s what we’re talking about today on the Doc On The Run Podcast.
What if you could be out on a run, sun on your face, running two weeks ahead of schedule, faster than what you thought, or what some doctor told you?
That would be amazing, right?
Let me tell you that neither me, nor anyone, can promise you that a bone stimulator, snake oil, or fairy dust is going to make that happen.
However, it is true that bone stimulators have been shown to actually speed up fracture healing significantly, particularly problematic fractures.
The question I get all the time from runners with metatarsal fractures is, “Well, okay, if a bone stimulator might help, will my insurance company pay for a bone stimulator to speed up a metatarsal fracture, stress fracture, or some other fracture that’s really inhibiting a quick return to running?”
When will an insurance company pay for my bone stimulator to help my metatarsal fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Everyday I help runners who are stuck by giving them a different perspective during a second opinion call.
When we get on the call, we do a couple of things to get focused in the right direction and get them unstuck.
1) We figure out what their real goal is with running, not with injury. What race did you sign up for? How fast do you want to run? What are your long term goals with running?
2) If those are the goals you really want to achieve, how is your present injury interfering with those goals?
What astonishes me is that many of the times when I talk to these athletes and I ask them what they’re doing to work toward those goals, they are doing nothing. They tell me they are not running. They are losing all of their fitness. They are very frustrated.
Today on the Doc On The Run Podcast we’re talking about two ingredients for recovering from any overtraining injury faster.
Ankle sprains are probably the most common musculoskeletal injury affecting runners. It is really easy to roll an ankle and find yourself limping, unable to run.
You might have sprained your ankle tripping on a root or rock when you’re out running on a trail.
Maybe you were wearing some fancy shoes going out to dinner and you stepped on a little reflector on a crosswalk, twisting your ankle.
No matter how you injure the ankle, if your ankle is painful and swollen it is definitely going to interfere with your running.
What are the three biggest mistakes runners make with ankle sprains?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
In this episode, we’re talking about three mistakes I see almost every runner make when they call me for help.
Let’s be clear, runners do not call me when they are on their run and first start getting foot pain.
More often, aching runners go see a doctor, talk to a running buddy, or seek information online to get a rough idea of what’s going on.
When those steps don’t help, it is my job to help them figure out which mistake they are making.
What are the three steps every injured runner is missing when they call me and ask for help?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A couple of weeks ago, I was invited to give some lectures at the Heartland Podiatry Conference in Des Moines, Iowa. The conference organizers asked me to give an entire “Doc On The Run session” during which I presented five lectures back to back…all on how doctors could approach treatment of injured runners differently.
During the attendee question and answer session, a doctor asked:
“Do you use ankle braces for ankle sprains, and under what circumstances would you recommend braces for recovering runners?
This question came out of what’s called Conservative Management of Ankle Sprains in Runners Who Want to Run.
Do I recommend ankle braces for runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have trouble with your Achilles tendon and a doctor told you that you might actually rupture it and tear completely if you continue to run, you should probably be worried.
If you are anxious about your Achilles, stay with me.
I have some good news and some bad news.
A recovering runner in the Runners Aid Station asked me…
“If I rupture my Achilles tendon, if I just ignore the tendinosis, if I just block out the pain, continue to run, continue to train, and then it does rupture, would I be able to run after it heals?”
Great question…
Will I be able to run after a ruptured Achilles tendon?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question from one of the YouTube viewers. The specific question was, are calcified Achilles tendons more prone to tendon rupture in runners?
That’s a great question.
I think if you ask most doctors, their answer is probably going to be yes.
But since I got this very specific question, I actually wanted to see if there is any research that truly proves whether or not Achilles tendons that have calcification or ossification within them, whether or not they’re actually more prone to rupture in runners.
Are calcified Achilles tendons more prone to rupture in runners?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
What would happen if you did this?
Walk into your doctor’s office and say,
“Hey, look, I’m a runner. My situation is complicated. I really want to train. I really want to get back to running. I would like you to take an hour, sit down with me and let’s really work through this so that I can get back to training.”
Right now when you picture yourself going into your doctor’s office and asking for a full hour, how does that make you feel?
If you don’t think you could walk in and ask the doctor directly, what if you called the office in advance and tried to explain you have a complicated situation and you would like an hour of the doctor’s time.
What do you think would happen?
Ask for an hour and tell your doctor you need more time because you are a runner.
That’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you have pain in the ball of the foot, especially around your second toe joint where the toe attaches to the foot, you may be suffering from a plantar plate sprain.
Many years ago, if you had this kind of pain, it would probably have just been called “capsulitis” by your doctor.
But a plantar plate injury is something that has become more recognized as a distinct pathology in the last 10 or 20 years. Plantar plate injuries do not get misdiagnosed nor ignored as often as before.
Plantar plate injuries are very difficult to heal in runners because the ligament gets stretched and strained every time you stand on your foot or bend your toe.
But the joint capsule can also get injured. Joint capsule injuries and plantar plate injuries are not the same.
Capsulitis vs. plantar plate sprain. What’s the difference?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
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.
After years of doing the Doc On The Run Podcast and making YouTube videos to explain overtraining injuries that can interfere with running, I have gotten a lot of interesting questions.
We’ve had over a million views on YouTube, and over 300,000 downloads of the podcast which all equal a lot of questions.
Mostly overtraining injury questions center on a search for a shortcut. Many injured runners also think the solution is in only one action.
Don’t search for less than what is needed.
That’s what we’re talking about today on the Doc On The Run Podcast.
If you are a runner and you have an injury, my guess is that you are most worried about how long you will need to stop running.
When people call me for a webcam consultation or an in-person second opinion evaluation, I see runners making the same mistakes over and over.
If you’ve made one of these mistakes, don’t beat yourself up too much.
There is not that much you can do about the past.
But you can take action today, change course and get focused on what you need to do right now to get back to running faster.
Dwelling on what you have done incorrectly will only slow you down.
But if you don’t identify mistakes, you can’t fix them.
Today, on the Doc On The Run Podcast, we’re talking about how mistakes mean the most time off running.
Last week I was lecturing at the International Foot & Ankle Foundation medical conference in Hawaii. Specifically, I had been asked to give a couple of talks on treating running injuries.
During the day I was moderating the surgery and sports medicine session, Dr. Gary Labianco was giving a lecture on Metatarsal Fractures.
He said something that led us to today’s episode. It was genius!
“If you want to heal a metatarsal fracture, you have to break bone faster than you break it down.”
What he means is that you have osteoclasts and osteoblasts, not just repairing bone, but also removing bone throughout the healing process.
That is true. But let’s think about the other side of that equation.
Not just physicians pulling your activity back to stop breaking bone down so fast, but all of the things you as a patient could do to make bone faster.
Wanna heal a stress fracture faster? Make bone faster than you break it down!
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Growth happens outside of your comfort zone. This is true for both emotional growth and physical growth.
Very few patients who call me for help with a stress fracture are not really upset.
They all feel like they wasted months of time with treatments that either didn’t help, or made them worse. They are still not running.
All of these runners seem to express the same concern, the fastest path back to running seems just as mysterious as that supposedly invisible crack in the bone.
Is your doctor pushing you out of your comfort zone?
And is that discomfort going to help you heal that stress fracture so you can run?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just did a consultation call with an injured runner who had a really interesting history with his heel pain. There was some concern that he might actually have a calcaneal stress fracture and not a plantar fascia issue.
In case you don’t know, “calcaneal stress fracture” is just the medical term for a stress fracture in the heel bone.
The heel bone is the largest bone in your foot, and runners can sometimes develop a stress fracture in the heel bone.
They are relatively rare, but there are a couple of ways that you can get these stress fractures.
The good news is calcaneal stress fractures heal pretty quickly. But if you have one, you really don’t want to run on it.
How can a runner tell a heel bone stress fracture from plantar fasciitis?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
If you have this pain on the outside of your foot near the cuboid bone, you might start worrying you have a cuboid stress fracture.
Cuboid stress fractures are rare.
In fact, cuboid stress fractures account for less than 1% of all the stress fractures that happen in the foot in athletes.
But there is something more common that can feel like a cuboid stress fracture.
Doctors call it “capsuloligamentous strain.”
How can a runner tell the difference between a cuboid stress fracture and this thing called capsuloligamentous strain?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
If you have been running with a nagging aching pain on the outside of your foot, just in front of your ankle, you might think you have a cuboid stress fracture.
If you then get an x-ray of the foot and it shows a tiny little extra bone sitting just next to the cuboid, well that bone has a specific name and it is called an Os Peroneum.
Sometimes you can get pain from the Os Peroneum, sometimes you can get pain from the cuboid bone that’s right next to it.
If you’re a runner and you have Os Peroneum pain, how do you tell the difference from a cuboid stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
If you call me and you tell me, I think I have a cuboid stress fracture, the first thing I’d say is…pretty unlikely.
In fact, cuboid stress fractures are less than 1% of all the stress fractures that happen in the foot in athletes.
So they really are very rare.
One thing you can get that’s actually much more common is arthritis within the joint. That’s also pretty rare, but you can tell the difference.
How can a runner tell the difference between a cuboid stress fracture or calcaneocuboid joint arthritis?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
“Subluxed Cuboid” is just a cuboid sitting slightly out of position.
Stress fracture of the cuboid is very different from a subluxed cuboid.
If you have this aching pain on the side of your foot, and you’ve been told maybe it’s “cuboid syndrome” or a “subluxed cuboid,” but it’s not getting better, you could have a thing called a cuboid stress fracture.
The reason you probably weren’t told it was a cuboid stress fracture is that, first of all, those are really rare. Cuboid stress fracture is less than 1% of all stress fractures in the foot.
If you’re a runner and you call me, say, “Hey, I really need to do a webcam call because I think I have a cuboid stress fracture,” the first thing I would think is…probably not.
But you might and, if you do, you do not want to ignore it because a cuboid stress fracture, when ignored, gets worse over time.
What’s the difference between a cuboid stress fracture and a subluxed cuboid, and how can you tell the difference if you’re a runner?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
If you are a runner and you’ve had pain on the outside of your ankle or the outside of your foot, kind of near the heel you may have been told that you have peroneus longus tendinitis.
Sometimes peroneus longus tendinitis is the wrong diagnosis. You might actually have a cuboid stress fracture.
Which one’s worse?
Well, I’ll tell you that in terms of really destroying your ability to run, definitely an ignored cuboid stress fracture is worse.
How can you tell the difference between a cuboid stress fracture and peroneus longus tendinitis?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner who has been told that you have a cuboid stress fracture, you might be worried that there’s an actual crack in the bone.
A visible crack on x-ray is what I think of when I picture a truly fractured cuboid bone. There is a huge difference between a cuboid bone with a crack, vs. without a crack.
The cuboid bone is an irregular bone. It’s small, but it’s important. It sits right in between your heel bone and the fourth and fifth metatarsal bones.
When you roll your ankle and your foot rolls under you, you can compress the cuboid and crack it.
Repeatedly compressing the cuboid can lead to a stress fracture in the bone.
What’s the difference between a cuboid stress fracture and a truly fractured cuboid bone?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you are a runner and you get an aching pain on the top of the foot, and it’s not getting better, you might have this weird thing called a cuboid stress fracture.
Cuboid stress fractures are often misdiagnosed as an “ankle sprain” or “foot sprain.”
The cuboid bone is positioned in a way that it can get squished in between the other foot bones.
Cuboid stress fractures can cause a lot of trouble if you ignore it, because it can get worse and turn into an actual fracture.
Even worse, the weakened cuboid bone can get crushed completely if you ignore it.
Today on the Doc On The Run podcast we’re talking about cuboid stress fracture fundamentals for runners.
Just today I was seeing a runner during a house call and he had a neuroma. So, understandably, he put a neuroma pad in his shoes.
When he was running, his neuroma suddenly got way worse!
I asked him what happened.
He said, “I moved it a little bit. I moved it from where you put it before and I thought it would take more pressure off, but I think it actually made it worse and it really flared it up.”
What happens if you run with a neuroma pad in the wrong place?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
I was just speaking at a medical conference in Las Vegas, and of course I flew on a plane to get there.
To me, as a podiatrist, the most dangerous two spots in the airport are in the security screening line.
I don’t like standing on those yellow footprints in the security scanner spots because I think it’s a little gross to stand without shoes, where thousands of people a day step barefoot.
I see people in airports with fungal toenails and with athlete’s foot infections. I can see the skin on their feet peeling, and I know exactly what’s happening.
When that skin is peeling they are shedding live fungal filaments and fungal spores everywhere they step.
And I worry that travelers are depositing, sharing and spreading foot fungus on those yellow footprints.
Want a foot fungus pro tip? Well, I’m going to give you one. Wear old socks to the airport.
It might be kinda gross, but that’s what we’re talking about today on the Doc On The Run podcast.
If you are a runner with a painful tendon or ligament issue like chronic plantar fasciitis, Achilles tendonitis or plantar plate sprain that just won’t get better, you might have done some research into injections and found a thing called a PRP or “platelet-rich plasma injection.”
The way that PRP injections are marketed by some doctors, you might think that it’s mostly unicorns and fairy dust, but there is some actual science behind platelet-rich plasma. and the effect that it can have on these tendons and ligaments that aren’t healing very well.
Corticosteroid injections have also been around for a much longer time.
Both types of injections can be used as treatments for tendon and ligament sprains in runners.
The question is whether or not there is any real scientific evidence to support Platelet Rich Plasma injection or Corticosteroid injections for chronic tendon or ligament injuries. Is one injection any better than the other?
PRP science explained. Is there a difference between PRP injections, corticosteroid injections, and placebo?
That’s what we’re talking about today on the Doc On The Run Podcast.
The #1 concern all injured runners face is time.
How long will I have to use crutches.
How long will it take the surgery to heal.
How long will I have to wear a fracture walking boot.
How long will I have to stop running.
How much running fitness will I lose in that time.
I feel like most of the runners who call me for a second opinion over webcam are making a critical mistake. They are hiding from the injury.
Are you an injured runner who’s hiding from your injury?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
If you have ever run with a rock in your shoe, you know just how painful a little pebble can be.
Sometimes a callus forms in a way that it gets rock hard and starts to get embedded in the skin.
Painful calluses can literally feel like a rock taped to your foot. The problem is that callus removal pads don’t work.
Using a pumice stone to shave down the surface of the callus doesn’t really help much either.
But you can fix them the same way I do using what I call the Strawberry Stem Technique.
Let’s talk about how they form and how this technique works.
Today on the Doc On The Run podcast, we’re talking about how you can fix painful calluses in a runner with what I call the Strawberry Stem Technique.
The whole key to rapid running injury recovery is to proceed with confidence.
If you are using a fracture walking boot or crutches, you must do so confident the boot is necessary…and not based on guesswork.
If you are starting range of motion exercises for a torn tendon, you must be confident you can work past pain, without worrying you might cause a re-injury.
You need to make sure that you know that the present action in your recovery is necessary.
You also need to understand how you can gain confidence in your next step in recovery.
Today on the Doc On The Run Podcast, we’re talking about how injured runners must proceed with confidence.
One time at a medical conference, an expert lecturing on biomechanics said,
“When a runner develops Hallux Rigidus, he becomes a swimmer instead of a runner.”
Most of the doctors in the audience laughed.
I really didn’t think that was very funny. I actually have hallux rigidus myself, and it doesn’t disrupt my running.
It is true Hallux Rigidus can cause pain and swelling in the big toe joint. If you aren’t careful the joint can get destroyed.
If you understand a little bit about the mechanics of the joint, it may help you understand how to avoid the arthritis that can hamper your ability to run in the future.
How can pronation cause hallux rigidus in a runner?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
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.
When you have two painful problems in different parts of the same foot, things can get complicated.
I recently had a call with an injured runner with a couple of different problems.
On the outside of his foot, between the third and fourth toes, he has a painful neuroma. The other problem is that he’s got bursitis. The inflamed bursa is in a completely different place, no where near the irritated nerve.
When a runner has two injuries, like a neuroma on one side of the foot and bursitis on the other side of the foot, which one is worse?
Which one should you pay attention to first?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
I just got off a call with a runner who needed a second opinion with his running injury recovery.
He had a fracture and it has been improving. But because it was painful and swollen, he was still icing it daily.
At his last follow-up appointment, the doctor actually said, “I think you’re good enough to actually start cycling at this point, to get back a little of your running fitness.”
So, the question is, should I stop icing?
Do I need to keep doing that? If my injury is good enough to start cycling can I stop icing?
Does a release to cycle mean you’re good enough to stop icing your foot?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
Sometimes a doctor really needs to touch your foot to make the diagnosis. But not always with runners.
Since the pandemic pushed so many of us into Zoom meetings, we all know it’s pretty easy to get on a web-cam call when it’s really difficult to meet someone in person.
There are a couple of times when webcam second opinion visits can be almost as good as meeting in the doctor’s office.
There are lots of benefits to the webcam calls that do make them almost as valuable as in person visits.
When is a webcam second opinion just as good as an in-person doctor’s visit for runners?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
Today’s episode comes from a great question I got during one of the Runners Aid station calls.
This was someone who had a plantar plate sprain and had talked to a doctor about a couple of different procedures that might actually, potentially, speed up the healing.
He wanted to know about the difference between these two things called dry needling or a PRP injection.
Today on the Doc On The Run podcast, we’re talking about dry needling versus PRP in runners.
Ivan has a great question. After watching the watching the video “Can I Run After Wearing a Fracture Boot?” he wanted to know: “It still swells and has a lot of pain what do I do?”
