By Dr. Christopher Segler

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…

There are three ways that a doctor might convince you that it's really time to have surgery and fix that plantar plate ligament that's been making you miserable when you've been trying to run. To you, it may not seem that bad. It kind of aches. It kind of swells. It kind of bugs you. But then the doctor suddenly says, “Look, it's not getting better…

Today's episode comes from one of the YouTube videos and it was specifically a comment that someone posted on one of the videos that was called “Five worst exercises for hallux rigidus”. This came from Matt and he asked: "When can you start doing push-ups again, if you have hallux rigidus?" Well, that's what we're talking about today on the Doc On …

I'm not going to tell you that any runner should want to use crutches. I'm also not going to tell you that you will enjoy wearing a fracture walking boot. But there are reasons that you may want to do things a little differently if you're a runner. The critical issue is that runners must really try to speed up the healing process as much as possibl…

Most of the runners I see who have pain in the ball of the foot from a plantar plate sprain rarely start out with a completely torn plantar plate tear. More often, runners ignore the pain from the plantar plate sprain and it evolves into a full thickness plantar plate tear. Surgery is only needed when the plantar plate is torn in such a way that th…

Sometimes when you get injured and have to stop running, you start to lose your identity. One of the things that I notice most in runners who have gone weeks or months without running, is they are really bummed out. These runners seem really grumpy. In some cases, they don't even view themselves as a "runner" anymore...well, because they're "not ru…

I just had a consultation with a runner who had foot pain that she thought might be a stress fracture that had been coming and going for about a month. She had been increasing her training volume and doing strength exercises that are supposed to build her running fitness. The pain seemed to be volume related. The more training she did, the more she…

Just this morning, during the live Stress Fracture Masterclass I had an interesting question. The story went like this. An athlete who is a State ranked high school cross country and track, had to suddenly stop running due to intense pain that started about 15 days ago. He went and saw a doctor. He got x-rays. He got an MRI, had a physical exam whe…

Let's say you had an ankle injury a long time ago. You sprained the ankle when you were out on a trail run, it got better , and you went right back to running. But over time, you slowly got more and more pain in the ankle. In that case, you doctor might order an MRI of your ankle, or a similar imaging study called an MRA (instead of MRI). What's th…

I recently saw a runner who thought that he might have a tibial stress fracture. But it turns out, it was just shin splints, which of course is good news. Because you don't really want a tibial stress fracture. Shin splints is much easier to treat. One of the questions he asked me was about the best running shoes based on his foot type. This runner…

If you got pain on the ball of the foot, at the base on the 2nd, and you have been running in a minimalist shoe, running uphill, doing lots of calf raises, or running on steps, you could have an injury to a little bitty ligament called the plantar plate ligament. If you get an injury to the plantar plate, sometimes your second toe will drift toward…

If you roll your ankle on a trail run and it turns black and blue and swollen, you may think you just have to take a few days off. In fact, if you research how long it will take to get back to running, you might find a study that says that if you do early range of motion after an ankle sprain, it only takes 4 days to get back to pre-injury levels o…

Last night, I was doing a consultation with an athlete who had a fracture when she accidentally kicked a piece of furniture. Her foot was swollen, it was black and blue. The foot was really painful and she couldn’t walk on it. She went to urgent care and they took x-rays. She was a little concerned that they told her that it wasn't broken. So, she …

If you're out on a run, and you have heel pain that suddenly hurts a lot, you may have a calcaneal stress fracture, especially if you see bruising and swelling. If you go see a doctor, they take an x-ray, and they don't see anything at all but they squeeze your heel and it hurts. The suspicion goes up. If your doctor gets an MRI that shows a calcan…

Last night, I was doing a consultation with an athlete who actually broke one of her toes and her main question was: Can I compete in four weeks? I have a competition in four weeks, I want to compete. Do you think I'll be ready? Well, I actually told her, no joke, I actually said, “I'm very sorry, but my crystal ball is broken.” However, I can tell…

Yesterday, I went to an appointment with a friend who had an appointment with an orthopedist. She had 3 fractures. She wanted to know what she could do in terms of activity while she's healing and recovering from these different injuries. I just went with her, not as her physician, but to serve as a friend and advocate for her at her appointment. T…

Yesterday, I was doing a consultation with an athlete who broke one of her toes when she accidentally kicked a piece of furniture. If you fracture your toe, and you just run and ignore it, it can turn into a painful nonunion (non-healed fracture). As a runner, you want to speed the healing as much as possible. One of the ways to stimulate fracture …

If you're a runner with heel pain you may think you have plantar fasciitis. But if it is not getting better, your heel pain may be caused by "neuritis." I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe. I was giving a…

I recently did a consultation with a runner who had gotten a plantar plate injury. He had been getting better by using some of the tricks I teach in the Plantar Plate Course For Runners. He got better, he was protecting it, he reduced the stress and strain on the ligament, and he got back to running. He was doing great. But then he had a setback wh…

I was just at the International Foot & Ankle foundation meeting in Lake Tahoe listening to a lecture given by a Professor of Biomechanics and Podiatric Medicine at Barry University. He said that a cortisone injection can be used as a "stop gap treatment" in heel pain caused by plantar fasciitis. The idea is that some runners may need pain relief so…

I just had a conversation with a runner who has a plantar plate injury. He got the plantar plate sprain trying to build his uphill running strength in preparation for a trail race. This is no rookie mistake. He is a longtime ultra marathoner with lots of experience. But he made a common mistake determined runners can make. Today on the Doc On The R…

Taping is one of the oldest and simplest ways to treat foot pain and injuries to the toes, feet and ankles. There is a specific way to take your ankles after an ankle sprain so you can start running earlier. If you have a plantar plate sprain you might try taping the toe to decrease some of the stress and strain on the plantar plate ligament when y…

I recently saw an elite runner who had what he thought was shin splints. One of the findings on the MRI report was something called "hyperemia." He asked me: “What does that mean? Does that mean I have a stress fracture? Does that mean I have shin splints?” What does hyperemia mean when you see it on an MRI report or an ultrasound report and you ha…

I believe the most commonly prescribed and most overprescribed treatment for injured runners is probably a fracture walking boot. The big question for your doctor is... Is the fracture walking boot really necessary or not, given my stage of injury recovery? When is a fracture walking boot really necessary for a metatarsal stress fracture? Well, tha…

When you get an overtraining injury from running, it's not because you did too much, because you were too strong or too motivated. You got injured because you were too weak. You were too weak to sustain the stress applied to that piece of tissue, that one injured piece of tissue that got injured when you did one workout. That's what really happened…

There are a lot of confusing things you can see on an MRI report, on an x-ray report or an ultrasound report when you're a runner with pain that you think might be a stress fracture. One of those findings that may be reported on your medical imaging study is a thing called "cortical thickening." I want to explain what that is so you can better unde…

I just had an interesting call with an elite runner, who's a high school cross country runner. He developed a tibial stress fracture, or stress reaction. But he thought it was shin splints. When I looked at it with ultrasound, I saw some stuff that made me really worried about it. So, I got an MRI to confirm. The first question he had was, what's t…