Doc On The Run Podcast

I just got off of a Stress Fracture Strategy call with a real runner who has been suffering from a stress fracture for 47 days.  Over the past five weeks she has been getting worse, not better. And she hasn't even been running for more than a month! If you have a stress fracture, or a stress reaction and you are: 1. worried about canceling race because of a stress fracture 2. your stress fracture is not getting better fast enough 3. worried you're going to lose your running fitness waiting for the stress fracture to heal  This episode will help you understand the strategies I use whenever I worked directly with runners with stress fractures, and apply those strategies to help you figure out how to speed up your stress fracture recovery.

Today on the Doc On The Run Podcast we are talking with Alexandre Dufresne about his journey and getting back to running after having suffered 2 metatarsal stress fractures at same time! If you think back about your training leading up to the 2 stress fractures, if you could go back in time, do you think there's any one thing you could have changed in your training routine that might have prevented it from developing into such a serious problem? Listen up to find out!

Today on the Doc On The Run Podcast we are talking with Patrick Durante about Automatic Negative Thoughts and how they affect runners.   Many years ago I was having a discussion about daily stressors with a friend of mine name Maury. He said something I have never forgotten.   “It's not the lions and tigers that will get you. It's the ants and mosquitoes because problems.”   Every single over training injury that afflicts runners as a consequence of developing too much stress. The constant buzzing of mosquitoes and ants may drive you crazy. And Today we are talking about the creepy, crawly kind of ant, but A.N.T. or Automatic Negative Thoughts that buzz through our heads and inhibit our ability to finish races on time, complete training runs in a gratifying way, and may even may inhibit our recovery from hard workouts or over training injuries.

If you're a runner with a stress fracture you're probably trying to figure out everything you can do right now this going to speed up healing of the injured bone, so you can get back to running as soon as possible.   If you have been thinking about bone broth or nutritional supplements like vitamin D and calcium you already know how important it is to get the nutritional building blocks into your system so your osteoblast cells can't start repairing and rebuilding the crack in the bone.   Did you know there's actually a cookbook written specifically to address the nutritional requirements four building healthy bones? Well, there is…it is called The Healthy Bones Plant-Based Nutrition Plan and Cookbook and in today's episode I am getting to got to sit down with Dr. Laura Kelly who wrote that cookbook.

No matter what injury you have, it could be a stress fracture or it could be tendinitis or it could be a sprained ligament, but whatever you do you have to sure you don't get re-injured, because that could be brutally demoralizing! Because most runners think jogging is a lot easier than “real running” you might presume it's a lot safer for you to just start jogging to test out your state of recovery. Today on the Doc On The Run Podcast, we're talking about why jogging is a terrible way to test the state of healing of a running injury.

Hussein asked me an interesting question. He said,  “I fractured my tibia and fibula. Is it normal after 50 days the fracture is still visible under x-ray, but I am walking with crutches and putting partial weight bearing without any pain or discomfort? My treatment was with a fiberglass cast without any surgery since the bones were not displaced.” Is it normal for a fracture to be visible on my x-ray after 50 days?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

If you have a high arched foot that is prone to getting stress fractures, a podiatrist may have told you that you need cushy running shoes. I got a question from someone who was given that advice. She said, “I am so confused, I thought stress fractures were from pounding. I got a stress fracture, and my doc said it was my cushy shoes. I do not understand how this is true.” How do cushy running shoes cause stress fractures 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. 

Today's question comes from Priscilla, after she watched the video “Proof you do not have to stop running with a metatarsal stress response.”  She says: “I am a distance runner, I got a fourth metatarsal stress fracture, I was in the boot 3 months. X-ray is showing some healing but not 100%. I have been walking but I fear it will open up again. Is pain and fear of putting full pressure without the boot normal? I want to run, it is frustrating.” Is pain and fear normal after a fourth metatarsal stress fracture?  Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast. 

I have heard lots of different things that runners tell me their doctors said..., "You are not built like a runner." "You cannot run with your foot type." "Running just does not work for you.  Decades ago, an orthopedic surgeon who did my reconstructive knee surgery said to me,  "If you ever run, you will have to have a total knee replacement within 10 years." My knee is still good. And I have been running for decades. I did my first 50-mile trail race when I turned 50. I have done 15 Ironman triathlons. So clearly, my doctor's advice to stop running was wrong. Did your doctor ever tell you to stop running after a stress fracture?  Well, I hope not, but if so, this episode might be for you because that is what we're talking about today on the Doc On The Run Podcast. 

