Doc On The Run Podcast

How long should I use crutches?

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...

Plantar wart treatment options in runners

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 restaurantwith 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....

Bone bruise vs stress reaction in a runner

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 ...

FHL tenosynovitis PRP injection vs. Cortisone injection

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 cortis...

How pneumonia made my Kona dream come true

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 do...

What is subungual melanoma?

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 p...

FHL Tenosynovitis vs Sesmoiditis

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...

697 Hallux rigidus shoe traits for runners

Work out now or do more workouts later

Most important tibial stress fracture detail is location

Andrea ran 3:09 in the Tokyo Marathon with calcaneal stress fracture!

Don’t ask when can I run after an injury… Ask how I can 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 bac...

Plantar Plate Sprain and Deep Peroneal Neuritis

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? To...

Can I run every day on the Alter G treadmill?

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 trai...

Can I run after a spiral fracture of the fibula?

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 i...

How your running shoe insert can show risk of plantar plate sprain

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 on...

How an injury happened is more important than what happened

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 o...

The 4 worst traits of a running shoe for Morton’s neuroma

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 ...

When is an MRI most reliable for a soft-tissue running injury?

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 believi...

Advice for flat footed runner with plantar plate injury started on a treadmill

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 I wear softer shoes when running a custom orthotic?

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 tr...

When is an MRI most reliable for a bone running injury?

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.

Find the one thing that causes the most pain

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 MR...

How your running shoe insert can show risk of metatarsal stress fracture

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 whe...

Your identity needs to be that of a recovering runner

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. Yo...

Is stretching safe with a calcaneal stress fracture?

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...

MRI essentials for runners, slice size matters

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...

How ankle stiffness can lead to another stress fractures in a runner

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 t...

I rolled my ankle and foot hurts here. What is it?

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 ...

MRI essentials for Runners, T1 vs T2 images

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 wa...