Anytime a runner gets a stress fracture, the main goal is to confirm the foot is healed enough to withstand the forces and stresses applied to the injured bone.
In the episode we are going to talk about:
3 indicators of ongoing tissue damage when you have a stress fracture.
3 strategies used to decide when it’s safe to run after stress fracture.
Questions I would ask you if you called me for a stress fracture second opinion consultation.
Today on the Doc On The Run Podcast we’re talking about what to do if a stress fracture in the foot still swells and hurts a lot after wearing a fracture walking boot.
Let’s say you’ve had an aching pain in the ball of the foot that’s been going on for several weeks.
You’ve tried lots of stuff. You tried icing it. You tried some over-the-counter inserts that you got.
Maybe you stopped running all together. Maybe even used a fracture walking boot.
But after weeks, you’re not getting anywhere.
Today on the Doc On The Run Podcast we’re talking about how you need to find your target when you’re not getting better.
I was just on a call with a cross-country runner who had had a second metatarsal stress reaction.
A stress reaction is basically like a mild stress fracture, but without any crack in the bone.
She was doing well and her foot had been getting better.
But then when she went for her first run, she had pain in her foot.
The pain during that first run was in a completely different bone. The new problem was not in the second metatarsal, it was in the fifth metatarsal on the outside of the foot.
Let’s talk about how that happens.
Today on the Doc on the Run podcast we’re talking about how a second metatarsal stress fracture might cause a fifth metatarsal stress reaction.
The radiologist reading your MRI knows nothing about your problem.
The only clues a radiologist gets about your injury are described in the clinical history section of the MRI order from your doctor.
I just got off a call with a runner who had gotten an MRI order from his doctor. He had a long history of injury but the only description on the MRI order was “Concern for fracture.”
This runner had more than just a concern for a possible fracture.
But because there was such a limited description for the radiologist, the injured runner was understandably irritated and frustrated that the radiologist didn’t have the full information.
I will admit that I also get very upset about this when I’m looking for something obscure that the radiologist is likely to miss, unless it’s on their radar.
But there is an up-side to everything!
Today on the Doc On The Run podcast, we’re talking about the benefit of your radiologist being clueless.
This episode has a whole bunch of complicated-sounding terms that you may have never heard before.
One of them is sinus tarsi syndrome, and the other one is FHL tenosynovitis or flexor hallucis longus tenosynovitis.
Sinus tarsi syndrome is often confused with ankle pain.
FHL tenosynovitis is often confused with plantar fasciitis.
These conditions affect opposite sides of the same foot. Yet, one can lead to the other.
Today on the Doc on the Run podcast, we’re talking about how sinus tarsi syndrome can cause flexor hallucis longus tenosynovitis.
Imagine your doctor tells you that you have a metatarsal stress fracture and you should not run.
Why would you come home from the doctor and call me asking, “Can I run in cleats with a stress fracture?”
Believe it or not, that actually happened.
In this case we are talking about an athlete who is actually getting better and who wanted to train on the track.
He wanted to run in cleats.
Aside from the uncertainty, he was doing okay. He was a little hesitant and wasn’t sure if cleats would aggravate the injury right or not.
Can I run in cleats with a stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
A runner called me and said, “I got some new running shoes and they made my bunions worse overnight. I think I need surgery now.”
The problem is that bunions do not typically get worse quickly.
Bunions get worse slowly because the bone is changing position.
In this episode, we’re going to talk about how it’s possible bunions could get worse from a new pair of shoes.
If you are a runner with bunions this is a situation you may want to understand.
Today on the Doc on the Run podcast, we’re talking about how new running shoes might have made your bunion bigger.
We’ve all heard the saying that time heals all wounds.
While that may be true, time also kills your running fitness when you’re not training.
You have to remember that the enemy of your running fitness is not the fracture walking boot.
The enemy of your running fitness is not the crutches.
The enemy of your running fitness is not your doctor.
The enemy of your running fitness is time!
Today on the Doc On The Run podcast we’re talking about how time is the enemy when you have a running injury.
Today I was talking with a runner who has been diagnosed with a longitudinal split of the peroneus brevis tendon.
The concern with this kind of tear in the peroneal tendon is that if you can’t get it to calm down, it can only get worse.
Continually moving, irritating and producing inflammation in and around injured peroneal tendons just causes them to get weaker over time.
Many surgeons are quick to offer surgery to correct the problem.
This runner wanted to know the details of all the different treatment options when a runner gets diagnosed with a longitudinal split of the peroneus brevis tendon.
Today on the Doc on the Run podcast, we’re talking about the 5 choices runners have when there is a split or tear in the peroneus brevis tendon.
It really seems incredible that we now have over 600 episodes of the Doc On The Run Podcast!
Today’s episode is a little different in that I actually want to ask you a question.
How do you stay motivated when you have been injured?
I’m really interested to know because this is one of the most important things you can do as an athlete when you’re recovering from an over training injury.
Much of what I’ve learned that helps injured runners is not stuff I learned in medical school.
Much of the strategies and techniques that seem to work best, I’ve learned in large part from seeing how creative injured runners can be.
Today on the Doc on the Run podcast, we’re asking a question, how do you stay motivated when you are injured?
Today we’re talking about some of the x-ray changes that happen when you get hallux rigidus or hallux limitus.
If your doctor tells you the x-rays show hallux limitus…what does it mean?
We’re going to talk about these five things that you can see commonly on the x-rays when you have hallux rigidus.
Today on the Doc On The Run podcast, we’re talking about five changes on x-rays when you get hallux rigidus.
I know a lot of people are not even going to listen to this episode because I’m talking about stretching.
Many runners seem to recoil from the topic of stretching.
But if you get injured and you go to a physical therapist, you can take it to the bank that they are going to give you some stretching exercises to do.
Why?
Because stretching helps when you have tissue that is predisposed to injury because it’s too tight.
When you have that issue, you need to stretch that tissue.
Today on the Doc On The Run Podcast, we’re talking about how stretching is like a rest day, finite pain that pays off.
If you have pain in your foot under the big toe joint, the doctor might tell you that you have an issue with one of these two little bones called sesamoids.
Interestingly, some people have a sesamoid bone that is not broken, but looks like it broke apart.
If you understand how that happens, it may help you understand your x-rays and the doctor’s description of your condition.
Today on the Doc on the Run podcast, we’re talking about a broken sesamoid versus a bipartite sesamoid. What’s the difference?
Today’s topic comes from a longtime listener named Jenny. She wrote a really nice review that I wanted to share with you.
She said, “If you are a runner, you need to listen. What I love about Doc On The Run Podcasts is that each one covers one topic, is short, sharp, full of useful practical information that you can apply right away without having to go and do more reading or research.”
She also asked, “Would you consider doing an episode on return to running after an accident and how to overcome the fact that everyone tells you that you should not run, even when your surgeons and physios have said that it is safe for you to run and really good for you to exercise?”
Thank you Jenny! And yes, that is a great idea for a topic!
Today on the Doc On The Run Podcast, we’re talking about how to overcome friends, telling you not to run after a traumatic accident.
If you get pain and swelling and discomfort particularly in and around the big toe joint, you may have a condition called hallux limitus or hallux rigidus.
Hallux limitus and hallux rigidus are both conditions that affect the big toe joint. It causes pain right where your big toe attaches to your foot.
Many runners with this condition don’t even understand the difference between hallux limitus and hallux rigidus.
There are really a few things that define the difference between these two conditions.
Understanding the differences may help you get clarity after a doctor visit.
Today on the Doc On The Run Podcast, we’re talking about hallux rigidus versus hallux limitus. What’s the difference?
The problem is not that you have a stress fracture.
The problem is not that you have an Achilles tendonitis issue that is bugging you.
The problem is that you have been given advice that freaks you out and convinces you to do absolutely nothing while you wait to recover.
How do I know? Because I don’t help people get better from running injuries. Instead, I help injured runners figure out how to run.
That’s what I really do.
Today on the Doc On The Run podcast, we’re talking about why you need to focus on possibilities and not limits or obstacles when you’re an injured runner.
Yesterday, I saw a runner who has plantar fasciitis. Plantar fasciitis is the most common condition affecting the foot in runners.
When a runner gets plantar fasciitis, it is often because the plantar fascia ligament is too tight. The tight ligament becomes overstretched and strained. Heel pain is the result.
Since it is safe to assume that the plantar fascia ligament on the bottom of the foot is just way too tight, you may want to stretch it. But with every potential treatment comes risk.
Stretching the plantar fascia can be risky and has the potential to cause more trouble for a couple of reasons.
Today, on the Doc on the Run Podcast, we’re talking about two reasons that stretching the plantar fascia can be bad for runners.
I want you to really think about which decision might be missing in your process of running injury recovery right now.
Is it the decision to just go for it?
Is it the decision to start exercising today?