Today's episode comes from a question on the Doc On The Run YouTube channel regarding the video entitled “Proof you do not have to stop running with a metatarsal stress response.”  Brian was clearly frustrated. He commented: “I wish… I have a big swollen reason under the second metatarsal. It tingles a bit while running. Slight burning. I have to alter my landing to not irritate it. I'm finished. Rest in peace to my running VO2 max. I got to focus on cycling.” Does a stress response equal "rest in peace" to my VO2 max?  Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast. 

Just this morning I was on a coaching call with a runner who is recovering from a stress fracture. Almost every runner I talk to can immediately start exercising and start doing stuff to maintain their running fitness if they understand how severe the injury is, and they don't have to just take time off.  It is heartbreaking to me truthfully when I talk to somebody who has been completely off of their foot and on crutches in a fracture walking boot and worse, not exercising at all for two weeks, four weeks, or six weeks before I ever talk to them.  Today on the Doc On The Run Podcast, we're talking about why you should convert your off-season training program to your recovery program when you have a stress fracture. 

I got a question from an injured runner, and she wants to know about the amount of time it takes to heal a stress reaction in the sesamoid bone in your foot. She said: “I have had a stress reaction in my tibial sesamoid that led to a lot of pain and swelling. I am reading mixed reviews on healing time. I have been off it for three weeks now, either on crutches and taping the toe to immobilize it or in a walking boot with tape on the toe and sesamoid dancing pads to avoid pressure on the bone. I am a 38-year-old healthy female.” Today on the Doc On The Run Podcast, we're talking about sesamoid stress reactions and the expected healing time. 

Today's question comes from someone who watched the YouTube video on the Doc On The Run YouTube channel called “How long before I can run with a stress fracture.” The comment was: “Thank you so much for this video. I want to ask if resting for three weeks, complete bed rest and I can afford to do this because I am a student, and it is summer holiday then I can walk to my college to do daily normal tasks. I do not do any physical training or running and my college is about a kilometer away.” Will three weeks of bed rest heal a stress fracture?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

There is nothing worse than being told to stop running, especially when you have no idea how long you're not going to be able to run.  You like your doctor. She is nice. She is smart and helpful. She seems to really care about your running, and even listens to you talk about your last run.  But when she tells you, that you cannot run, there are three questions that you need to ask. Today on the Doc On The Run Podcast, we're talking about the top three questions to ask your doctor when she tells you, you have to stop running because you have a metatarsal stress fracture. 

When you get a stress fracture, the main thing you are trying to do is figure out how bad it is. How much does it hurt? How can you get it to heal as quickly as possible? Although inflammation is an important part of the healing process, it can be very disruptive to two parts of your process of getting back to running.    What are the two worst things about inflammation when you have a stress fracture?  Well, that is what we're talking about today on the Doc On The Run Podcast. 

When you get a stress fracture, the main thing you are trying to do is figure out how bad it is. How much does it hurt? How can you get it to heal as quickly as possible? Although inflammation is an important part of the healing process, it can be very disruptive to two parts of your process of getting back to running.    What are the two worst things about inflammation when you have a stress fracture?  Well, that is what we're talking about today on the Doc On The Run Podcast. 

One of the most useless obsessions I witness in runners is to focus on the grade a doctor uses to label the stress fracture.  You should care if you can run, you should care if you can work out, you should care if you have to sit around in a fracture walking boot and do nothing. Most of the time runners call me and they are trying to get an answer from me on what they can do, I know their stress fracture grading is useless.  The reason for that is because I just asked two questions based on it and if you ask your doctor these same two questions, it will help you figure out whether or not you can start working out sooner. Today on the Doc On The Run podcast, we're talking about two questions that prove to me your stress fracture grading is useless. 

