Doc On The Run Podcast

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 make them worse very, very quickly. 

It's really important when you get a plantar plate sprain to identify the one thing that caused the injury so you stop doing it.

Today on the Doc On The Run Podcast, we're going to talk about my advice for a flat-footed runner who has a plantar plate injury that started from running on a treadmill.

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 true motion control shoe?"

Can I wear softer shoes when running with a custom orthotic?

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

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 MRIs, X-rays, CT scans, and all the medical imaging they wanted (but could not track the runner's pain), I bet I would get runners back to running faster.

Find the one thing that causes the most pain when you're running.

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

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 whether or not you're at risk for a metatarsal stress fracture?

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

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. 
 
You also start to lose your identity as a fit runner. 

We all feel good when we run. We feel good when we accomplish goals. We feel good when we do a long run at a good pace. 

But all that gets washed away when you're sitting around recovering from an injury.
 
Your identity needs to be that of a recovering runner. 
 
That's what we're talking about today on the Doc On The Run Podcast. 

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 heel bone.
 
She noticed a lot of stiffness and irritation around the ankle joint, because she'd been immobilized and off of the foot for quite a long time. Anytime you use a boot or crutches, you get lots of indiscriminate scarring. You can't run unless you fix that.
 
Is stretching safe with a calcaneal stress fracture? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast.

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 or not. 

Did the MRI miss my plantar plate sprain?
Can the MRI show me the actual crack in the bone?
Where is the tear in the tendon or ligament?
 
This episode on the size of the slices might help you. It will also help you a lot if you're going in to get an MRI because you have an injury and your doctor is going to order an MRI.
 
Today on the Doc On The Run Podcast, we're talking about MRI essentials for runners, slice size matters. 

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 time. 
 
After you wallow in tears, you decide to be a "good patient." You go with the plan.

You sit around in the boot.

You don't do anything. 

You don't take the boot off. 

You don't run.

You don't exercise. 

And a month or two later...you finally get clearance to run!

But when you first go for your run, everything feels super stiff! Your running form is terrible. You feel really slow. But more than anything else, you really notice how super stiff everything feels around the ankle.

Today on the Doc On The Run Podcast, we're talking about how ankle stiffness can lead to another stress fracture in a recovering runner. 

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 what structure could be damaged.  Then you can decide whether or not it's dangerous for you to ramp up your activity.

If a doctor gives you a vague answer that usually tells me that the doctor doesn't know what's going on. 

But if you really think about where the pain is, AND the mechanics of rolling your ankle during an ankle sprain event... you can figure it out!

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

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