Is it the decision to sign up for some specific event that can get you motivated?
Is it the decision to get a second opinion?
Which decision is missing in your running injury recovery? That’s what we’re going to talk about today on the Doc on the Run Podcast.
I was just on a call with a runner suffering from a plantar plate sprain.
He had a great question:
Is inflammation really bad or is it good when you have a plantar plate sprain?
Physicians commonly prescribe anti-inflammatories. There are many approaches used by injured runners to manage inflammation, reduce inflammation, and hopefully make your foot feel better.
If inflammation is bad for the plantar plate ligament, part of your recovery plan should include some sort of anti-inflammatory treatment.
But if the inflammation is good for the plantar plate, you should not try to interfere with the inflammatory response.
Is inflammation good or bad for a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
Doubt comes from confusion. Confusion leads to paralysis when you’ve been injured and you don’t know what to do to maintain your running fitness.
Doctors tell you to sit still.
Pill pushers tell you to take medicine.
Gizmo peddlers tell you to buy expensive devices.
Many runners don’t really even know what they can do, other than rest.
If you are going to doubt anything when it comes to your running injury recovery, what you should doubt is the validity of sitting around doing nothing while waiting for healing.
Today on the Doc On The Run podcast, we’re talking about how doubt does the most damage to a recovering runner.
If you are reading this, maybe you have sesamoiditis, a sesamoid stress reaction or a metatarsal stress fracture.
This is a real example from a real patient. This story really illustrates how MRIs can show misleading clues leading to a potential misdiagnosed leading your doctor astray.
It is crucial that you focus more on your running goals, your injury progress and what it really means precisely where you have pain in your foot. Then and only then can the MRI findings be put in the proper perspective.
Too much emphasis on MRI findings can make you think you have a different injury.
Today on the Doc On The Run podcast we’re talking about how sesamoid pain got misdiagnosed as fourth and fifth metatarsal stress reactions.
How do you know your injury is improving? How do you know that you got the green light to start running? How do you know it is healed?
Well, when I talk to runners, most of them say something like:
“Well, my x-ray shows this. Does that mean that I can run?”
“My blood test showed that, does that mean I can run?”
“My doctor said this, but I heard that on some other podcast, so does that mean I can run?”
There is lots of confusion around how you can tell when you are getting better as you start regaining running fitness after an injury starts to heal.
Timing is the crucial piece of information if you really want to run.
Today on the Doc On The Run podcast, we’re talking about two ways an injured runner can tell the injury is actually improving.
I was recently invited to give a lecture at a foot and ankle medical conference in Seattle. I was giving a talk called Conservative Treatment of Ankle Sprains in Runners Who Want To Run.
This was an attempt to teach physicians what I do with ankle sprains. Mostly I was trying to get them to think about what they need to do to get runners back to running as quickly as possible instead of just doing the standard ankle sprain protocols with their patients.
The Ottawa Ankle Rules are a set of rules that were created in Canada to reduce people from getting unnecessary ankle X-rays when they have an ankle sprain and go to the emergency room.
Today on the Doc On The Run podcast, we’re talking about a common fracture missed by the Ottawa Ankle Rules.
I was just on a call with a runner who called me for a consultation of an ankle injury.
He had some funny looking stuff on his ankle x-rays. That was why he was scheduling a second opinion.
The bummer in this whole thing was that he actually told me that maybe 10 years ago or so, he’d had a similar ankle injury.
He’s pretty sure it was on the same side, but he wasn’t really sure because he didn’t have a copy of the x-rays.
Today on the Doc on the Run Podcast, we’re talking about why you should always ask for copies of your x-rays.
I just got a call from a runner who I have seen before. He had swelling in his Achilles tendon, and he was worried about it.
He was worried that he could have a ruptured or completely torn Achilles tendon.
If you are a runner and you get a complete rupture of the Achilles tendon, this is one of the worst things that could possibly happen to you.
A torn Achilles is way worse than a broken bone. The worst thing you could do is ignore a torn Achilles. You do not want to ignore it!
Today on the Doc On The Run podcast, we’re talking about an easy at home test you can do if you think you have a complete rupture of the Achilles tendon.
Every time I am in the Recovering Runner’s Aid Station where I answer questions for injured runners, I get questions about how to get an advantage.
Everybody wants an advantage.
I don’t think most people cheat.
There are some people who cheat, but certainly not everyone.
But I think it is okay to look for an unfair advantage when you’re injured and you’re trying to get back to running.
The truth is, getting an unfair advantage when you are injured is actually really easy to do.
Today on the Doc On The Run podcast, we’re talking about three unfair advantages in healing running injuries.
Let’s say you are out running on a trail and you catch a root and you roll your ankle.
You limp back home and you realize that your ankle is all swollen. It is bruised, it hurts and you’re really bummed out.
You are trying to figure out what you can do to get this thing to calm down faster and get back to running. Well, there are lots of different options.
How can a diagnostic injection help an ankle sprain?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
I was just lecturing at the International Foot and Ankle Foundation meeting in Seattle. I was giving talks on running injuries. A doctor in the audience asked me if “not running” was the safest way for runners to heal running injuries.
Keep in mind, this was a doctor asking the question.
Have you ever thought this makes sense?
After all, if a runner gets a running injury, and they stop running, that’s the safest way to get it to heal. Or is it?
Do you agree that not running is the safest way to heal a running injury?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
Let’s consider you are a runner with a painful neuroma.
The more you run, the more painful the foot becomes.
But it only started with some weird little sensations.
Eventually it starts to get more numb. You notice more tingling, then more burning pain. Now your doctor wants to talk you into surgery.
You just want the problem fixed. So you go to the operating room and then you’re shocked to find out that you still have pain later.
By the way…that’s not malpractice. It just means you had a bad outcome.
But if you’re the runner, you’ve got to figure out what to do.
Today on the Doc On The Run podcast we’re talking about two different types of injections your doctor might offer you after a failed neuroma surgery.
I was listening to a podcast about the way that disagreements happen.
He said, anytime there’s a disagreement, no matter what, there are two possibilities.
If there are two people arguing about something, one person could be right, and the other could be wrong. That means roughly speaking, there’s a 50% chance that one person is wrong all the time.
This is true of physicians as well.
Let’s say, I come to your home to see you and help you with a metatarsal stress fracture. You’ve been told you have a neuroma. But it seems like you have a stress fracture, based on your x-rays or your story.
What if there’s a 50% chance your doctor might be wrong?
Well, that’s what we’re talking about today on The Doc on the Run Podcast.
One of the questions I got in the Runners Aid Station was:
“Do I really need a fracture walking boot?”
This is a runner who went to the doctor, and was told, “You have extensor tenosynovitis. The best way to get it to calm down is to remove the inflammation and stop aggravating the tendons.”
If you get aching pain on the top of your foot, it might be caused by an irritated extensor tendon sheath (which is the little tube around the extensor tendons as it goes out to the toes on the top of the foot). If so, you might be thinking you need something drastic to stop the tendons from moving so it can calm down.
Do I need a fracture walking boot for extensor tenosynovitis?
Well, that’s what we’re talking about today, on the Doc On The Run podcast.
Maybe you have been taking some time off because you have been injured.
Maybe you took some time off because you spent way too much time in a fracture walking boot.
Maybe all of your training just took a backseat to all the chaos and confusion of the pandemic.
But none of that would be as bad as having a doctor tell you that your hip was injured because you are just way too fat to run!
Irrespective of why, if you are a runner, and you feel like you are running just a little bit too slow, I can promise this discussion is going to help you today!
We are going to talk about why it’s not really so bad to be in the slow zone.
You’re getting to hear from Martinus Evans, host of the The 300 Pounds and Running Podcast Network, who runs the “Slow AF Run Club” and who is also the author of the “Zero to Running” guide.
Today on the Doc On the Run Podcast, we’re talking about 300 Pounds and Running!
If you’re reading this, it’s probably not because you love toenail fungus. It it also probably not because you think black toenails are pretty. In fact, you probably think both are pretty gross and you would be right.
But this bruised black toenails and toenail fungus joining the party is mostly preventable.
All runners should understand the circumstances that can put you at risk of getting a fungus infection in the nail which runners call “toenail fungus,” or which doctors call “onychomycosis.”
It is often the fungus that actually causes the skin infection called athlete’s foot.
It’s very, very common. Fungus is all over the place! Don’t freak out, but it’s probably in your shoes right now!
Whether or not the fungal spores and fungal filaments will cause an infection on your feet, just depends upon the circumstances that you set up as a runner that actually allow it to get in and cause real trouble.
How can a bruised toenail from running cause toenail fungus?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
If you get a plantar plate sprain, the first thing you may notice is pain and irritation at the ball of the foot, right where the second toe attaches to the foot. If the foot feels swollen, puffy or sore in that spot, it could be a plantar plate sprain.