Ibuprofen is a very popular medication among runners. I have seen ibuprofen tablets scattered on the course at every marathon and triathlon I have ever done.  Runners take it when they have aches and pains, or to get through races, but I can tell you that there is only one valid reason to take ibuprofen. To me, the only time a runner with a stress fracture should take ibuprofen is when you have what I call a non-skippable race. Today on the Doc On The Run Podcast we're talking about the only time a runner with a stress fracture should take ibuprofen. 

After you recover from a stress fracture and you are getting back to running, there really are some details you have to pay attention to if you want to avoid a re-injury.  The name of the game is increasing your activity to the point that your metatarsal stress fracture can withstand the stresses you are applying to it.  What are the two most dangerous parts of a run when you have a stress fracture?  Well, that is what we're talking about today on the Doc On The Run Podcast.   

When you get a metatarsal stress fracture from running, if you get a crack in the bone, it will eventually start to heal. If you keep exercising, walking, running, doing elliptical training, and you are aggravating the fracture at all, the bone callus will get larger.  Over time, the bone callus will remodel, and that lump will get thinner. The lump of bone will get smaller. But if you are having pain because you have a huge lump of bone in your foot, at some point you might want to take a look at it with medical imaging.   Should I get an MRI or an X-ray when I have a large bone callus after a stress fracture, and I want to assess the callus remodeling?  Well, great question and that is what we're talking about today on the Doc On The Run Podcast. 

Metatarsal stress fractures are something I talk about a lot because they are one of the most common reasons a runner has to stop running.  One of the reasons you would stop running is that you do not want something called "plastic deformation" of the healing metatarsal.  What is plastic deformation of a metatarsal stress fracture in a runner? Well, that is what we're talking about today on the Doc On The Run Podcast.   

If you get an aching pain in your foot when you are running, and it turns out it is a metatarsal stress fracture, you are not alone. Stress fractures are extremely common.  But the last thing that you need is to stop running, take all this time off, get it to heal, and then get re-injured when you start running again.  There really are only three reasons that I see in runners when they get re-injured after they have fully recovered from a metatarsal stress fracture.  Are there really only three reasons for stress fracture re-injury?  Well, yes, and that is what we are talking about today on the Doc On The Run Podcast. 

One of the most common causes of foot pain in runners is a metatarsal stress fracture.  Most of the runners who get a metatarsal stress fracture, complain of an aching pain in the middle, on top of the foot.  This episode is going to explain some of the reasons a runner may have pain after a metatarsal stress fracture has “healed” and you are starting to run again.  What are five causes of foot pain after a metatarsal stress fracture heals?  Well, that is what we're talking about today on the Doc On The Run Podcast.

Imagine you are months into training for an ultra-marathon. You are entering your peak build phase. You feel strong. You're excited about your upcoming race and the possibility of a new PR.   Then you get an aching pain in your foot and you're told you have a stress fracture.    If you found yourself in that exact situation, and you had to choose one, which would you pick:   1. a doctor who understands running injury treatment  2. a coach who understands training with injuries   My personal opinion is that having a coach who understands training through a running injury is actually way more important than having a doctor who understands running injury treatment.    Today on the Doc On The Run Podcast we are talking with Isobel and Ron of Peak Endurance Coaching about mindset, training shifts and what ultra-coaching has taught them about avoiding re-injury when training for ultras.

Today's episode comes from a comment posted on one of the videos on the Doc On The Run YouTube channel. This was on the video that this person watched. It was called, “Can I still run after I heal a fibular stress fracture?” and in that video, I was trying to talk about how you can decide basically whether or not you can run after you have had a fibular stress fracture.  He said: “Hello, I got a fibular bone crack while running and I have an army physical in 25 days. Please tell me the solution due to which I will be able to give my physical fitness test.” I got a fibular stress fracture, and I have to run in 25 days. What should I do?  Well, that is what we're talking about today on the Doc On The Run Podcast.   

Today's episode actually comes from a comment posted on a video on the Doc On The Run YouTube channel. That specific video was entitled "Best Exercise for Plantar Plate Sprain in Runners." “Hi Doc, awesome help in all these plantar plate videos. I have been told by my podiatrist that I have a grade one possible border lane, grade two sprain/tear, and I am struggling to get it to heal while I keep running.” What should a 53-year-old runner with a plantar plate sprain do?  That's what we're talking about today on the Doc On The Run Podcast. 

