Doc On The Run Podcast

Is time or range more important with gluteus medius activation exercise?

I was just on a follow-up call with a trail runner who has chronic ankle instability. She had some follow-up questions about some of the exercises I gave her to do. Gluteus medius weakness is known to contribute to ankle instability. One of the exercises I gave her will strengthen the gluteus medius muscle. She asked a very specific question about fixing injury when you have identified a weakness, and you are trying to get back to running. Which is more important, time or range of movement when ...

How big is the plantar plate ligament?

I was just on a webcam call with a runner who had a plantar plate injury. We were reviewing her MRI. And one of the first things I did was check to see how big the slices were on the MRI. That's because there can be a wide variation on how tight those cuts are when the MRI imaging machine is taking those pictures. Believe it or not, there's research that shows how big the plantar plate ligament usually is. How big is the plantar plate ligament? Well, great question and that is what we're talking...

How should I ramp up my mileage after injury?

I have a great question from a runner who was injured and is now recovering. She is getting better, she is back to running, she is advancing her mileage, she is increasing her strength, and her stability. And she asked me during a call whether or not she should follow some specific formula to get back to running. She asked me about the "10% rule." How should I ramp up my mileage after I have been injured but I am returning to running? Should it be by percentage? Should it be by miles? What is it...

Should I do proprioceptive retraining exercises before or after I run?

Last night I was on a follow-up call with a trail runner who had chronic ankle instability. She was working hard to get strong enough to run on trails without worrying about rolling her ankle. One of the things that she was working on was proprioceptive retraining. "Proprioception" just means your ability to tell position and space. She called me about a week later and she asked: “Should I do proprioceptive retraining exercises for my ankle before or after I run?” Well, that is a great question ...

How does chronic synovitis lead to plantar plate injury?

I was recently on a second opinion web cam call with a runner who had a plantar plate injury. One of the things we were talking about as was managing the inflammation in the joint next to the sprained plantar plate ligament. The plantar plate ligament is basically a thickened plate of collagen that helps hold the toe down against the ground and reinforces the bottom of that joint capsule. Inflammation in the joint which doctors call "synovitis" can damage the plantar plate. The chronic inflammat...

Does a stress fracture always hurt when walking?

I just got off a second opinion consultation call with a runner who called because he thought he had a stress fracture, and he asked a great question... He said, “Well, I don't get it. It hurts every time I run, but it doesn't hurt when I walk. So, that means I don't really have a stress fracture, right?” Does a stress fracture always hurt when walking? Well, that is a great question, and that is what we're talking about today on the Doc On The Run Podcast.

#1 most worrisome problem with toenail lost to running

Have you ever had a toenail turn black and blue, and maybe even got so much of a bruise that the toenail fell off? A lot of runners think of bruised toenails as a badge of honor for doing super long runs and completing marathons. But you do not want toenails to fall off! Believe it or not, I have had runners ask me if I would permanently remove their toenails so that they would no longer get black toenails. But I do not recommend it. What is the number one most worrisome problem when you lose a ...

Should I get an MRI to tell me if I can run now?

One of the questions I often get from runners is whether or not they can get a clear indication that the overtraining injury has healed enough that they can start running. This is most common with stress fractures and plantar plate injuries, and things like Achilles tendonitis. All of these injuries, regardless of which specific one it is, whether it is a tendon, a ligament, or a bone, you want to know if you can start running and if it is healed. And it makes sense that you would want to get an...

What are the 3 types of bone edema on MRI in a runner with stress fracture

I was just on a call with an injured runner who had what she thought was a stress fracture. We were talking about the way bone stress injury shows up on an MRI. We all would like to believe MRI creates a perfect picture. It is true that there is a tremendous amount of images and information that you can get from an MRI, but you have to understand that most of the imaging of bone on MRI is not really looking for a crack. It's looking for trouble in the form of inflammation or edema within the bon...

Always closely compare right foot vs left foot with a running injury

Just this morning, I was on a second opinion call with a runner who had an issue. He said, “It is only going to take a few minutes. I would not even use the entire time because I have a simple problem.” Every time I do a consultation, I try to see if I can compare the right foot versus the left foot. I wanted to see both of his feet and he just showed me the one that was hurting. I told him I needed to see the other one and he said it did not hurt and it did not matter, but it does matter. It is...