A one common injection performed for plantar plate ligament sprains is a corticosteroid injection.
I just spoke with a runner who thought the doctor did the injection in the wrong part of the foot.
She saw a podiatrist, and the doctor did a corticosteroid injection for the plantar plate sprain. She was confused afterward and asked me if the doctor did the injection with the right or wrong technique. I’ll explain why she was confused.
I think my doctor did the wrong injection for the plantar plate ligament.
Well, that’s what we’re talking about today on the Doc On The Run podcast.
This morning I was on a call answering injury questions live in the Injured Runners Aid Station.
This runner actually said,
“Well, my doctor said that since I got a running injury, the solution is to stop running.”
When I think about this, there are really only two approaches to the questions of whether or not you have to stop running entirely to heal an overtraining running injury.
Do I have to stop running and lose my running fitness entirely just to heal?
Well, that’s a great question and that’s what we’re talking about today on the Doc on the Run podcast.
I was just speaking with a woman who has a suspected mild plantar plate sprain. What was interesting is the fact that she doesn’t really have a whole lot of pain.
I was explaining how important it is that she actually figures out her baseline “pain” numbers. I was explaining that even if you don’t call it “pain” you have to rate the level of discomfort so you can track it.
How bad is it when walking with or without running shoes, or simple things like walking up and downstairs.
Now, the problem is that she said, “well, it’s not really painful so I can’t put a pain number on it.”
I understand it may not really be painful. Particularly if you’re an athlete with a high pain tolerance.
When you have a mild plantar plate sprain you must figure out what it is that you call discomfort or pain. You have to track it.
Does a mild plantar plate sprain always hurt?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
I just got off a webcam call in the Injured Runners Aid Station. The runner who called me, had some down with a cold.
He had been sick for a few days. He wasn’t running. He was curious about whether or not his injury was going to actually get worse while he was ill. Because he knows that when he’s sick, his immune system is working really hard to try to fight the infection. And your immune system can’t do everything all at once.
If you have an injury, it is widely accepted that the illness is going to slow down your potential ability to rebuild tissue and repair damaged tissue, whether a metatarsal stress fracture or an Achilles tendon injury.
Can my foot injury heal while I’m sick?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run podcast.
The plantar plate ligament is a little ligament on the bottom of the ball of the foot, right where the toe attaches to the foot. The function of the plantar plate ligament is to reinforce the joint and support the toe by helping to hold it down against the ground.
Anatomically, the plantar plate ligament resists the motion doctors call “dorsiflexion,” where the toe gets pulled up away from the ground.
Even though the plantar plate ligament is really small, its function is vital.
Doing exercises to help support the plantar plate, can help to decrease some load on the ligament.
Today on the Doc On The Run Podcast, we’re talking about the single most effective exercise to support the plantar plate in runners.
If you recently started getting some aching pain on the outside of your ankle every time you run, you might have a condition called peroneal tendonitis.
Peroneal tendonitis is a problem often encountered by runners with high arches. It can often be exacerbated by running in ultralight unstable shoes or running on trails when you’re feeling too tired to maintain good form.
The two peroneal tendons are both on the outside of the ankle. But they do different things. The way you position your foot to reduce the stress and strain on the one injured tendon, will have to be different because they each do different things.
Today on the Doc On The Run podcast, we’re talking about how to tell the difference between the peroneus longus and the peroneus tendon when you’re a runner.
If you get pain on the top of the foot when you’re running you might discover you have a painful condition called extensor tenosynovitis.
“Tenosynovitis” just means you have irritation and inflammation within the tendon sheath, or the little tube that surrounds the extensor tendons that fan out toward the toes on the top of the foot.
There are really 2 keys to calming the tendon sheath. You have to decrease the inflammation with the tendon sheath. But you also have to stop irritating the swollen tissue inside the tendon sheath.
The easiest way to stop that irritation when you run is to stop putting pressure right on that irritated spot.
Today on the Doc On The Run podcast, we’re talking about how to lace your running shoes when you have extensor tenosynovitis.
The other day in the Recovering Runner’s Aid Station, I got a great question:
“If I get stress and strain on my foot, because I’m overweight, should losing weight be part of the strategy to actually get my foot to recover as fast as possible?”
There are lots of ways to reduce the stress and strain on one injured part of your foot.
Obviously, the more your body weight, the more pressure on your foot when you stand, walk or run.
Sometimes doctors will tell patients, “If you weighed 20 pounds less or 40 pounds less, well, there’d be less stress and strain on your foot…and you would heal faster.”
But it’s an unrealistic strategy for several reasons.
Should weight loss be a part of your running injury recovery strategy?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
Yesterday I saw a runner with a plantar plate sprain. She wanted to know if stretching the toe would help the plantar plate ligament heal faster.
Plantar plate sprains happen because the plantar plate ligament gets overstretched, and strained.
When you get a plantar plate injury, the fastest way to allow healing is to reduce the stress and strain on that injured ligament.
If you’re thinking about whether or not to stretch the toe or do something to try to help the condition improve faster, you really need to think about the mechanics that are actually involved when you have a plantar plate injury.
Should you stretch the toe that has a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
Think about what happens when you start running.
You decide you want to run. You make a decision, then you go out and you actually run.
You start working on your running form. Maybe you hire a coach You add a little speed work. You also start doing some strength training to supplement your running fitness. Eventually you even start working on your pacing strategies for your races.
These are all things that are important pieces of running. But thinking about your pacing strategy when you haven’t even started running is a really bad idea. It doesn’t matter what you think about pacing if you can’t actually run the whole distance.
There is a most important piece, at each point in the process. This is especially true in running injury recovery as well.
Today on the Doc On The Run podcast, we’re talking about finding your number one missing piece in your running injury recovery.
Overtraining injuries only happen when you ignore a problem.
No runner wants to be injured.
Most runners who call me for web-cam visits have been tuning out the signs of impending injury…long before they actually got injured. You get an overtraining injury because you did feel something, but you ignored it.
Don’t forget…you could not become an accomplished runner if you were not capable of tuning out discomfort and putting in the work to become a strong runner.
But that works against you when you get injured.
Tuning out injury, tuning in for recovery and that’s what we’re talking about today on the Doc on the Run podcast.
I just did a web-cam call with a runner who had a thing called a “mallet toe” deformity. He had pain in the ball of the foot when running.
He said he was reading about plantar plate sprains, and thought, “Maybe I have a plantar plate sprain because I got this funky toe.”
He wanted to know if a mallet toe could cause a plantar plate injury.
Can a mallet toe cause a plantar plate injury?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
When we think about training for endurance events like marathons, we expect the payoff to feel good.
We are patient with the process, yet in the progression of building fitness, we always expect that when we have a breakthrough run, it’s going to feel great.
It is just not true.
When you do a run that is a lot longer, or a lot faster, you know you’ve made a breakthrough.
Breakthrough runs do not always feel great and that’s what we’re talking about today on the Doc On The Run podcast.
I was just watching an injured runner walk. We were trying to pin down her diagnosis and figure out why she was getting injured.
She asked me what I actually saw when analyzing her gait.
One of the things I saw was that she had this thing called extensor substitution.
She wanted to know how it contributed to the issues she has been having when she was running.
Today on the Doc On The Run podcast, we’re talking about extensor substitution in runners.
What happens when you look down at your feet as you run?
Many injured runners start looking down toward the injury, even as they run.
What do I mean by that?
We start to hunch over, our running form falls apart, and we do all the things that are completely counter to everything that we know about good running form.
If you’re running after an overtraining injury, you really need to keep your head up.
That’s what we’re going to talk about today on the Doc On The Run podcast.
If you are reading this because you are researching Achilles tendinosis, I’m sorry.
Achilles tendinosis is one of the worst injuries a runner can get.
Tendinosis is a serious problem and must be treated aggressively.
It is helpful to understand what you really need to do.
You also need to understand Achilles tendinosis treatments doctors often recommend, which you might want to avoid.
Today on the Doc On The Run podcast, we’re talking about Achilles tendon calcification in runners with tendinosis.
Let’s imagine you got injured. You are recovering. But you want to get your running fitness back.
One of the things that’s really important to think about…is what it takes to ramp up without getting re-injured.
Most runners ignore the weakness that predisposes them to injury in the return-to-running period.
To avoid that common trap, you must track your progress and pay attention to everything.
In this episode, I’m going to let you listen in on a recording from an actual live session in the Injured Runner’s Aid Station explaining the keys to ramping up and running without getting reinjured, while using the advantages that you already have with your runner’s mindset.
Today, on the Doc On The Run podcast, we’re talking about how injured runners cannot find a solution when refusing to even look at the problem.
In my experience, there are only two types of runners who really need a fracture walking boot to treat plantar fasciitis.
1. Runners who don’t mind losing all their running fitness.
2. Runners who were told they have plantar fasciitis, but actually have been given the wrong diagnosis.
Are you in one of those two groups? Then ask yourself…
Which kind of runners really do need a fracture walking boot for plantar fasciitis?