Today's episode comes from a comment posted on a video on the Doc On The Run YouTube channel. He posted a comment, and he said: “This happened to me, I got a stress fracture on my right foot in the third metatarsal. I stopped all sports for two months and somehow ended up with two more stress fractures.” Today on the Doc on the Run podcast, we're talking about somebody who stopped sports for two months and got two more stress fractures. 

There really are three steps that I figured out that you need to do if you have a stress fracture but need to start running.   Runners call me or ask questions about whether they can run with a "grade 2" or a "grade 3" stress fracture, but many times they do not even understand what that means.    Truth is, the runner has not actually figured out how bad the stress fracture is, right now.   What are the three steps you need to take if you want to start running with a stress fracture?    Well, that is what we're talking about today on the Doc On The Run Podcast. 

If you have a second metatarsal stress fracture, and you want to stop stressing the second metatarsal, so it can heal faster, you must take stress off that bone.  If you apply more pressure to all metatarsals (except the second), it will heal faster.  One of the runners who signed up for the metatarsal stress fracture course for runners was doing better and had starting to run.  He asked me a question I had just not thought of before.  He asked: Should I stop using the metatarsal offloading pads after I start running again and my stress fracture is healing?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

One of the most common runners' injuries I see for second opinion is a plantar plate sprain.  A plantar plate sprain happens usually on the bottom of the second toe. It is a little bitty ligament that gets sprained or partially torn.  Most of those runners with a plantar plate injury want to know how long is it going to take to get back to running. Recently a few runners told me they asked chat GPT, or some AI program to try to figure this out. So, I wanted to tell you what AI told me when I asked this question of "how long can I run after a plantar plate sprain." How long before I can start running after a plantar plate sprain?  Well, that is what we're talking about today on the Doc On The Run Podcast.

The navicular bone isn't a big bone, but is a critically important one. A fracture of the navicular is one of the most frightening things that I see in runners.  If you get a navicular stress fracture, there are a few mistakes that I often notice. If you can recognize them, you may spend a lot less time in a fracture boot, or off running.  What are the top five navicular stress fracture mistakes I see in runners?  Well, that is what we're talking about today on the Doc On The Run Podcast.

I get lots of questions from injured runners about stress fractures.  As a consequence, one of the most common questions I get is, "How long before I can run if I get a second metatarsal stress fracture."  So, in this case I decided to ask Dr. CHAT-GPT that question and see what happens! How long before I can run with a second metatarsal stress fracture?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.

Today on the Doc on the Run podcast, we're talking with Dr. Ralph Gonzalez about running UTMB Mont Blanc after recovering from a plantar plate sprain and Achilles tendinosis. Specifically, he's here to talk about his path from injury to crossing the finish line at UTMB and what inspired him to run the challenging race. From plantar plate sprain and Achilles tendinitis to running UTMB Mont-Blanc.

I was talking with an injured runner who had a stress fracture in the second metatarsal bone. He was working hard to get it to heal faster. He had gone through the stress fracture course for runners, and he was doing great. He asked me a question: When can I walk at home barefoot with a second metatarsal stress fracture?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

I have recently had a rash of runners with navicular fractures.  The navicular is a bone that is right on the top of your foot, in front of your ankle and it's also at the apex of your arch. Navicular fractures are scary because doctors often recommend surgery.  There are four times when you might really need to have surgery for a navicular fracture and in this episode, we are going to talk about why.  What are the four times a navicular fracture might need surgery?  Well, that is what we're talking about today on the Doc On The Run Podcast.  

I was on a second opinion call with a runner. She developed a stress fracture in her accessory navicular bone. If that wasn't enough, she then started having pain in her arch in the tendon that pulls on her big toe. That tendon is called the Flexor Hallucis Longus Tendon, or FHL Tendon.  Can an accessory navicular stress fracture cause flexor hallucis longus tendinitis in a runner? Well, the short answer is yes, and I am going to explain how in today's episode of the Doc On The Run podcast.

Jones fracture is a scary injury if you are a runner. If you have been diagnosed with a Jones fracture and want to start running sooner, you must understand the severity. Can a bone scan help you tell the difference between a Jones fracture stress reaction and a styloid stress reaction in a runner? Well, good question and that is what we're talking about today on the Doc On The Run Podcast. 