Doctor’s job vs. Runners job in healing overtraining injury

Every time a runner calls me who signs up for a consultation and they want a second opinion, they have already seen a doctor and they are often very frustrated. They are very frustrated because they were in a boot for a long time and it did not help, or they were told to not run for months, and it did not help. I hate to tell you this but almost every time I talk to one of these runners who is justifiably truly upset because the doctor did not listen to them about their goal. But the problem is ...

3 ways stress fracture in a runner turns into non-union

One of the most common injuries I see in runners is a stress fracture. All overtraining injuries in runners are stress induced injuries and a stress fracture of course implies too much stress applied to the bone. A stress fracture is not a problem that you get not because you ran too much, not because you ran too far, or too soon. Stress fractures only result when your training exceeds the bone's threshold to recover before your next workout. If you keep doing that, it could get much worse. What...

Can I massage the foot with plantar plate sprain

Anything the runners does to heal faster will get the runner back to running faster. Even simple things you can do at home can help change the course of an injury. On of the oldest treatments for musculoskeletal injury, and one any runner can do themselves, is massage. A runner on webcam just asked me whether or not it might help her plantar plate injury recover faster. The short answer is: Yes, massage can help as along as you do not injure the plantar plate ligament further in the process. How...

#1 most important action when you roll your ankle running

Runners who have rolled their ankle often have trouble figuring out when to get back to running. Mostly they seem to be worried about a subtle fracture or delayed ligament healing. If you think it is no big deal when you roll your ankle, you might be right, and you might be wrong. What is the number one most important action you can take when you roll your ankle running? Well, that is what we're talking about today on the Doc On The Run Podcast.

How to calculate amount of rest between running injury and a race

I know if you call me for a consultation, it is not because you want to talk to me because you watched a YouTube video or listened to a podcast, it is because you have a race and everybody else is telling you there is no way you can do it. Well, that may be my specialty, but today I am going to help you understand how you can figure this out yourself. It is not really that complicated, it is just that other doctors do not want to tell you how to do it, so I am going to try to explain it to you. ...

Compressive stress on plantar plate in runners

I recently posted an episode that was talking about four different kinds of stress and strain that can be applied to the plantar plate ligament that might slow down the healing of that little bitty ligament in runners. I got a couple of questions about that and one of them was specifically about how to tell whether or not that is really a problem and one person wanted to know if they had a dropped metatarsal if that might be contributing to this issue of compressive stress. Today on the Doc On T...

Fat Pad Displacement vs. Atrophy in runners with plantar plate injury

If you have a pain in the ball of the foot, underneath the base of the toes, that is right where your fat pad cushioning is located. There is a lot of misunderstanding about what fat pad atrophy really is, particularly when it is related to something like a plantar plate injury. Sometimes runners have true fat pad atrophy, but that is rare. More often runners have fat pad displacement that feels like atrophy. I think that fat pad displacement is more common than atrophy, and I am going to try to...

Difference between plantar plate stress and strain

I know I talk a lot about how necessary it is to reduce the stress and strain on the plantar plate ligament when you are a runner, especially if you are trying to get ready for a race while healing. It is really difficult to do, but not impossible. What are the four forms of stress and strain that can affect runners with plantar plate injuries? Well, that is what we're talking about today on the Doc On The Run Podcast.

Single leg exercise benefits for injured runners

I am going to make a statement and see if you agree with me. “Rest is bad, and exercise is good.” Do you agree? Almost every runner who calls me for a second opinion consultation has been injured, has been told they have to rest, and they have been told they cannot exercise in order to get better. Sometimes that is true. But 100% rest is rarely the case in runners. Unless you fell off the roof and broke your back and both, then you can probably use one of your legs to exercise and maintain some ...

Is stress on the plantar plate ligament bad for runners?

I was just on a call with an injured runner who has been healing from a plantar plate sprain. If you have had one of these, you know they're problematic. The thing was that he asked me a question that really made me stop and think. What he asked was, “Is stress good or bad for the plantar plate ligament?” Well, that is what we're talking about today on the Doc On The Run Podcast.

