Doc On The Run Podcast

I know. You don't want plantar plate surgery. But if your plantar plate ligament doesn't repair itself, or your doctor doesn't help it repair itself, you might get talked into surgery. If you have plantar plate repair surgery, you may spend a lot less time running over the weeks following surgery...because you have to let it heal. There are really three mistakes that I see runners make when they've had a plantar plate injury. This episode will help you avoid them. What are 3 big mistakes runners make that lead to plantar plate surgery? Well, that's what we're talking about today on the Doc On The Run Podcast.

This episode comes from a question posted by one of the Doc On The Run YouTube viewers as a comment on the video “Where to run with plantar fasciitis.” In the video, I was trying to explain which surfaces can help you the most when you're trying to run with plantar fasciitis. The only way to do that is to make sure you are decreasing the stress and strain on the plantar fascia ligament. But the question was... Is the plantar fascia really a ligament? Well, that's what we're talking about today on the Doc On The Run Podcast.

There are three ways that a doctor might convince you that it's really time to have surgery and fix that plantar plate ligament that's been making you miserable when you've been trying to run. To you, it may not seem that bad. It kind of aches. It kind of swells. It kind of bugs you. But then the doctor suddenly says, “Look, it's not getting better, let's have surgery.” Well, how does the doctor convince you that it's time for surgery? What are the things a doctor does, that might actually lead you to believe that it really is time to have surgery? What are the three ways that a doctor might convince you that you need surgery if you're a runner with a plantar plate injury? 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 videos and it was specifically a comment that someone posted on one of the videos that was called “Five worst exercises for hallux rigidus”. This came from Matt and he asked: "When can you start doing push-ups again, if you have hallux rigidus?" Well, that's what we're talking about today on the Doc On The Run Podcast.

I'm not going to tell you that any runner should want to use crutches. I'm also not going to tell you that you will enjoy wearing a fracture walking boot. But there are reasons that you may want to do things a little differently if you're a runner. The critical issue is that runners must really try to speed up the healing process as much as possible, so that you can avoid losing your running fitness. What are the three time-sensitive problems solved when you use a fracture walking boot and crutches at the same time? Well, that's what we're talking about today on the Doc On The Run Podcast!

Most of the runners I see who have pain in the ball of the foot from a plantar plate sprain rarely start out with a completely torn plantar plate tear. More often, runners ignore the pain from the plantar plate sprain and it evolves into a full thickness plantar plate tear. Surgery is only needed when the plantar plate is torn in such a way that the plantar plate ligament cannot be expected to heal without surgery. But there are some mistakes that could lead a runner to the operating room. Plantar plate surgery is a failure to act quickly. That's what we're talking about today on the Doc On The Run Podcast.

Sometimes when you get injured and have to stop running, you start to lose your identity. One of the things that I notice most in runners who have gone weeks or months without running, is they are really bummed out. These runners seem really grumpy. In some cases, they don't even view themselves as a "runner" anymore...well, because they're "not running." If you want to heal and get back to running as quickly as possible this can be a real problem. How can self-judgment actually slow down your injury recovery when you have an overtraining injury as a runner? Well, that's what we're talking about today on the Doc On The Run Podcast.

I just had a consultation with a runner who had foot pain that she thought might be a stress fracture that had been coming and going for about a month. She had been increasing her training volume and doing strength exercises that are supposed to build her running fitness. The pain seemed to be volume related. The more training she did, the more she would notice the discomfort in her foot. But when we x-rays of her foot, the radiologist suggested this could be an "acute on chronic" stress reaction. What does that mean? What is the difference between a chronic stress reaction, or an acute on chronic stress reaction in a runner? Well, that's what we're talking about today on the Doc On The Run Podcast.

Just this morning, during the live Stress Fracture Masterclass I had an interesting question. The story went like this. An athlete who is a State ranked high school cross country and track, had to suddenly stop running due to intense pain that started about 15 days ago. He went and saw a doctor. He got x-rays. He got an MRI, had a physical exam where the orthopedic doctor poked around and tried to figure out what was going on. The Orthopedist gave on diagnosis, but the Radiologist suggested a different diagnosis. This is where the trouble comes in. So, the runner was told a couple of different things, 1) a stress reaction, or 2) stress fracture, possibly of A) the third metatarsal or B) intermediate cuneiform bone, at the base of the third metatarsal. Confused yet? So was this runner! What do you do if you think you have a stress fracture, you see an orthopedic doctor and the radiologist who reads your images s disagrees about your diagnosis. Well, that's what we're talking about today on the Doc On The Run Podcast.

Let's say you had an ankle injury a long time ago. You sprained the ankle when you were out on a trail run, it got better , and you went right back to running. But over time, you slowly got more and more pain in the ankle. In that case, you doctor might order an MRI of your ankle, or a similar imaging study called an MRA (instead of MRI). What's the difference between MRI or MRA in a runner with an old nagging ankle injury? That's what we're talking about today on the Doc On The Run Podcast.

