Doc On The Run Podcast

If you are a runner with a plantar plate sprain and you already had an MRI, but you are still not getting better, the MRI report may not answer every question that matters.

In this episode, Dr. Christopher Segler explains four questions he believes runners should ask their doctors about MRI imaging of a plantar plate injury. He discusses MRI slice thickness, why the plantar plate is difficult to image, why your doctor should personally review the MRI images instead of relying only on the radiology report, why you should ask to see the suspected plantar plate injury on the images, and when ultrasound may help confirm what is actually happening.

The goal is to help runners have a more useful discussion with their doctors, better understand the severity of the injury, and avoid losing unnecessary running fitness while waiting for a workable plan.

A runner recovering from an overtraining injury may notice new sensations, tension, discomfort, or other “noise” as activity

increases. That can be confusing, especially when the goal is to rebuild strength without overloading tissue that is still weaker than

normal.

In this episode, Dr. Christopher Segler explains a simple construction-site analogy for understanding some of the sensations that

can show up during recovery. Healing tissue requires materials to be carried in and damaged materials to be carried out, and fluid

movement around the injury can create sensations that become more noticeable as activity increases.

The key is not to ignore pain or major swelling. It is to understand what the changes mean by carefully tracking injury severity,

daily steps, repetitions, symptoms, and how those measurements change as activity increases.

The goal is to match the strength of the healing tissue with the right strength-building activity so you can keep progressing without

overloading the injured structure.

What should you do if you are five weeks away from a half marathon and develop a metatarsal stress reaction?

In this episode, Dr. Christopher Segler talks with a real runner who is preparing for a half marathon in Argentina after developing a fifth metatarsal stress reaction. He has already stopped running for five weeks and has been maintaining fitness with stationary cycling.

The discussion focuses on the information a runner needs in order to decide what activity can be added safely: establishing injury severity, tracking pain trends, monitoring tenderness, reducing inflammation, maintaining strength and stability, and increasing stress on the bone systematically instead of simply going out for a test run.

Dr. Segler also explains why X-rays can miss some stress fractures, how MRI and ultrasound may provide additional information, why zero pain is not always the only useful benchmark, and why runners need measurable baseline numbers before progressing activity.

How much should you move your ankle when you have a metatarsal stress fracture?

An elite Masters track athlete asked Dr. Christopher Segler this question after noticing that her ankle was getting stiff while

wearing a fracture walking boot for a third metatarsal fracture.

Ankle stiffness matters because once you return to running, restricted motion can increase the forces applied to the foot and may

contribute to other overtraining injuries.

But aggressively forcing ankle motion while the metatarsal is still healing can also put unnecessary stress on the injured bone.

In this episode, Dr. Segler explains the concept of doing “a little motion, a lot” instead of “a lot of motion, a little,” why frequent

gentle ankle movement may be preferable to forceful end-range stretching, and why tracking discomfort is essential when

deciding when to increase activity.

What should you do when Achilles tendon pain comes back after you thought it was better?

In this episode, we listen in on a real strategy call with a runner who had Achilles tendinosis for years, improved after treatment, returned to running, and then had the pain flare again after hill training.

The key lesson is that the next step is not guessing which treatment might work. The next step is figuring out exactly how severe the problem is, what activities trigger it, and what information you need to make a smart decision about running, treatment, and recovery.

If you have Achilles pain that keeps coming back, this episode will help you think more clearly about what to track, what to avoid, and how to build a better plan.

A runner with a third metatarsal stress fracture was doing everything right. Her injured left foot was getting much better — but

then her “good” right foot started aching.

That can be frightening. Does it mean you are developing another stress fracture?

In this episode, Dr. Christopher Segler explains why the uninjured foot can become overloaded when you are using a fracture

walking boot, crutches, or a knee walker, how compensatory stress can trigger metatarsal aching, and why you should not

simply ignore new pain in the other foot.

You’ll also learn why systematically tracking pain and activity can help you determine whether the aching foot is getting better

or heading toward a more significant problem.

A runner thought he had another ordinary ankle sprain. He could still walk, he checked the Ottawa Ankle Rules on himself, and he concluded that he did not need an X-ray. But almost a week later, the swelling and bruising still were not behaving like his previous ankle sprains - and the X-rays showed that his ankle was actually broken.

In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why runners can be especially vulnerable to self-diagnosis after an ankle injury, how an athlete's pain tolerance can make a serious injury seem deceptively manageable, and why a clinical decision rule is not the same thing as examining yourself.

In this episode you'll learn:

• Why runners may underestimate the significance of pain after an ankle injury

• What the Ottawa Ankle Rules are actually designed to do

• Why being able to walk does not prove that your ankle is not broken

• How extensive bruising and persistent swelling change the level of concern

• Why a violent inversion-and-eversion mechanism deserves extra attention

• How anchoring bias can make a familiar ankle sprain diagnosis feel more certain than it really is

• When an ankle injury is not following the expected recovery trajectory

• Why objective evaluation matters when an injury simply is not behaving normally

Can a stress fracture actually heal with too much bone?

Yes - and in some runners, that extra bone canbecome a problem of its own.

In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why a very large bone callus does not always mean a stress fracture is safely healed. He walks through two runner cases: one in which a large callus hid an unstable fracture heading toward nonunion, and another in which prolonged irritation produced a completely healed but excessively thick metatarsal that crowded the surrounding soft tissues.

In this episode you'll learn:

• Why bone callus forms around a stress fracture

• How continued motion can create a deceptively large callus

• Why a big callus can coexist with an unstable fracture or nonunion

• How prolonged irritation can leave a healed bone too thick

• Why excess bone can crowd muscles, nerves, and other soft tissues

• Why simply “running less” may not reduce stress enough

• What pain, bruising, and swelling can tell you about injury severity

• Why measuring improvement matters before you increase activity

Can you still do your race after breaking a toe?

Many runners assume a broken toe automatically means canceling the event. But that's not always true.

In this episode of the Doc On The Run Podcast, Dr. Christopher Segler shares a real strategy call with a runner preparing to hike the Tour du Mont Blanc after suffering a displaced fourth toe fracture only one week before departure.

In this episode you'll learn:

• The two complications that can permanently affect future running after a broken toe

• Why pain isn't the only thing you should monitor

• How swelling predicts future problems

• Why shoe stiffness matters more than most runners realize

• How to determine whether your toe is stable enough to test

• Why a broken toe doesn't always mean canceling your race

Have you ever felt guilty about taking a day off during stress fracture recovery?

For many runners, the hardest part of getting back to running isn't the injury itself—it's resisting the urge to complete every planned workout.

In this episode of the Doc On The Run Podcast, Dr. Christopher Segler shares a simple mental strategy that can help runners recover faster by changing the way they think about recovery days.

In this episode, you'll learn:

• Why runners often feel guilty about taking a recovery day

The goal isn't simply working harder.

The goal is getting stronger while protecting your healing bone so you can get back to racing as quickly as possible.