Doc On The Run Podcast

How your running shoe insert can show risk of plantar plate sprain

One of the worst injuries you can get when you're a runner is a plantar plate sprain. It's a stretching, a straining, a tearing of this tiny little ligament at the ball of the foot called the plantar plate. 

Every time I do a second opinion consultation over webcam for a runner with a suspected plantar plate sprain,  I ask them to do one simple thing. 

I want to look at the insert in their running shoe: "Go get it, right now, preferably one you've been running in for a long time, not a brand new one." 

Pull out the insert and let's see what the wear pattern shows us. 

Today on the Doc On The Run Podcast, we're talking about how your running shoe insert can actually show whether or not you're at risk of a plantar plate sprain. 

How an injury happened is more important than what happened

During a recent call with a runner who signed up for a series of phone calls, we were trying to figure out exactly what happened to cause his foot pain. 

 The way that doctors are taught to think goes something like this:  Come up with a particular name called a "diagnosis" and then do a "procedure" that the insurance covers.

 Doctors focus on making sure the diagnosis code matches the insurance requirements so they will send a check.

This process does not serve runners well. Runners need to focus on how they got injured...so they do not do it again. 

 How an injury happened is much more important than what happened. 

 Does that make sense? 

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

The 4 worst traits of a running shoe for Morton’s neuroma

One of the most common nerve related running injuries is a thing called Morton's neuroma. A "neuroma" is just an irritated nerve. A "Morton's neuroma" occurs specifically in the foot between the 3rd and 4th toes.

When a neuroma first starts, the nerve is just a little bit irritated, and it may feel a bit weird.

In one of the original descriptions of Morton's neuroma, it described a sensation or feeling of wet leather being stuck to the bottom of the foot. That odd sensation is the result of the nerve getting aggravated. It starts to send little erroneous signals to your brain.

 

If the nerve is getting irritated, you want to make sure your running shoes are not making it worse. 

What are the four worst traits of a running shoe if you have a Morton's neuroma? 

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

When is an MRI most reliable for a soft-tissue running injury?

If you have a soft tissue injury in your foot related to overtraining, you (or your doctor) may be thinking about getting an MRI.

If you have a ligament injury, plantar plate sprain, partial tear of the plantar fascia, an Achilles tendon partial rupture, Achilles tendinosis, or peroneal tendinitis,  the timing of the MRI is extremely important.

MRIs can be really useful tools. They give you over a hundred images of your foot. Because you have so many pictures, the detail can fool you into believing the MRI is a complete picture, but it is not. 

When is an MRI most reliable for a soft tissue running injury? 

Well, that's what we're talking about today on the 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.