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…

By 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…

I got an interesting question from a runner who had a plantar plate injury. This runner had a long course of sort of misdiagnosis, mistreatment and various plantar plate "misadventures." But when we started working together, he started to do some specific things to improve quickly, and he is doing great now. He asked: “Which comes first after my pl…

I had a call from a patient who wanted to know about surgical removal of Morton's neuroma. She said she went to the doctor. The doctor said, “Well, we can just take the nerve out. It is not a big deal. We do this all the time.” The reason she called me for a second opinion was because the doctor told her we have to cut a ligament to take the painfu…

I got a comment from a runner who posted this question on one of the YouTube videos on the Doc On The Run YouTube channel. He says he had plantar fascia surgery just over 3 months ago. He said that following the operation, he followed all of the surgeons post-operative instructions "to a tee." He was feeling great, until he started developing a sma…

I was just on a call with a runner who had a plantar plate injury that has been bothering him for about a year and a half. We did a series of calls to talk about some changes in his treatment that could get him moving in the right direction. He asked me a great question when I was on a call with him this morning. He said: “Can I run in zero drop sh…

When you have hallux rigidus, the problem is the big toe joint does not want to move. Many doctors will simply tell you that your big toe joint, or the "first metatarsal phalangeal joint" is getting progressively stiffer and developing arthritis. If you wear shoes that irritate the joint more, the condition will only gets worse. The question is wha…

Today's episode comes from a comment on one of the YouTube videos on peroneal tendinitis. A limping runner asked the question: “Can peroneal nerve tendinitis cause fifth metatarsal to be tender to the touch and when walking, I am not sure if I have a stress fracture.” When I read this comment, I became confused because I am not sure what is going o…

I got a great question from a runner with a sesamoid fracture that turned into a "non-union." The sesamoid bones are two tiny little bones under the big toe joint. When you break one of the sesamoids, if two pieces of bone do not heal back together, we call a "sesamoid fracture non-union." In this runner's case, she used a bone stimulator. She wore…

The primary way I help runners is through telemedicine second opinions. I help runners who are not running, who have not been getting better, who are frustrated, and help them figure out what they need to do to get past the injury and back to running. Once they are on track and have made lots of progress, they want to know “When should we check in …

I saw a runner today and I did a cortisone injection to treat her sinus tarsi syndrome. She asked me a great question. She said, “Is the cortizone injection something I am going to need to do every three to six months?” She had been reading up on corticosteroid injections and had found that some athletes with certain conditions may have injections …

The most important first step with any athlete who signs up for a webcam second opinion or series of coach coaching calls is to ask, “What is your goal?” I was lecturing at a medical conference in Wisconsin where I was doing a whole morning session on running injury talks and diagnosis of subtle fracture patterns in athletes. What I told those doct…

Today, I had a final follow-up call with a runner who did a series of consultation calls with me to get advice every week. After the series of calls he had improved and was better, but disclosed to me that he felt like he had been depressed. He thought he might have depression because he realized something had significantly changed in his goal sett…

This morning, I was on a second opinion call with a runner who had a couple of different injuries in his foot. The main problem keeping him from running was an injury to the collateral ligaments in one of his toes. "The toe feels weak and unstable." He is understandably worried that the instability is going to cause a problem if he runs. He was ask…

This morning, I had a conversation with a runner who had an injury. He has been getting a lot better and one of the things that really seemed to help the injury improve was wearing compression socks. His question was a really good one. He said: “I had so much improvement with wearing compression socks, but with the injury I have, every time I take …

If you get an overtraining injury like a metatarsal stress fracture or a plantar plate sprain or Achilles tendonitis, or peroneal tendonitis, a doctor might prescribe a fracture walking boot. Well, it is designed to hold you still so that you can hopefully walk on something like a fracture and still let it heal. The reason for this episode is this …

I was doing a second opinion webcam consultation with a runner who noticed a lump in the calf muscle. The knot in the leg wasn't limiting his running. In fact, when he was running, this lump in the calf muscle felt better, not worse. So, you have to wonder, could the knot "not" be a big deal? There are really 3 things a runner can do immediately af…

Today I am about to drive to the airport, get on a plane, fly to Wisconsin to give five lectures on running injuries at a medical conference. As I was finalizing that talk on medical imaging strategies for athletes, I was thinking about a conversation that I had yesterday with an athlete who had a very frustrating course and actually called me for …

I know. You don't want plantar plate surgery. But if your plantar plate ligament doesn't repair itself, or your doctor doesn't help it repair itself, you might get talked into surgery. If you have plantar plate repair surgery, you may spend a lot less time running over the weeks following surgery...because you have to let it heal. There are really …

This episode comes from a question posted by one of the Doc On The Run YouTube viewers as a comment on the video “Where to run with plantar fasciitis.” In the video, I was trying to explain which surfaces can help you the most when you're trying to run with plantar fasciitis. The only way to do that is to make sure you are decreasing the stress and…