Is it somebody with mild plantar fasciitis, moderate plantar fasciitis, severe plantar fasciitis?
That’s what we’re talking about today on the Doc On The Run podcast.
One of the worst things when you’re an injured runner is to stop taking action.
Think about what would happen if you did this with a marathon. If you were to sign up for a race and you didn’t do anything to actually gain fitness in preparation for that event, would you expect to do well?
It blows me away when I see injured runners who have spent years in disciplined training, yet then when they get injured, they just sit in a puddle of inaction that keeps them stagnant and prevents them getting back to running.
Anxiety robs injured runners of action, and that’s what we’re talking about today on the Doc On The Run podcast.
I got a great question from someone who had a plantar plate injury. His toe was a little bit crooked.
He was wondering whether or not the position of the toe could determine whether or not plantar plate surgery would be necessary.
His question was,
“Do I really need to have surgery if my toe is crooked? Is that a good indicator of whether or not I need plantar plate surgery just because the toe is sitting out of position a little bit?”
I thought it might be helpful to explain when it might actually be necessary to have surgery, and when it might not be necessary to have surgery.
Does a crooked toe mean you have to have surgery for a plantar plate injury?
That’s what we’re talking about today on the Doc On The Run podcast.
Plantar fasciitis is one of the most common causes of heel pain and it’s also one of the most common reasons people actually go to the podiatrist.
The fastest way to get plantar fasciitis to calm down is to reduce the stress and strain to the plantar fascia ligament so that it’ll actually begin to heal.
So if you’re going to try to run, you have to do something to reduce the stress and strain to the plantar fascia ligament, while you’re running to make sure you aren’t over-stressing the fascia.
Today on the Doc On The Run podcast, we’re talking about where to run when you have plantar fasciitis.
Nothing will destroy your running fitness faster than wasting time on the wrong treatment. Second opinions are one of the most effective ways to ensure you are not wasting time monkeying around with the wrong diagnosis, or the wrong treatment.
That’s why I do lots of running injury second opinions over webcam.
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.
If you are a runner with a plantar plate sprain, you may be really frustrated.
Unfortunately, plantar plate sprains are difficult injuries to get better quickly. One key is to make sure it doesn’t come back once you’re running.
When I do second opinions for runners with plantar plate sprains, they ask…Should I have a cortisone injection?
The short answer is there are only two times when it makes sense to get a cortizone injection around the plantar plate.
Today on the Doc On The Run podcast, we’re talking about the only two times a cortisone injection makes sense for an injured runner with a plantar plate sprain.
Faith and doubt are both beliefs.
If you’re taking action to maintain your running fitness, you have Faith you’re going to get better.
If you’re doing nothing to maintain your running fitness it’s because you have Doubt.
No matter what the specific injury, there is always some action, some step you can take to gain confidence, move from Doubt to Faith and start getting back on the right track.
Which belief is running your injury recovery? That’s what we’re talking about today on the Doc On The Run podcast.
Is resting overrated for runners?
The short answer is yes, but I want you to think about something.
If it’s true in training, then it must be true in over-training injury recovery.
Whenever I am speaking at a medical conference and I say this, doctors in the audience tend to cross their arms and glare at me.
It seems even some runners scratch their heads when I say it. But it is true. And I want you to really think about this.
If it is true in your training, then it should be true in your over-training injury recovery. That’s what we’re talking about today on the Doc On The Run Podcast.
This episode actually comes from Eryn and she’s somebody who was listening to the Doc On The Run podcast and then sent in a question. She said that she was 10 weeks out after getting a dancer’s fracture in the fifth metatarsal while she was trying to qualify for Boston and getting ready.
What she said is, “I’m one week in using my EXOGEN bone stimulator one time a day for 20 minutes. I heard you say that you had a runner who healed after two weeks using the device.”
She also wanted to know about, “What else was your patient doing? Did they follow the standard protocol? Was he taking any supplements or other treatment to help the bone?”
Today on the Doc On The Run podcast, we’re talking about a dancer’s fifth metatarsal fracture in a runner who was training for Boston.
All day long I talk to injured runners and help them figure out what they could be doing differently to get back to running as quickly as possible.
I have realized is that the majority of injured runners are choosing, or have been told by a doctor, to follow one of four different running injury recovery strategies.
Today on the Doc On The Run podcast, we’re talking about the 4 strategies for running injury recovery.
In today’s podcast we have Patrick from the Running Lean Podcast here on the show, and you’re going to love this episode.
Patrick McGilvray is a podcast host, Licensed Primary Sports Nutritionist, NASN Certified Personal Trainer, UESCA Certified Running Coach, Master Life & Success Coach, experienced marathoner and ultrarunner, and The Weight Loss Coach for Runners.
Patrick helps runners properly fuel their bodies and their minds so they can achieve peak performance and optimal health and fitness.
Today on the Doc On The Run Podcast we’re talking about how “Running is NOT an effective weight loss strategy.”
I was just on a call with a guy who signed up for the Runner’s Aid Station and one of the things we were talking about is he had noticed that while he was doing some specific exercise I gave him to restore some of the balance to actually make him a little more stable and more efficient.
He noticed he was getting a lot of soreness in his leg.
He was actually explaining what he was getting in terms of muscle soreness and we discussed whether or not it was really a problem and something you really need to pay attention to.
Today on the Doc On The Run podcast, we’re talking about soreness in your leg when you’re working on your balance and you’re trying to get back to running after an injury.
What exactly is primary repair of the planter plate? Well, that’s a surgery where we actually go in and sew it back together. We fix it. We repair it. We do something to actually make it strong and hopefully heal again, so you can get back to running.
But we’re going to talk about three different methods for actually doing that and some of them are kind of similar.
They’re different approaches and they have different risks and benefits.
Today on the Doc On The Run podcast, we’re talking about three different techniques for primary repair plantar plate ligament surgery.
When other doctors ask me what I do, I tell them rather simply I help runners figure out how to stay fit, hang onto their running fitness and get back to running as quickly as possible.
The other day I was talking to a woman, who wanted my help and wanted to schedule a consultation, and she committed what I call the cardinal sin of runner-self-criticism.
She said, “I know you only work with runners. I only ran 2.65 miles yesterday, and so I am not really a runner.”
When she said that, I not only immediately thought of Jill Angie from the Not Your Average Runner Podcast…but I found myself quoting her!!!
The very next day I asked Jill if she would come back on the show to share some of her insight, wisdom and glowing energy with all of you today.
Today on the Doc On the Run Podcast, we’re talking about how you can get back to running in 30 days.
I have talked about this before in other episodes where you basically have four kinds of structures that you could consider having surgery on.
You could have bone surgery, you could have ligament surgery, tendon surgery, or joint surgery and of course, when you have an injury to only the ligament, the plantar plate ligament, you might be wondering why in the world would the doctor want to do surgery on the bone as well?
Today on the Doc On The Run podcast, we’re talking about why you might need bone surgery for a plantar plate ligament repair.
The worst runner to call me for a second opinion is someone who has been in a fracture walking boot or not running for 12 weeks or so.
Why is that so bad?
Well, they’re extremely aggravated. They’ve seen at least one doctor, probably a bunch of times. They’ve probably had several x-rays.
They’ve been waiting and waiting but they’re not getting better and they’re very upset about that.
Today on the Doc On The Run podcast, we’re talking about how waiting for an x-ray can cause you to miss your window with a stress fracture.
If you are a runner and you’re thinking about surgery, you’re probably maybe thinking about a second opinion, but maybe just doing your initial research, but some doctor has probably already suggested the idea of surgery to you.
This is one of the four categories is tendon surgery and we’re going to talk a little bit about that, about what it means, what tendon is actually operated on and what the procedures really entail so that you can understand that a little bit better.
Today on the Doc on The Run podcast, we’re talking about tendon surgery for plantar plate repairs.
In this episode we’re talking about stress fractures and we’re talking about what happens when you as a runner, wished something to be true and it’s not a fact.
It’s really important that you understand this.
Some of the wishes are things like, well, I want to run. The second one is I don’t want there to be a crack on my x-ray. Some facts are, well, my podiatrist took an x-ray and there was no crack.
So what does that do?
Today on the Doc On The Run podcast, we’re talking about stress fracture wishes as fodder for facts.
In today’s episode we’re talking about two different joint surgeries that are commonly performed as a component of plantar plate repair in injured runners.
This is a really important thing to understand. There’s two different kind of procedures. They both have different risks and benefits, and we’re going to talk briefly about them so you at least know what they are.
So if your doctor tries to sell you one of these procedures, you can at least know what you’re buying.
Today, on the Doc On The Run podcast, we’re talking about two different joint surgeries for plantar plate repair.
In today’s episode we’re talking about bias and bias, of course, is where somebody is already kind of made up their mind about what should be going on with you.