I recently saw a runner who thought that he might have a tibial stress fracture. But it turns out, it was just shin splints, which of course is good news. Because you don't really want a tibial stress fracture. Shin splints is much easier to treat. One of the questions he asked me was about the best running shoes based on his foot type. This runner really needed more stability than got from the running shoes that he was wearing. What are two different ways shoes can actually cause shin splints in runners? That's what we're talking about today on the Doc On The Run Podcast.

If you got pain on the ball of the foot, at the base on the 2nd, and you have been running in a minimalist shoe, running uphill, doing lots of calf raises, or running on steps, you could have an injury to a little bitty ligament called the plantar plate ligament. If you get an injury to the plantar plate, sometimes your second toe will drift toward your big toe or away from your big toe. The toe drifting sideways can happen for two different reasons. They are very different causes and so they are treated differently. Why does the toe drift sideways when you have a plantar plate injury? Well, that's what we're talking about today on the Doc On The Run Podcast.

If you roll your ankle on a trail run and it turns black and blue and swollen, you may think you just have to take a few days off. In fact, if you research how long it will take to get back to running, you might find a study that says that if you do early range of motion after an ankle sprain, it only takes 4 days to get back to pre-injury levels of activity. However, if you do that, you can wind up with a lot of trouble later. When I lecture at medical conferences on how doctors should treat ankle sprains in runners, I teach 3 phases of ankle sprain injury recovery. If you are a runner with an ankle sprain, and you understand them, it'll help you get back to training and running without another ankle sprain. What are the three phases of ankle sprain recovery in runners? Well, that's what we're talking about today on the Doc On The Run Podcast.

Last night, I was doing a consultation with an athlete who had a fracture when she accidentally kicked a piece of furniture. Her foot was swollen, it was black and blue. The foot was really painful and she couldn’t walk on it. She went to urgent care and they took x-rays. She was a little concerned that they told her that it wasn't broken. So, she called me for a second opinion. My doctor missed a fracture on my x-rays. What should I do about that? Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.

If you're out on a run, and you have heel pain that suddenly hurts a lot, you may have a calcaneal stress fracture, especially if you see bruising and swelling. If you go see a doctor, they take an x-ray, and they don't see anything at all but they squeeze your heel and it hurts. The suspicion goes up. If your doctor gets an MRI that shows a calcaneal stress fracture, the doctor is probably going to tell you, "you can't do anything until the stress fracture heels." Today on the Doc On The Run Podcast, we're talking about calcaneal stress fractures in runners and I have some good news and some bad news.

Last night, I was doing a consultation with an athlete who actually broke one of her toes and her main question was: Can I compete in four weeks? I have a competition in four weeks, I want to compete. Do you think I'll be ready? Well, I actually told her, no joke, I actually said, “I'm very sorry, but my crystal ball is broken.” However, I can tell you how to figure that out because that is what I teach athletes to figure out when they do the Fast Track challenge. I have a broken toe and I want to compete in four weeks. Is it possible? Well, that's what we're talking about today on the Doc On The Run Podcast.

Yesterday, I went to an appointment with a friend who had an appointment with an orthopedist. She had 3 fractures. She wanted to know what she could do in terms of activity while she's healing and recovering from these different injuries. I just went with her, not as her physician, but to serve as a friend and advocate for her at her appointment. This episode is going to explain why you really need to take an advocate with you to any doctor's appointment. I went to an orthopedic appointment yesterday and they told me to come back in four weeks. What do I do now? Well, that's what we're talking about today on the Doc On The Run Podcast.

Yesterday, I was doing a consultation with an athlete who broke one of her toes when she accidentally kicked a piece of furniture. If you fracture your toe, and you just run and ignore it, it can turn into a painful nonunion (non-healed fracture). As a runner, you want to speed the healing as much as possible. One of the ways to stimulate fracture healing is with a thing called a bone stimulator. This particular athlete actually happened to already have a bone stimulator. Her question was pretty obvious: “Can I just use that bone stimulator for this broken toe since it's a different kind of fracture?” Well, that's what we're talking about today on the doc on the run podcast.

If you're a runner with heel pain you may think you have plantar fasciitis. But if it is not getting better, your heel pain may be caused by "neuritis." I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe. I was giving a lecture called “When Heel Pain is NOT Plantar Fasciitis in Runners.” One of the conditions I was talking about was "medial calcaneal neuritis." One of the doctors in the audience asked a really great question... He said, “I see a lot of people that have Baxter’s neuritis, and it's down on the bottom of the heel it's plantar , it’s not on the side of the heel, it’s not medial neuritis, it's different. What would you do to tell the difference between these two conditions in a runner, given the circumstances you just explained in the talk?” Today on the Doc On The Run Podcast we're talking about medial calcaneal neuritis versus Baxter’s neuritis in a runner.

I recently did a consultation with a runner who had gotten a plantar plate injury. He had been getting better by using some of the tricks I teach in the Plantar Plate Course For Runners. He got better, he was protecting it, he reduced the stress and strain on the ligament, and he got back to running. He was doing great. But then he had a setback when he went to the synagogue. He was dressed up and wearing some fancy dress shoes, and he started to get plantar plate pain again. Today on the Doc On The Run Podcast, we're talking about how dress shoes with a long toe box can actually work as a lever against your plantar plate.