Doc On The Run Podcast

How to tell soft tissue vs bone injury in a runner

All overtraining injuries are difficult. 

The problem is that you're trying to not lose your running fitness while giving the injured part enough of a rest so it can actually heal.
 
A runner asked me an interesting question the other day, he actually said, “Okay, if I have bruising and swelling, does that mean I'm more likely to have a bone injury or a soft tissue injury?”
 
What are the key differences between a soft tissue injury and a bone injury in a runner? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast. 

Was the plantar plate ligament injured before my MRI?

I was recently doing a second opinion consultation with a runner over a webcam to review the MRI of his foot. 
 
What we found was that he had what looked to be attenuation and a partial tear in the plantar plate ligament on his MRI. 
 
There was a lot of inflammation in the foot around the ligament, not just within the ligament itself. 

He asked me was really good question:
 
“Could my plantar plate ligament been have injured long before I ever got an MRI?”
 
Well, that's what we're talking about today on the Doc On The Run Podcast. 

Running injuries are like compounded interest in reverse

Every runner who gets injured is in a race against time.  

It is a race to not lose your running fitness. 
 
You know you are going to get weaker. You know you're going to get stiffer. You're probably really concerned that you're going to lose all that aerobic fitness that took months or years building up.
 
Running injuries are like compound interest but in reverse. 
 
That's what we're going to talk about today on the Doc On The Run Podcast. 

When to worry an ankle sprain is a Lateral Process Fracture

I just saw a runner who sprained her ankle.  It's been about a month and she's still having pain. Pain and swelling persisting a month later, are not good. There are a couple of reasons that that can happen. 
 

Anytime doctors see persistent swelling and pain after an ankle injury, they become concerned there might be a fracture. 
 

When should a runner who rolled an ankle be concerned that there might be a fracture like a lateral process fracture? 
 

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

Worst imaging study for plantar plate injury in runners

If you are a runner with pain in the ball of the foot at the base of the second toe and start researching online, you may become concerned you have a thing called a plantar plate injury. 
 

If so, you may be wondering whether X-rays or MRI imaging may be needed to tell what is wrong. Before seeing a doctor, it may be helpful to understand which are helpful, and which imaging studies are a waste of time. 
 

What is the worst possible medical imaging study you could get if you're a runner with a suspected plantar plate injury? 
 

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

My pinky toenail split in half

Just this week, I got a call from an injured runner about a new problem. I've seen him before for some other issues, but in this case.

He said that he thought maybe he actually had an ingrown toenail on his pinky or that the toenail itself had split in half and it was bugging him a little bit.

I said “Well, send me a picture. I'll take a look and see.”

My pinky toenail split in half. Is that a problem?

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

When to add weight bearing exercise with stress reaction

Today's episode comes from a YouTube viewer who posted a question, 
 
“I have a low risk grade stress reaction in my posterior tibia. Interestingly, there is some research discussing the benefits of weight bearing bone building exercise once tolerated pain free, like hops jumps and step ups. Do you have any advice on when and how to integrate these types of exercises into a rehabilitation program?” 
 
When is it okay to add weight bearing exercises when you've had a bone injury like a stress reaction? 
 
That is what we are talking about today on the Doc On The Run Podcast.

Could peroneal tendon pain really be a nerve problem?

Today's episode comes from a YouTube viewer named John, who wrote in with a question about nerve pain vs. peroneal tendon pain. 
 
He said ”I'm experiencing discomfort in my fifth metatarsal/peroneal tendon below the ankle. There is no swelling. However, upon hamstring stretch, especially in a downward dog position, this area feels like it's on fire. The fact that I cannot do downward dog right now, with my right heel down. I'm starting to think this may be a nerve. It's been hurting for about 10 days.”
 
Could peroneal tendon pain really be a nerve problem? 

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

Are “stress reaction” and “metatarsalgia” the same?

Today's question comes from one of the YouTube viewers. Tasnim, wrote in and wanted to know whether or not "stress reaction" is the same terminology that is used in the UK for the term "metatarsalgia". 
 
This question points out how confusing these two terms can be when you have forefoot pain that might be a stress fracture, might be a plantar plate sprain, or could even be a neuroma. 
 
Are stress "reaction" and "metatarsalgia" the same terms? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast. 

Is there always bruising with a plantar fascia partial rupture in a runner?

You're out on a run, and you suddenly start having extremely sharp heel pain.

You think it's plantar fasciitis. 

But when you look at your foot, you see a huge bruise. 
 
That's not plantar fasciitis. That's where you ripped something. 
 
Is there always bruising with a partial rupture or a tear in the plantar fascia? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast.