Bởi Dr. Christopher Segler

I was recently on a follow-up call with a runner who is recovering from a calcaneal stress fracture. She was doing really well, the stress fracture was healing, and her heel pain had completely resolved. So it was time to start ramping up her running. Since she wanted strategies to decrease stress on the stress fracture, we talked about increasing …

If you get a metatarsal stress reaction, you might be confused for a number of reasons. First You are probably trying to figure out whether or not it is really just a subtle stress fracture or, if it is something more ominous? Second, you are also probably trying to figure out how to make the pain go away as fast as possible so you can get back to …

I just got a really obscure question from a runner suffering from chronic stress fractures. She was asking about a surgical procedure called a tibialis anterior tendon lengthening in order to address a situation where she had the same kind of 5th metatarsal stress fracture, again. Today on the Doc on the Run podcast, we're talking about tibialis an…

If you sprain your ankle, you know that you need to protect it. The old treatment algorithm used to be R.I.C.E.: rest, ice, compression and elevation. The newer protocol is P.R.I.C.E.: protection, rest, ice, compression and elevation. Compression is one of the main things you need to do when you get an ankle sprain. When you sprain the ankle, it sw…

Sometimes runners have to do a whole lot of digging trying to figure out the difference between a couple of different surgical solutions for a recurring injury. Pain under the big toe joint can be because you are getting a stress reaction or a stress fracture in one of the two little sesamoid bones. It is pressure to that bone that is causing all t…

I got a call from a worried runner who had a stress fracture. The fracture was not healing so he called for a second opinion. One of the things that he did not understand was this x-ray report that he got. The x-ray report and it said that he had "two millimeters of displacement of the fractured metatarsal bone without angulation." So, in this epis…

The plantar plate ligament that gets injured in runners is typically located on the bottom of the foot, at the base of the second toe. It gets inflamed, it gets irritated, it may feel weird at first. The plantar plate may not even feel sprained, or sore, or injured. It might just feel like this weird sort of fullness sensation. I got a question fro…

I got a call from a runner who had a stress fracture that was not healing, who needed a second opinion. When we were on the webcam call, one of the things that he did not understand was the specific medical terms on his MRI report. The MRI report said that he had "troughing" of the fractured metatarsal bone. I just thought that it might be helpful …

I was on a call with an active athlete who is recovering from a couple of different injuries and her main goal is to get back to running at high intensity. But while she has been injured and she cannot really run, what she has been doing is cycling, swimming, and doing a number of different strength training workouts to supplement her running fitne…

When you have a plantar plate injury, it can be frustrating. The whole problem stems from a tiny little ligament right at the base of the second toe that is getting irritated, stretched, and strained. If its really bad, you might even have some tiny little tears in the plantar plate ligament. I was just talking to a runner who asked me about other …

I get lots of calls from runners who need a second opinion for running injuries like metatarsal stress fractures. Many times they are confused by medical terminology in their imaging reports. In this particular case, the runner wanted to know what it meant when her radiology report said that there was "5 millimeters of shortening of the second meta…

I was just on a call with a trail runner who is recovering from both a sesamoid bone injury as well as a peroneal tendon injury. Right now she is focusing on working toward running on long technical trail runs in the mountains. To that end she is doing a lot of different forms of activity to supplement her running fitness. During our call, she aske…

If you are a runner and you got diagnosed with a plantar plate sprain, you probably already figured that out plantar plate sprains can be frustrating. The plantar plate ligament is on the bottom of the foot, at the base of the second toe and it helps hold the toe down against the ground. What is crossover toe deformity? Well, if you look at the foo…

Today's episode comes from a question that I got during a second opinion webcam call with a recovering runner. She is running, she is doing fantastic, and she wanted to know if she should hire a running coach. By the way, this is a very experienced, very fast marathon runner. After injury recovery, do I need to hire a running coach? Well, that is w…

Today's episode comes from a question posted in the comments section of one of the Doc On The Run YouTube channel videos. Specifically, it came after a viewer watched the video entitled Top Three Clues of a Plantar Fascia Rupture and Davis posted a question. He wanted to know, does a full or partial plantar fascia rupture greatly increase your risk…

I was just on a follow-up webcam call with a runner who has chronic ankle instability but wants to get back to running on trails. She is trying to decide when it is safe for her to make the transition from running on a smooth, flat surface like asphalt to running on uneven technical trails. Since she had a long time off of running for a long time a…

If you are a runner, and you have pain in the ball of the foot, and you have been diagnosed with a plantar plate sprain, you probably already realize you are in for a lot of trouble. It is very difficult to get the plantar plate ligament to heal while you are still running. If you caused a plantar plate injury by hyperextending the toe, then obviou…

What if I told you that you could skip two days and avoid an overtraining injury altogether? Well, if you are injured, you would probably go back and skip any two days I picked on your calendar, right? Overtraining injuries are preventable. You do not get overtraining injuries because you ran too much. You get overtraining injuries because you did …

Today's episode comes from a question that was posted as a comment on one of the videos on the Doc On The Run YouTube channel about the difference between a stress reaction and stress fracture in the fibula in runners. He said: “Hey, I really appreciate the video, I go to the gym a lot and I was doing the treadmill at maximum speed and one day my f…

I was just on a follow-up call with a trail runner who has chronic ankle instability. She had some follow-up questions about some of the exercises I gave her to do. Gluteus medius weakness is known to contribute to ankle instability. One of the exercises I gave her will strengthen the gluteus medius muscle. She asked a very specific question about …

I was just on a webcam call with a runner who had a plantar plate injury. We were reviewing her MRI. And one of the first things I did was check to see how big the slices were on the MRI. That's because there can be a wide variation on how tight those cuts are when the MRI imaging machine is taking those pictures. Believe it or not, there's researc…

I have a great question from a runner who was injured and is now recovering. She is getting better, she is back to running, she is advancing her mileage, she is increasing her strength, and her stability. And she asked me during a call whether or not she should follow some specific formula to get back to running. She asked me about the "10% rule." …

Last night I was on a follow-up call with a trail runner who had chronic ankle instability. She was working hard to get strong enough to run on trails without worrying about rolling her ankle. One of the things that she was working on was proprioceptive retraining. "Proprioception" just means your ability to tell position and space. She called me a…

I was recently on a second opinion web cam call with a runner who had a plantar plate injury. One of the things we were talking about as was managing the inflammation in the joint next to the sprained plantar plate ligament. The plantar plate ligament is basically a thickened plate of collagen that helps hold the toe down against the ground and rei…

I just got off a second opinion consultation call with a runner who called because he thought he had a stress fracture, and he asked a great question... He said, “Well, I don't get it. It hurts every time I run, but it doesn't hurt when I walk. So, that means I don't really have a stress fracture, right?” Does a stress fracture always hurt when wal…

Have you ever had a toenail turn black and blue, and maybe even got so much of a bruise that the toenail fell off? A lot of runners think of bruised toenails as a badge of honor for doing super long runs and completing marathons. But you do not want toenails to fall off! Believe it or not, I have had runners ask me if I would permanently remove the…

One of the questions I often get from runners is whether or not they can get a clear indication that the overtraining injury has healed enough that they can start running. This is most common with stress fractures and plantar plate injuries, and things like Achilles tendonitis. All of these injuries, regardless of which specific one it is, whether …

I was just on a call with an injured runner who had what she thought was a stress fracture. We were talking about the way bone stress injury shows up on an MRI. We all would like to believe MRI creates a perfect picture. It is true that there is a tremendous amount of images and information that you can get from an MRI, but you have to understand t…

Just this morning, I was on a second opinion call with a runner who had an issue. He said, “It is only going to take a few minutes. I would not even use the entire time because I have a simple problem.” Every time I do a consultation, I try to see if I can compare the right foot versus the left foot. I wanted to see both of his feet and he just sho…

Every time a runner calls me who signs up for a consultation and they want a second opinion, they have already seen a doctor and they are often very frustrated. They are very frustrated because they were in a boot for a long time and it did not help, or they were told to not run for months, and it did not help. I hate to tell you this but almost ev…

One of the most common injuries I see in runners is a stress fracture. All overtraining injuries in runners are stress induced injuries and a stress fracture of course implies too much stress applied to the bone. A stress fracture is not a problem that you get not because you ran too much, not because you ran too far, or too soon. Stress fractures …

Anything the runners does to heal faster will get the runner back to running faster. Even simple things you can do at home can help change the course of an injury. On of the oldest treatments for musculoskeletal injury, and one any runner can do themselves, is massage. A runner on webcam just asked me whether or not it might help her plantar plate …

Runners who have rolled their ankle often have trouble figuring out when to get back to running. Mostly they seem to be worried about a subtle fracture or delayed ligament healing. If you think it is no big deal when you roll your ankle, you might be right, and you might be wrong. What is the number one most important action you can take when you r…

I know if you call me for a consultation, it is not because you want to talk to me because you watched a YouTube video or listened to a podcast, it is because you have a race and everybody else is telling you there is no way you can do it. Well, that may be my specialty, but today I am going to help you understand how you can figure this out yourse…

I recently posted an episode that was talking about four different kinds of stress and strain that can be applied to the plantar plate ligament that might slow down the healing of that little bitty ligament in runners. I got a couple of questions about that and one of them was specifically about how to tell whether or not that is really a problem a…

If you have a pain in the ball of the foot, underneath the base of the toes, that is right where your fat pad cushioning is located. There is a lot of misunderstanding about what fat pad atrophy really is, particularly when it is related to something like a plantar plate injury. Sometimes runners have true fat pad atrophy, but that is rare. More of…

I know I talk a lot about how necessary it is to reduce the stress and strain on the plantar plate ligament when you are a runner, especially if you are trying to get ready for a race while healing. It is really difficult to do, but not impossible. What are the four forms of stress and strain that can affect runners with plantar plate injuries? Wel…

I am going to make a statement and see if you agree with me. “Rest is bad, and exercise is good.” Do you agree? Almost every runner who calls me for a second opinion consultation has been injured, has been told they have to rest, and they have been told they cannot exercise in order to get better. Sometimes that is true. But 100% rest is rarely the…

I was just on a call with an injured runner who has been healing from a plantar plate sprain. If you have had one of these, you know they're problematic. The thing was that he asked me a question that really made me stop and think. What he asked was, “Is stress good or bad for the plantar plate ligament?” Well, that is what we're talking about toda…

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 m…

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. Sh…

Bởi Dr. Christopher Segler

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 elsewhe…

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 significant…

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. Sh…

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 misdiagnos…

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 h…

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…

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 surg…