If you get a stress fracture in the fifth metatarsal, there are a couple of reasons why you might want to sleep in a fracture walking boot. Your goal is to keep the total amount of stress applied to that stress fracture under your threshold for healing, throughout the entire 24-hour period.  Why should I sleep in a boot for a fifth metatarsal stress fracture?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

If you get a metatarsal stress reaction or a metatarsal stress fracture your doctor may order medical imaging to figure out how bad it really is.  Your doctor's goal is to really figure out if it is a stress reaction or is it a stress fracture. What is the difference when it comes to medical imaging using a bone scan versus an x-ray when you are looking for a second metatarsal stress fracture in a runner? Well, that is what we're talking about today on the Doc On The Run Podcast.   

You have a couple of options when you get injured.  One option is to wait so long that you know for a fact it has to be healed enough that it can withstand the forces of running.  The other option is to move that timeline faster and make things happen a lot quicker. The only way to do that is by testing. One of the things you can test with is a test run.  A runner asked me how long her first test run should be, if she had been two weeks since the injury actually had happened. Let us say you have been injured and you take a couple of weeks off. How long should your test run be?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.

Whenever you consciously give your brain direction, your subconscious brain will go to work to achieve it. Your subconscious mind is not just controlling things that you want to happen but it's controlling things that you don't want, too.  If you focus on negativity, if you focus on your injury getting worse, you will probably get worse. So, the question is can you take this aspect of your brain and controlling your subconscious mind and use it to your advantage when you are trying to heal and get back to running? Can simply thinking about healing make your running injury heal faster?  Well, that is what we're talking about today on the Doc On The Run Podcast. 

I was just on a call with an injured runner who is about to go out for a test run.  She is very excited because she is going to get either a yes or a no on deciding if the tissue in her foot that is been healing is strong enough to withstand a little bit of running at a medium pace for a short distance.  This is an important test because if it hurts, obviously no running, right? You got to wait some more. But because you want to get a yes, you want to make sure that your chances of getting the yes are as high as possible.  The way that you do that is you protect the foot as much as possible. So, the shoes you should use for your test run really do matter a lot.  If you are going to go out and try a test run after you have been injured, what kind of shoes should you wear? Cushioning shoes or stability shoes?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.

What if you were ramping up for several years to run 100 miles, but then you got tendinitis? If you start getting pain because you have been doing lots of hill repeats, you could get irritation of the FHL tendon and specifically the tendon sheath that surrounds it where it bends around the back of the ankle. One of the treatment options is to inject it with corticosteroids.  So, this runner called me and wanted to know whether or not it would be a good idea for her to inject the tendon sheath with cortisone before her trail race.  If my FHL tendon is inflamed and irritated, should I inject the tendon sheath before my 100-mile trail race?  Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

If you get pain on the top of your foot because you irritated the extensor tendons, they can be very painful.  A runner asked me recently about using athletic tape to heal extensor tenosynovitis. Since it seems like athletic tape can help almost any type of musculoskeletal injury, you might be wondering, could taping help the tendons or the tendon sheath on the top of your foot when it gets aggravated. Should I use tape if I have extensor tenosynovitis?  Well, that is what we're talking about today on the Doc On The Run Podcast. 

Yesterday I was at the Twin Cities Foot and Ankle Conference in St. Paul, Minnesota. The reason I was there is I was invited by the Minnesota Podiatric Medical Association to come and give a one-hour lecture, about "What's New in Sports Medicine."  It may not surprise you that most of what I was talking about was how to help injured runners get back to training, full activity, after overtraining injuries, as quickly as possible. After my talk, another doctor out in the hallway approached me, and she asked an interesting question. What she asked was...  “If you yourself had an overtraining injury, whether it was a stress fracture, a plantar plate sprain, a tear of the plantar fascia, a split in the peroneal tendon, no matter what the injury was, if you yourself were given a deadline of 30 days to healing that thing enough, you could actually run outside without worrying about re-injuring that piece of tissue, what exactly would you do?”    If I had only 30 days to return to full running after an over training injury, what would I do?  Well, that is what we're talking about today on the Doc On The Run Podcast.