Doc On The Run Podcast

Cuboid stress fracture vs. Degenerative changes in OS Peroneum. How can a runner tell the difference?

If you have been running with a nagging aching pain on the outside of your foot, just in front of your ankle, you might think you have a cuboid stress fracture. 
 
If you then get an x-ray of the foot and it shows a tiny little extra bone sitting just next to the cuboid, well that bone has a specific name and it is called an Os Peroneum. 
 
Sometimes you can get pain from the Os Peroneum, sometimes you can get pain from the cuboid bone that's right next to it. 

If you're a runner and you have Os Peroneum pain, how do you tell the difference from a cuboid stress fracture? 
 
Well, that's what we're talking about today on the Doc On The Run podcast.

 

Cuboid stress fracture vs. Calcaneocuboid joint arthritis. How can a runner tell the difference?

If you call me and you tell me, I think I have a cuboid stress fracture, the first thing I'd say is...pretty unlikely. 
 
In fact, cuboid stress fractures are less than 1% of all the stress fractures that happen in the foot in athletes. 
 
So they really are very rare. 
 
One thing you can get that's actually much more common is arthritis within the joint. That's also pretty rare, but you can tell the difference.
 
How can a runner tell the difference between a cuboid stress fracture or calcaneocuboid joint arthritis? 
 
Well, that's what we're talking about today on the Doc On The Run podcast.

 

Cuboid stress fracture vs. Subluxed cuboid. How can a runner tell the difference?

"Subluxed Cuboid" is just a cuboid sitting slightly out of position. 

Stress fracture of the cuboid is very different from a subluxed cuboid. 

If you have this aching pain on the side of your foot, and you've been told maybe it's "cuboid syndrome" or a "subluxed cuboid," but it's not getting better, you could have a thing called a cuboid stress fracture. 
 
The reason you probably weren't told it was a cuboid stress fracture is that, first of all, those are really rare. Cuboid stress fracture is less than 1% of all stress fractures in the foot.
 
If you're a runner and you call me, say, "Hey, I really need to do a webcam call because I think I have a cuboid stress fracture," the first thing I would think is...probably not. 
 
But you might and, if you do, you do not want to ignore it because a cuboid stress fracture, when ignored, gets worse over time.
 
What's the difference between a cuboid stress fracture and a subluxed cuboid, and how can you tell the difference if you're a runner? 
 
Well, that's what we're talking about today on the Doc on the Run podcast.

Cuboid stress fracture vs. Peroneus longus tendinitis. How can a runner tell the difference?

If you are a runner and you've had pain on the outside of your ankle or the outside of your foot, kind of near the heel you may have been told that you have peroneus longus tendinitis. 

Sometimes peroneus longus tendinitis is the wrong diagnosis. You might actually have a cuboid stress fracture. 

Which one's worse? 
 
Well, I'll tell you that in terms of really destroying your ability to run, definitely an ignored cuboid stress fracture is worse.
 
How can you tell the difference between a cuboid stress fracture and peroneus longus tendinitis? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast.

Cuboid stress fracture vs. truly fractured cuboid bone. How can a runner tell the difference?

If you're a runner who has been told that you have a cuboid stress fracture, you might be worried that there's an actual crack in the bone.
 
A visible crack on x-ray is what I think of when I picture a truly fractured cuboid bone. There is a huge difference between a cuboid bone with a crack, vs. without a crack. 
 
The cuboid bone is an irregular bone. It's small, but it's important. It sits right in between your heel bone and the fourth and fifth metatarsal bones.
 
When you roll your ankle and your foot rolls under you, you can compress the cuboid and crack it. 
 
Repeatedly compressing the cuboid can lead to a stress fracture in the bone. 
 
What's the difference between a cuboid stress fracture and a truly fractured cuboid bone? 

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

 

Cuboid stress fracture fundamentals for runners

If you are a runner and you get an aching pain on the top of the foot, and it's not getting better, you might have this weird thing called a cuboid stress fracture. 

Cuboid stress fractures are often misdiagnosed as an "ankle sprain" or "foot sprain." 

The cuboid bone is positioned in a way that it can get squished in between the other foot bones. 

Cuboid stress fractures can cause a lot of trouble if you ignore it, because it can get worse and turn into an actual fracture.

Even worse, the weakened cuboid bone can get crushed completely if you ignore it.

Today on the Doc On The Run podcast we're talking about cuboid stress fracture fundamentals for runners.

What happens if you run with a neuroma pad in the wrong place?

Just today I was seeing a runner during a house call and he had a neuroma. So, understandably, he put a neuroma pad in his shoes.

When he was running, his neuroma suddenly got way worse!

I asked him what happened.
 
He said, "I moved it a little bit. I moved it from where you put it before and I thought it would take more pressure off, but I think it actually made it worse and it really flared it up."
 
What happens if you run with a neuroma pad in the wrong place? 
 
Well, that's what we're talking about today on the Doc on the Run podcast. 

Foot Fungus Pro Tip: Wear old socks to the airport

I was just speaking at a medical conference in Las Vegas, and of course I flew on a plane to get there. 
 
To me, as a podiatrist, the most dangerous two spots in the airport are in the security screening line. 

I don't like standing on those yellow footprints in the security scanner spots because I think it's a little gross to stand without shoes, where thousands of people a day step barefoot. 

I see people in airports with fungal toenails and with athlete's foot infections. I can see the skin on their feet peeling, and I know exactly what's happening. 
 
When that skin is peeling they are shedding live fungal filaments and fungal spores everywhere they step.

And I worry that travelers are depositing, sharing and spreading foot fungus on those yellow footprints. 
 
Want a foot fungus pro tip? Well, I'm going to give you one. Wear old socks to the airport.

It might be kinda gross, but that's what we're talking about today on the Doc On The Run podcast.

PRP science explained. PRP vs. Corticosteroid vs. Placebo injections.

If you are a runner with a painful tendon or ligament issue like chronic plantar fasciitis, Achilles tendonitis or plantar plate sprain that just won't get better, you might have done some research into injections and found a thing called a PRP or "platelet-rich plasma injection."

The way that PRP injections are marketed by some doctors, you might think that it's mostly unicorns and fairy dust, but there is some actual science behind platelet-rich plasma.  and the effect that it can have on these tendons and ligaments that aren't healing very well. 

Corticosteroid injections have also been around for a much longer time. 

Both types of injections can be used as treatments for tendon and ligament sprains in runners.

The question is whether or not there is any real scientific evidence to support Platelet Rich Plasma injection or Corticosteroid injections for chronic tendon or ligament injuries. Is one injection any better than the other?

PRP science explained. Is there a difference between PRP injections, corticosteroid injections, and placebo? 

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

Are you hiding from your injury?

The #1 concern all injured runners face is time. 

How long will I have to use crutches.

How long will it take the surgery to heal.

How long will I have to wear a fracture walking boot. 

How long will I have to stop running.

How much running fitness will I lose in that time.

I feel like most of the runners who call me for a second opinion over webcam are making a critical mistake. They are hiding from the injury.

Are you an injured runner who's hiding from your injury?

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