They’re biased, they’ve got a slanted opinion and that opinion is based on something other are than exactly what is going on with you.
When you get a second opinion, bias is the worst possible thing, because it’s very difficult for a doctor to change their mind once they think they know what’s going on.
Today on the Doc On The Run podcast, we’re talking about bias in second opinions for runners and how you can avoid it.
In today’s episode we’re talking about the four classes of procedures that affect four different anatomic structures in your foot when you have a plantar plate injury.
I think t’s really helpful if you’re really frustrated, you’re really demoralized and you’re in this very vulnerable place where it’d be easy for a doctor to talk you into surgery without you really understanding what’s going on.
That’s what we’re going to talk about today is give you a basic understanding of the four different kinds of surgeries that are offered to patients with these injuries so that you can make a better decision when you talk to your doctor.
Today on the Doc On The Run podcast, we’re talking about the four types of procedures you might get offered as surgical correction for a plantar plate sprain.
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.
A couple of years ago Martha was on the podcast talking about how hip arthritis has impacted her running and how she has been able to gain a different perspective on her running goals.
She is the host of the Martha Runs The World Podcast.
In this episode we are talking about some basic principles and strategies for resuming running after surgery or a major over-training injury.
Today on the Doc On the Run Podcast we’re talking about restarting and running again after surgery with Martha Runs The World.
This is the thing I came up with when I actually was thinking about what I do differently with runners now that I’ve been for about a decade, basically focusing just on injured runners, what do I do differently than when I had a normal practice where I saw everybody with any kind of foot problem?
Let’s think about what happens when you decide to run a marathon. Nobody just wakes up and says, I think I’m going to run a marathon today, it doesn’t work that way. What usually happens is you have something that triggers your desire to actually run a marathon.
We all know it’s really a big goal, we know it’s inspirational, and you decide that you want to do a marathon.
So, what do you do?
Today, on the Doc On The Run podcast, we’re talking about the Marathon Method of Running Injury Recovery.
Today’s episode actually comes from something I read in one of the running forums where someone actually was saying that they were confused.
They had been to see a couple of different doctors and had a couple of different recommendations because they had heel pain.
The heel pain was in a little bit of an unusual area, the heel pain wasn’t exactly on the bottom, the heel pain wasn’t exactly on the back and it was sort of in the middle, right at the back of the heel where it curves around and they wanted to know what to do.
Is it plantar fasciitis or insertional Achilles tendonitis? That’s what we’re talking about today on the Doc On The Run podcast.
Several years ago I had the honor of speaking with Gary and interviewing him for an episode of the Doc On The Run Podcast, called From 400 Pounds To Running 100 Miles.
At one point in his life Gary, was seriously overweight and weighed about 400 pounds. But he was able to not only lose that weight, he became a 100 mile ultramarathon finisher and even did Leadville.
Gary’s not just an incredible athlete but he’s also a personal development expert. Today were really fortunate to have him back on the show to share his wisdom, experience and inspiration
with you today.
“Success Is Spelled Action” and that’s what we’re talking about today on the Doc On The Run podcast.
Let’s say you have this aching pain in the ball of your foot. You’ve been running and when you run, you get some sort of weird aching soreness in the ball of the foot.
You just know it’s in the middle of the ball of the foot and it hurts more when you run and it hurts kind of after you run.
Well, you go see a doctor. They look at you, they poke around, and they say, “I think you have a Morton’s neuroma.”
Then later you figure out either because you got a second opinion, either or you sign up for the Plantar Plate Masterclass and went through those things and started self-diagnosing you figure out that you actually have a plantar plate sprain.
You get really confused about why it is that someone would misdiagnose you with a neuroma.
Can a plantar plate sprain be misdiagnosed as a Morton’s neuroma? Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run podcast.
I was just giving a talk recently at the IFAF where I was talking about protocols that I use with injured runners to help them get back to activity after common foot and ankle injuries that happen to runners.
The thing is, and what I was telling them is there are a few things that I use as protocols. When I say my protocol or a doctor says protocol for a stress fracture is six weeks in a boot or two weeks on crutches, that is their protocol and that is a cookie-cutter treatment plan.
So in many ways, those decisions are made before you even show up and see the doctor.
But what you really need is a customized treatment plan.
The best protocol for injured runners is a customized recovery plan and that’s what we’re talking about today on the Doc On The Run podcast.
If you’re a runner and you think you have a grade five stress fracture because your radiology report said that or some doctor told you that, well, I have some good news and some bad news.
The good news is, is that you don’t even have a stress fracture if you have a grade five stress fracture. It’s not a stress fracture at all.
The bad news is, is a grade five stress fracture, is what we call a non-union, where you had a stress fracture, but that stress fracture actually failed to heal.
You have basically an unhealed, and probably not going to heal, stress fracture, unless you do something.
What is a grade five metatarsal stress fracture? Well, that’s what we’re talking about today on the Doc On The Run podcast.
What are the three best ways to diagnose extensor tenosynovitis in runners?
Well, it’s pretty simple. They’re really three ways that I think are effective and they can work, all of them.
It’s not necessarily true that one is better than another, but they all three can work.
Today on the Doc On The Run podcast, we’re talking about something really simple, it’s the three best methods for diagnosing extensor tenosynovitis in runners.
The way that I thought about this episode today is that I just got off the phone, I was on a consultation with a runner and he has a plantar plate injury and he was planning on getting an injection to help the plantar plate sprain heal a little bit faster.
He asked me a question that really stopped me in my tracks. He said, “How long should I give it before I throw in the towel?”
I thought, well, are you planning for this to not work? I actually literally asked him that, I said “If you’re thinking about when you’re going to decide that this hasn’t worked, that means you have to be planning for it to not work.”
Today on the Doc On The Run podcast, we’re talking about why you should not focus on plan B.
This is a great question that I got from somebody on a call who actually signed up and enrolled in the plantar plate class for runners.
He was going through the plantar plate course and he was actually trying to figure out what to do, and he was going to jumpstart the healing process by using a fracture walking boot.
He tried it on and he noticed that he was feeling some pressure because the inside of the fracture walking boot is basically flat.
Today on the Doc on the Run podcast, we’re talking about two ways you can modify a fracture walking boot if you have a plantar plate injury.
I recently got a call from someone who had a son who was in cross country and he’s been having some trouble. He’s had several weeks of not running, and she wanted to get some advice on what to do.
I got an interesting response via email, where she wanted to know what free advice I had for her son.
First of all, I don’t give advice when I don’t know what the problem is. I didn’t really know the story with her son.
We didn’t do a consultation, and no physician is going to give you advice if they don’t actually know what your circumstances are.
Today on the Doc On The Run podcast, we’re talking about the best free advice for injured runners.
Believe it or not, most of the time when I see a runner, either on webcam or in their home, and they have shin splints, and they’ve been given a fracture walking boot, they need the fracture walking boot and maybe even more.
But what that really tells me when a doctor says you have shin splints but you need a boot, that it’s really that the doctor is uncertain about the actual diagnosis, because in my view, most of the time, if you have shin splints, you do not need a fracture walking boot.
Should I use a fracture walking boot for shin splints?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
I was just lecturing at the IFAF meeting in Lake Tahoe and I was giving a couple of different lectures on running injuries, and one of them was about the protocols that I use with injured runners so that they can maintain their fitness, stay fit, stay active, and keep running.
One of the doctors asked me about how I make these decisions and I explained to them was that the worst piece of advice I myself ever received as someone who was injured was when this doctor told me, “Just let pain be your guide.”
How can you as an injured runner use pain as your guide? Well, that’s what we’re talking about today on the Doc On The Run podcast.
Today’s episode is going to be a good one for you to listen to, if you’ve been told that you have a tibial stress fracture, or if you just think you might have a tibial stress fracture.
If you get a tibial stress fracture, the chances are really good that the doctor’s going to do something to really restrict your running, and potentially your ability to move around at all.
For example, if you get a fracture walking boot and it’s on your right foot, well, you can’t even drive a car so you’ve got to take this seriously.
Is a fracture walking boot enough when you have a tibial stress fracture and you’re a runner?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
One of the phrases I often tell injured runners is that “nothing in medicine is free.”
For every potential treatment that might help some particular injury, you pay for it in risk.
A fracture walking boot is one of the simplest and most-often-prescribed treatments for overtraining injuries in runners. And although fracture walking boots maybe inexpensive, treating your running injury with one is definitely not free.
Today on the Doc On The Run podcast, we’re talking about how nothing in medicine is free especially with running injuries.
Today’s episode actually comes from a question sent in by Shay.
She said, “I have a plantar plate complete tear and I had surgery on my left foot in October 2019. So that was a couple years ago. I’m running with some new issues in the right calf, but the main thing I want to learn is how this injury occurs. I’m really afraid of it happening to my right foot.”
