Doc On The Run Podcast

Fat Pad Atrophy: withering away or wearing away?

Let me ask you to read 4 words and see how they land on you.

Skinny, weak, atrophy, neglect. 

As a runner, would you want any of those words used to describe you?

When the fat pad cushion between the bones and the skin under the heel or the ball of the foot gets thinner, doctors call it “atrophy.”  But don’t take it as an insult. 

What really causes more atrophy of the fat pad cushion under the ball the foot in runners…inactivity, or too much activity?

Well, that’s what we are talking about today on the Doc On the Run Podcast!

Biggest mistake doctor can make in runner who was on crutches

I was just giving a lecture at the 46th annual International Foot & Ankle foundation meeting at the Swedish Medical Center in Seattle.

A foot surgeon in the audience asked a great question during the question-and-answer period following one of my lectures. Specifically, the lecture was medical imaging strategies to avert misdiagnosis in runners.

She asked,  “After a runner has been offloaded with crutches and placed in a fracture walking boot or a cast for immobilization, do you incorporate cross training, or only focus on running?”

What is the one biggest mistake any doctor can make with a runner who has been on crutches? 

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

Endoscopic surgery for chronic plantar fasciitis in runners

Is taping the sesamoids good or bad for swelling?

I was recently working with a runner who had really bad sesamoid issues.

She was taping it to try to decrease some of the motion around the big toe joint that could have been irritating the sesamoid bones. 

She had a bunch of tape around the forefoot holding everything still. Weird thing was, she did not have swelling there. She had swelling elsewhere. 

Is taping the sesamoids good or bad if you have swelling in the foot? 

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

Ankle exercises for plantar plate?

I was on a call with a runner, and he has had a long history of plantar plate trouble. He had a whole bunch of different treatments, done time in a fracture walking boot and then got worse when he started running a number of different types. 

He was very frustrated. 

Over the last month since we started working together, he has been doing significantly better than he ever has in a year and a half.

I had him do a couple of things over the last week. It made a huge difference for him that he noticed right away.

Do I need to do ankle exercises if I had a plantar plate sprain? 

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

What summer sandals can I wear with sesamoiditis?

If you get an aching pain under the big toe joint, it might be an injury to one of the two little bones called the sesamoid bones. 

The sesamoid bone injuries make me super nervous. If you are a runner and you start getting pain and irritation if the sesamoids, you do not want to ignore it. 

I just got off a call with a woman who had sesamoiditis. She wanted to make sure that she was not doing anything to slow the recovery of her sesamoid stress fracture.

With summer coming up, she wanted to know what kind of sandals she might be able to wear.

What summer sandals should I wear if I have sesamoiditis? 

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

Can I run after cortisone injection for a neuroma?

I was just on a second opinion call with a runner. He is a triathlete, and he has had a long course of foot trouble. He was diagnosed with a plantar plate injury, but was not getting better. 

We figured out some missing pieces of his recovery puzzle and developed a plan of action.

Well, he acted on that game plan and turns out he had been misdiagnosed. What he has is a neuroma (not a plantar plate sprain).

He went back to his doctor and she then wanted to inject his foot with cortisone, but he had a race coming up.

And then he said, “Well, this is the problem. This is why I am calling you again, is that when I saw her, she said you have a neuroma so let's go ahead and inject it with cortisone.”

Can I run a race after a corticosteroid injection for a neuroma? 

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

Single most important stretch for Sesamoid fracture in runner

If you get a sesamoid fracture, you are probably worried. This is a scary injury if you are a runner. 

Since stretching is one of the main components of physical therapy after many running injuries, you may think about stretching and why it might help your injury recover faster. 

What is the single most important stretch if you are a runner who has had a sesamoid fracture? 

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

Should I expect to have plantar plate pain when I resume running

One of the most difficult running injuries is a plantar plate injury. 

I know, because I have had a plantar plate sprain myself. 

Plantar plate sprains are really frustrating because the plantar plate is a very small ligament. It takes very little to aggravate or stress the plantar plate, to irritate it, to stretch it, strain it, or injure it further when you are running. 

I had a patient who asked a really interesting question. He said:

“Should I expect to have pain as soon as I start running?”

I basically said, “Well, if you do, you are doing it wrong, because if you are having pain, you are stretching and straining the ligament in the way that is predictably going to re-injure it.”

Should I expect to have some pain when I return to running after healing a plantar plate sprain? 

Great question and that is what we're talking about today on the Doc On The Run Podcast.

Surgical options sesamoid fracture nonunion

If you have a fractured sesamoid bone, the biggest concern is that the sesamoid fracture will turn into a fracture nonunion.

"Non-union" means it did not unite. The two broken pieces did not get back together, and the fractured sesamoid bone did not heal. 

I was talking to a runner who had a sesamoid injury and she wanted to know whether or not surgery was a good option in her case. 

We talked broadly speaking about three different possible kinds of sesamoid surgeries.

Today on the Doc On The Run podcast, we’re talking about surgical options for sesamoid fracture nonunion.