Fat Pad Atrophy: withering away or wearing away?

Let me ask you to read 4 words and see how they land on you. Skinny, weak, atrophy, neglect. As a runner, would you want any of those words used to describe you? When the fat pad cushion between the bones and the skin under the heel or the ball of the foot gets thinner, doctors call it “atrophy.” But don’t take it as an insult. What really causes more atrophy of the fat pad cushion under the ball the foot in runners…inactivity, or too much activity? Well, that’s what we are talking about today o...

Biggest mistake doctor can make in runner who was on crutches

I was just giving a lecture at the 46th annual International Foot & Ankle foundation meeting at the Swedish Medical Center in Seattle. A foot surgeon in the audience asked a great question during the question-and-answer period following one of my lectures. Specifically, the lecture was medical imaging strategies to avert misdiagnosis in runners. She asked, “After a runner has been offloaded with crutches and placed in a fracture walking boot or a cast for immobilization, do you incorporate c...

Endoscopic surgery for chronic plantar fasciitis in runners

Is taping the sesamoids good or bad for swelling?

I was recently working with a runner who had really bad sesamoid issues. She was taping it to try to decrease some of the motion around the big toe joint that could have been irritating the sesamoid bones. She had a bunch of tape around the forefoot holding everything still. Weird thing was, she did not have swelling there. She had swelling elsewhere. Is taping the sesamoids good or bad if you have swelling in the foot? Well, that is a great question and that is what we're talking about today on...

Ankle exercises for plantar plate?

I was on a call with a runner, and he has had a long history of plantar plate trouble. He had a whole bunch of different treatments, done time in a fracture walking boot and then got worse when he started running a number of different types. He was very frustrated. Over the last month since we started working together, he has been doing significantly better than he ever has in a year and a half. I had him do a couple of things over the last week. It made a huge difference for him that he noticed...

What summer sandals can I wear with sesamoiditis?

If you get an aching pain under the big toe joint, it might be an injury to one of the two little bones called the sesamoid bones. The sesamoid bone injuries make me super nervous. If you are a runner and you start getting pain and irritation if the sesamoids, you do not want to ignore it. I just got off a call with a woman who had sesamoiditis. She wanted to make sure that she was not doing anything to slow the recovery of her sesamoid stress fracture. With summer coming up, she wanted to know ...

Can I run after cortisone injection for a neuroma?

I was just on a second opinion call with a runner. He is a triathlete, and he has had a long course of foot trouble. He was diagnosed with a plantar plate injury, but was not getting better. We figured out some missing pieces of his recovery puzzle and developed a plan of action. Well, he acted on that game plan and turns out he had been misdiagnosed. What he has is a neuroma (not a plantar plate sprain). He went back to his doctor and she then wanted to inject his foot with cortisone, but he ha...

Single most important stretch for Sesamoid fracture in runner

If you get a sesamoid fracture, you are probably worried. This is a scary injury if you are a runner. Since stretching is one of the main components of physical therapy after many running injuries, you may think about stretching and why it might help your injury recover faster. What is the single most important stretch if you are a runner who has had a sesamoid fracture? Well, that is what we are talking about today on the Doc On The Run Podcast.

Should I expect to have plantar plate pain when I resume running

One of the most difficult running injuries is a plantar plate injury. I know, because I have had a plantar plate sprain myself. Plantar plate sprains are really frustrating because the plantar plate is a very small ligament. It takes very little to aggravate or stress the plantar plate, to irritate it, to stretch it, strain it, or injure it further when you are running. I had a patient who asked a really interesting question. He said: “Should I expect to have pain as soon as I start running?” I ...

Surgical options sesamoid fracture nonunion

If you have a fractured sesamoid bone, the biggest concern is that the sesamoid fracture will turn into a fracture nonunion. "Non-union" means it did not unite. The two broken pieces did not get back together, and the fractured sesamoid bone did not heal. I was talking to a runner who had a sesamoid injury and she wanted to know whether or not surgery was a good option in her case. We talked broadly speaking about three different possible kinds of sesamoid surgeries. Today on the Doc On The Run ...