Doc On The Run Podcast

Should I work out today if I did not sleep well last night?

I was on a call this morning with a former professional Ironman triathlete. This guy is the real deal. He is not lazy. 

He is not unmotivated. He is not unathletic. He is a top tier kind of athletic guy, and he is very, very aware of his body. He is also very adept at the process of damaging tissue we call "training" and the need for healing those tissues to make his body stronger.

What he also understands is that the process of healing a ligament sprain (or "injury") is the same thing. 

During our call this morning, he pointed out that he barely slept last night. Since his plan was to ride on the trainer today, we were talking about the risk to the sesamoids. 

He used a term I had not heard before, calling it "multifaceted negatives."

Should I work out today if I did not sleep well last night? 

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

Should I just wait 4 weeks with a fibular stress fracture?

I got a question from a runner with a fibular stress fracture.

She said her primary care doctor got r x-rays of the fibula bone.

The doctor could not tell from the x-rays if the spot on my fibula that looks odd might be an old stress fracture or a new stress fracture in the fibula bone.

The recommendation from the primary care physician was basically to just wait for four weeks, let it heal, let it calm down. 

She asked:

“Is my primary care doctor's advice wrong?"  

Should I just wait for weeks to let my fibular stress fracture heal? 

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

How does taping help tibial sesamoid stress fracture in a runner?

I was on a call with a patient who was a professional Ironman triathlete. He had a tibial sesamoid stress fracture.

The sesamoid bones are little bones underneath your big toe joint. They are kind of like tiny little kneecaps that you stand on. And when you are trying to heal one, AND maintain your fitness, it can be a real challenge. But a couple of little tricks can help.

How does taping a tibial sesamoid stress fracture actually help you heal when you are an injured runner? 

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

The doctor’s job is not to tell you stop running

I was just lecturing at the International Foot and Ankle Foundation meeting in Hawaii. 

In the very first talk, I asked one of the doctors sitting on the front row, 

"What is your most important question about this patient?” 

And he answered, “How did it start?” 

I replied, “You do not care about how it started, you do not even care about the injury, you should care more about the runner's goals.”

You probably go to the doctor because your foot hurts, and you want your doctor to fix your foot. If you go there with that approach, that is exactly what you're going to get.

Any doctor can fix your foot, but you need the doctor to focus on your running goals instead.

What is the doctor's job when you have a running injury? Well, I can tell you what it is not. It is not to tell you to stop running. 

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

Can a doctor do hammertoe surgery on a runner with only a needle

Today's episode comes from a runner who asked me a very interesting question during a surgical second opinion webcam call.

She seemed to be really confused because the doctor had recommended performing hammertoe surgery in the doctor's office, and not an operating room. 

She thought that was weird. She was also confused because the surgery would be performed using only a needle and not a scalpel.

Can a doctor really do a hammer toe surgery using nothing but a needle? 

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

Timelines force decisions and action in injured runners

Last week, I was in Hawaii lecturing at the International Foot & Ankle Foundation Medical Conference. meeting.  

I had been invited to give several lectures on running injuries. One of those was about stress fractures for physicians, podiatrists, foot and ankle surgeons.

One of the objectives was to help them understand how they can look at stress induced injuries differently, with the intent of teaching the doctors that they really have to consider these timelines.

Timelines, forced decisions and action in injured runners, and that is what we're talking about today on the Doc On The Run Podcast. 

Does a mallet toe lead to plantar plate sprain in a runner?

Plantar plate injuries in runners are a common topic at medical conferences because they cause a lot of pain in the ball of the foot. 

I just spoke to a runner who had an interesting question about plantar plate injuries, which was a question I never would have imagined.

She wanted to know whether or not a "mallet toe" might lead to a plantar plate sprain.  She didn't really understand the difference between a "mallet toe" and a "hammer toe."  But she did understand that one or both are in some way related to plantar plate injuries. 

Does a mallet toe lead to a plantar plate sprain in runners? 

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

When is it okay to take NSAIDs with a running injury

Today I was on the call with an injured runner who is trying to figure out how soon she can start running. She had been having pain and she was getting relief by taking over-the-counter medication. She asked me whether not that was good or bad.

Whenever we have pain, we can simply take a pill, and the pain will go away. Non-steroidal anti-inflammatory drugs or NSAIDs are powerful readily available painkillers. I do not just get rid of inflammation they also control or reduce pain.

So, when is it okay or not okay to reduce your pain with NSAIDs if you are in the process of recovering from a running over training injury?

That is a great question and that is what we’re talking about today on the Doc On The Run podcast!

Can cryotherapy fix my accessory navicular

Today I was doing a consultation with a runner who has a thing called an "accessory navicular."

She thought that the bump was much more swollen than normal. 

She had basically rolled her ankle and banged that bone into a rock and then she was having some swelling there over the arch.

She did a form of cryotherapy called the contrast bath routine to reduce the inflammation.  It suddenly got much smaller. Like the bone shrank.

How can that happen? 

If I have an accessory navicular bone in my foot and I do the contrast bath routine, will that fix it? 

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

Toenail fungus oral medication liver testing options for runners

Okay...I'm just gonna say it...lots of runners get funky toenails. Runners get bruised toenails, black toenails. 

But the worst thing  is when the nail lifts up off the nail bed and you get fungal filaments that cause athlete's foot underneath the toenail. Then you get toenail fungus or onychomycosis.

If your doctor recommends oral antifungal medications, you may get worried about the side-effects of the medication.

Just today I saw a runner with toenail fungus. He wants it gone!

So I was talking to his primary care doctor about the potential of modifying the normal routine for oral medication for him so that he could reduce his concern for having liver problems as a consequence of taking this medication. 

Today on the Doc on the Run podcast, we're talking about a couple of options you have if you are thinking about taking oral medications for toenail fungus.