I talk to injured runners all the time. I lecture at medical conferences, teaching doctors what I do with runners who have these plantar plate injuries and Shay is reasonable to be concerned about this.
Today on the Doc On the Run podcast, we’re talking about the three ways plantar plate injuries occur in runners.
This weekend I was lecturing at the International Foot & Ankle Foundation meeting in lake Tahoe, and I was lecturing on running injuries.
At the beginning of that lecture, I was asking the group of doctors there and I said, “Well, if you had a runner with a fourth metatarsal stress fracture and they had this level of pain and this level of disability and this level of complaint about it, how long would you expect to have them in a fracture walking boot?”
There was a doctor from Flagstaff, Arizona who actually raised his hand and he said, “It depends.”
I was shocked because normally, people say four weeks or six weeks.
Today on the Doc On The Run podcast, we’re talking about how I finally got the correct answer on how long before you can run after injury.
I just got off the phone with a runner who had a plantar plate sprain. He was out on a run, he got a plantar plate sprain.
I saw him, I helped him understand what to do and what I showed him to do was exactly the same stuff I show you in the plantar plate sprain course.
He was doing much better, but he had a great question.
His question was, “When is my plantar plate sprain really healed enough that I don’t have to worry about it anymore?”
Well, that’s a great question and that’s what we’re talking about today on the Doc On the Run podcast.
Yesterday I was giving a lecture at the International Foot & Ankle Foundation meeting in Lake Tahoe. The topic was on protocols for return to running after recovering from over training injuries.
One of the most important points I was trying to make to the doctors in that session was that fitness is transient.
Fitness is only present in the presence of growth. If you’re an injured runner this is terrible news.
Today on the Doc On The Run podcast, we’re talking about why running fitness is transient.
One of the worst overtraining injuries you can get is a plantar plate ligament sprain.
The plantar plate ligament is a very small ligament on the bottom of the foot, where the toe attaches to the metatarsal phalangeal joint, right at the ball of the foot.
Injuries can happen in this spot for lots of different reasons. Regardless of the plantar plate sprain cause, the unfortunate reality is this…every single time that you stand, you’re stepping on the ligament.
Why do plantar plate sprains take so long to heal?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
There are 2 types of injured runners who call me.
Some runners are over the hump. They are in motion.
They’ve accepted that they’re injured and they’re going to have to do a whole lot of work to actually get back to running quickly.
Then there are other runners I see who are basically demoralized and depressed because they’re stuck in a rut. Are you an injured runner or a recovering runner?
There is a difference, and that’s what we’re talking about today on the Doc On The Run Podcast.
I got a question from a runner who’s had a metatarsal stress fracture who’s very frustrated, who’s trying to figure out how to get back to running.
He went and saw a doctor and he was told that he had a stress fracture and the doctor told him to take some time off of running.
Then he started watching some YouTube videos, started listening to some podcasts, and then asked me a very serious question:
How long do I have to wait to run with a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On the Run podcast.
I just got off a consultation call with a runner who called me for a second opinion. She had an injury. But she wanted to get back to running.
She said that a doctor told her she “wasn’t built to be a runner.”
Could that be true? What does a runner look like?
Does it make sense that you are (or are not) built like a runner?
And what if you start thinking you got injured because… I’m not built to be a runner.
Well, that’s what we’re talking about today on the Doc On The Run podcast.
In this podcast episode we’re talking about one of my favorite false beliefs.
“Rest Equals Recovery.” The idea that rest is essential to recovery after a workout makes sense to most runners.
But injured runners call me for a second opinion when they are told that complete rest is essential to recovery from a running injury. It seems excessive.
So why do I say “Rest equals recovery,” is a “false belief?” That’s what we’re talking about today on the Doc On The Run podcast.
In this episode we’re talking about whether or not you can’t run just because you got a running injury and this is a thing I hear all the time from injured runners.
They call me because they’re frustrated because they’re runners, they got a metatarsal stress fracture, or a plantar fasciitis, or a plantar plate ligament sprain, or Achilles tendonitis.
They say, “My doctor said I can’t run because I got a running injury. Does that make sense to you?”
Well, that’s what we’re talking about today on the Doc On The Run podcast.
A running injury is always bad. No runner is ever happy to have a stress fracture or to have plantar fasciitis or Achilles tendonitis…or something worse.
If you get an overtraining injury and you’re trying to recover, but you’re not getting better fast, you need to stop and evaluate.
The biggest problem I see with most injured runners is that they half do the recovery.
You stop running. You stop working out. All you do is sit around.
You are waiting and waiting and waiting to heal. But all of that waiting puts injured runners in a dangerous place.
Today on the Doc On The Run podcast we’re talking about the slippery slope of running injury recovery.
If you are a runner with a plantar plate injury, it is pretty easy for a doctor to make a convincing sales pitch on surgery. There are a couple of reasons that you should consider surgery for a plantar plate sprain.
The first reason surgery makes sense is you tried everything else and nothing non-surgical will work.
But you have to be honest about your non-surgical attempts.
Here are some examples I often hear from injured runners.
“I used the fracture boot a little bit, but had to take it off to drive.”
I “sort of taped the toe.”
I used some pads, “but I’m not sure if they are in the right spot.”
You have to be honest with yourself about those treatments before you can say that you failed those treatments. that.
But when you have clearly failed all of the non-surgical treatments and you cannot get better, then and only then does surgery makes sense.
Should a runner have surgery for a plantar plate injury?
That’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
I was recently doing a webcam call with an injured runner who wanted to know whether or not he should try to work on his running form.
He got injured and he started to get better. But the injury kept coming back. He was in a cycle of yo-yo healing. Better, then worse, then better again.
After a big race he got a lot worse. His question was whether or not working on his running form might help halt the recurring running injury cycle.
Should an injured runner work on running form?
Well, that depends and that’s what we’re going to talk about today on The Doc on the Run podcast.
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.
I was just on a call with an injured runner who’s been having trouble for a couple of months. He wanted to know what to do next.
The very next step in most cases is getting baseline numbers so you can figure out where you really are with your fitness, your injury, and your recovery…or lack thereof.
You’ve got to take an honest inventory!
The whole key to getting recovered as quickly as possible is letting the injury heal…while you work to maintain your running fitness so that you can get back to running faster.
Today on the Doc On The Run podcast, we’re talking about taking an honest inventory when you’re a runner with an injury who’s trying to get back to running.
If you’re a runner with running pain on the top of the foot, it could be lots of different things.
The actual diagnosis depends on what happened, what you did, and what it feels like now.
There are a couple of really common things causing pain in the top of the foot in runners.
Let’s talk about two common causes. It may be either a tendon or a nerve on the top of your foot.
Today on the Doc On The Run Podcast, we’re talking about how a runner can tell tenosynovitis from neuritis in the top of the foot.
If you’ve got an overtraining injury and you’re trying to figure out how to stay fit, a lot of people are going to think that you’re not normal.
You’re not going to be told that you’re normal when you’re trying to figure out how to maintain your running fitness while you’re recovering from a running injury and that’s exactly what all the people do that I work with.
I call them injury hackers.
Today on the Doc On The Run Podcast, we’re talking about how injury hackers are not normal.
I just saw a comment on our YouTube videos from a runner named Mary. She viewed the video on permanent calf atrophy, and how that can happen if you spend way too long in a fracture walking boot or a cast.
Mary replied and basically said, “Great. Now you depressed the crap out of me. Thanks. Ugh.”
Realizing that you have lost fitness to the point of atrophy can be really upsetting for any runner.
Well, I’ve got some good news and some bad news for you, and that’s what we’re talking about today on the Doc On the Run podcast.
If you’ve been running and you started having pain on the outside of your foot and then you went to see a doctor who diagnosed you with a thing called a Jones fracture, you’re probably really worried right now and that would be reasonable because most of the time when you get a Jones fracture you might wind up in surgery.
I think it’s important, if you’re considering whether or not you could run with a Jones fracture, you really have to think about what a Jones fracture is, where it’s located, why it’s so scary, and what you can do about it. The first thing is, of course, what is a Jones fracture exactly?
Can I run with a Jones fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This may seem like a crazy question when you first think about it, because skiing seems like a high stress activity. But I have had lots of runners who have asked me this question, and usually when they do, they have thought about it, and they point out that a ski boot is a very stiff and very protective piece of equipment.
The question though is not really, if it’s safe for you to wear the boot, the problem is, is it safe for you to ski with the boot and that leads to several questions that you’ve really got to ask yourself if you want to think about whether or not it’s actually safe for you to do it.
Can I ski with a metatarsal stress fracture? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
If you rest long enough any overtraining injury will eventually calm down.
But if you rest too long, you will lose all of your running fitness.
The difference between elite athlete who get better fast, and average runners who take forever to recover are the daily activities they focus on while recovering.
Today, on the Doc on the Run podcast, we’re talking about the two most important questions for recovering runners.
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.