Doc On The Run Podcast

Is there any difference healing a stress fracture vs. traumatic fracture?

I saw a runner who had a traumatic fracture, but she had been told it was a stress fracture. This did not make sense to her, because her injury wasn't from training for a race. 

She was trying to understand the difference in healing between a stress fracture with a crack when compared to the healing time of a traumatic fracture with a similar crack.

It's important to understand they were talking about similar cracks in similar bones that remain in a similar position. We're not talking about broken bones that are displaced.

If you jump off a ladder, you break the bone and it's moved out of position, that is a completely different story. Stress fractures don't generally get displaced as much as traumatic fractures. 

If there's a crack in the bone because of a stress fracture, the bone is not displaced. But how does that compare to similar (non-displaced )traumatic fracture?

Is there any difference in healing between a stress fracture versus a traumatic fracture?

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

 

Should I take NSAIDs for a non-union in a runner?

A metatarsal fracture "non-union" is what doctors call it when you broke the bone, it started to heal, but then the fracture kind of quit healing. Usually it means you got a bunch of scar tissue between the ends of the bone. 

Sometimes that happens without you or your doctor realizing it. The problem gets worse if you start running on it.  

The question is, "should I take non-steroidal anti-inflammatory drugs (or NSAIDs)? 

NSAID's are medications like ibuprofen and naproxen. These drugs are not steroids, but they stop inflammation. Many runners take them for all kinds of aches and pains after training. The question is, is it a good idea or not when you may have a metatarsal fracture non-union?

Should a runner take non-steroidal anti-inflammatory medications for a non-union? 

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

What causes most of the pain when I have a stress reaction?

If you get a metatarsal stress fracture, the first thing that you're going to notice is not that you have a broken bone in your foot. 

You are going to notice pain. 

Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it. 

The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs. 

As I explained this to a runner in the Injured Runners Aid Station, she asked "What really causes the pain?"

What causes most of the pain when you have a metatarsal stress fracture? 

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

When is a boot better than crutches for tibial stress fracture in a runner?

A stress fracture in your tibia, or shin bone, is a bad injury. You definitely don't want the crack to grow to the point where it could break. 

The big question is what will make a tibial stress fracture better, faster...crutches or a fracture walking boot? 

When is a fracture walking boot better than crutches for a tibial stress fracture if you're a runner? 

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

3 ways to tell if a fracture non-union is stable without imaging

This episode comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery. 

I was looking at her CT scan and she asked me an interesting question. 

She said, 

“Does it look stable?” 

And I said, “Can't tell.” 

It looks like a non-union. It looks like it’s broken and never healed.

What are the three ways you could tell whether or not a metatarsal fracture non-union is stable without getting an imaging study? 

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

What is a phalanx avulsion fracture in the big toe joint?

50% of your body weight goes through the big toe joint when you run. So, If you get a fracture in the big toe joint, it can be a serious problem.

One type of fracture in the big toe joint is called an avulsion fracture. 

I was just doing a consultation with a runner who had a phalanx avulsion fracture in the big toe joint. I wanted to show you what it really is and so that you can understand it better and what it might actually mean in terms of your returning to running.

What is a phalanx avulsion fracture in the big toe joint? 

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

What is better than NSAIDS for a stress fracture in a runner?

Non-steroidal anti-inflammatory drugs (or NSAIDs for short), like Ibuprofen and Naproxen, what we call  are extremely popular with runners because they get rid of lots of aches and pains. 

We often think inflammation results from hard exercise, so it stands to reason a non-steroidal anti-inflammatory will actually help after a long run.

I don't normally recommend runners take NSAIDs as a part of a training routine.

But there are a couple of alternatives that I would recommend over non-steroidal anti-inflammatory drugs.

What's better to take than non-steroidal anti-inflammatory drugs for a stress fracture in a runner? 

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

Difference between a mild stress fracture and a serious stress reaction in a runner?

I had a call with a runner who asked me an interesting question about the difference between a mild stress fracture and a serious stress reaction in a runner. She wanted to know if the difference was based on the amount of tenderness or pain that she had. 

Although it stands to reason that the more tenderness, the more pain you have, the worse it must be. However, that is not really what differentiates a mild stress fracture from a serious stress reaction. 

What's the difference between a mild stress fracture and a serious stress reaction in a runner? 

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

 

Worst time to check gout with a blood test (when you have pain)

If you get gout, it's going to be painful. It hurts because you get so much uric acid buildup in your bloodstream that it starts to crystallize, forming little bitty needle shaped crystals in the joint.

They are pointed, they're sharp and they are poking the tissue on the synovial tissue inside of the joint, and it hurts. 

When is the worst time to check for gout with a blood test? 

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

Can EPFR get me back to running?

Every runner who has heel pain wants it fixed. 

A lot of us think about this in the way that we fix automobiles. The alternator goes out in your car, you go get a new one put in. Your battery dies, you go get a new battery. But your foot doesn't work this way. So unfortunately, when you have surgery, you're trading one problem for another.

I have done endoscopic plantar fascia release surgeries, but not on any runners for more than a decade. Why do you think that is? 

Can an endoscopic plantar fascia release surgery get me back to running faster? 

Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.