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 obviously, you need to stop hyperextending the plantar plate by stretching it and pulling on it. At least, if you want to get back to running faster.

Today on the Doc on the Run podcast, we're talking about how hyper extension can lead to a plantar plate injury.

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 not recover enough before the workout that you were not actually strong enough to withstand.

What are the two most important days you should skip to avoid an overtraining injury? 

Well, that is what we're talking about today on the Doc On The Run Podcast.

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 fibula started hurting a lot after the gym in the lower leg on the outside and I found out it was my fibula. I took a day of rest and went back to the gym, and I was running on the treadmill even when my leg was hurting.”

What is this painful bump that might be a fibular stress fracture? 

Well, that is what we're talking about today on the Doc On The Run Podcast. 

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 fixing injury when you have identified a weakness, and you are trying to get back to running. 

Which is more important, time or range of movement when you are doing the gluteus medius activation exercises and you have ankle instability? 

Well, that is what we're talking about today on the Doc On The Run Podcast.

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 research that shows how big the plantar plate ligament usually is.

How big is the plantar plate ligament? 

Well, great question and that is what we're talking about today on the Doc On The Run Podcast. 

I have a great question from a runner who was injured and is now recovering. 

She asked me about the "10% rule." 

How should I ramp up my mileage after I have been injured but I am returning to running? Should it be by percentage? Should it be by miles? What is it? 

Well, good question and that is what we're talking about today on the Doc On The Run Podcast.

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 about a week later and she asked:

“Should I do proprioceptive retraining exercises for my ankle before or after I run?”

Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.

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 reinforces the bottom of that joint capsule.

Inflammation in the joint which doctors call "synovitis" can damage the plantar plate.

The chronic inflammatory fluid surrounding the plantar plate ligament is going to slowly degrade the collagen in the plantar plate ligament and make it more prone to stretching out, or worse, getting little plantar plate ruptures.

How does chronic synovitis lead to plantar plate injury? 

Well, that is what we're talking about today on the Doc On The Run Podcast.

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 walking? 

Well, that is a great question, and that is what we're talking about today on the Doc On The Run Podcast. 

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 their toenails so that they would no longer get black toenails. But I do not recommend it.

What is the number one most worrisome problem when you lose a toenail from running? 

Well, that is what we're talking about today on the Doc On The Run Podcast.