Today's episode applies to any injured running pondering surgery. 

I just spoke to a runner who was told she might need surgery to fix a non-union of a metatarsal fracture. 

I said, “Look, you have two choices. You can have surgery or not have surgery.”

We talked about what it meant if she did have surgery in terms of her recovery. And we also talked about how she could potentially get it to heal without having all the risk associated with surgery. 

What is the very last option you can do as a runner to avoid surgery? 

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

If you are an injured runner, you are probably limiting your activity. 

Doctors who don't understand how important it is for you to get back to running tend to limit runner's workouts more than necessary. They're more restrictive than necessary. And it costs you.

You lose more fitness, you get weaker, you get stiffer, you get neuromuscular changes that damage your running form, and disrupts your coordinated firing of muscle units that makes you efficient. 

All of that gets damaged over the weeks that you're not running. So, it's really important that you maintain your fitness.

Today on the Doc On The Run Podcast, we're talking about how the minimum restrictive intervention should always be the goal with injured runners. 

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I had an interesting question from an athlete who asked, 

“I had an injury, I went to see the doctor and got an X-ray. There was no crack on the X-ray, but my doctor called it a stress fracture. So, I'm confused.”

“I thought that a stress fracture happens when you run too much, too far, too soon, it overloads the bone, and you get a little crack in it. I didn’t do that. It was trauma, a sudden injury, not a bunch of force applied over a long period of time. I wasn't training for anything. I don't get it. Why is my doctor calling this a stress fracture?”

I had a sudden injury, but my doctor called it a stress fracture. 

That's what we're talking about today on the Doc On The Run Podcast. 

I recently did a webcam consultation with an athlete who has had a lot of trouble for a long time. He was very, very athletic. He started having pain and a whole lot of trouble that ensued afterwards that severely changed his athletic picture in only a couple of years. 

After years of seeing experts and not getting any better, he asked me to help him to do a second opinion and help him reassess where he was and what he might be able to do.

The way I think about this is really simple. Many of the bad things that happen after the original injury are because of compensation or your body trying to keep pressure off of that worst injury that happened first. 

So, I always tried to address that first injury, first!

Today on the Doc On The Run Podcast we're talking about why you need to fix the original pain first. 

I saw a runner who had a traumatic fracture, but she had been told it was a stress fracture. This did not make sense to her, because her injury wasn't from training for a race. 

She was trying to understand the difference in healing between a stress fracture with a crack when compared to the healing time of a traumatic fracture with a similar crack.

It's important to understand they were talking about similar cracks in similar bones that remain in a similar position. We're not talking about broken bones that are displaced.

If you jump off a ladder, you break the bone and it's moved out of position, that is a completely different story. Stress fractures don't generally get displaced as much as traumatic fractures. 

If there's a crack in the bone because of a stress fracture, the bone is not displaced. But how does that compare to similar (non-displaced )traumatic fracture?

Is there any difference in healing between a stress fracture versus a traumatic fracture?

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

A metatarsal fracture "non-union" is what doctors call it when you broke the bone, it started to heal, but then the fracture kind of quit healing. Usually it means you got a bunch of scar tissue between the ends of the bone. 

Sometimes that happens without you or your doctor realizing it. The problem gets worse if you start running on it.  

The question is, "should I take non-steroidal anti-inflammatory drugs (or NSAIDs)? 

NSAID's are medications like ibuprofen and naproxen. These drugs are not steroids, but they stop inflammation. Many runners take them for all kinds of aches and pains after training. The question is, is it a good idea or not when you may have a metatarsal fracture non-union?

Should a runner take non-steroidal anti-inflammatory medications for a non-union? 

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

If you get a metatarsal stress fracture, the first thing that you're going to notice is not that you have a broken bone in your foot. 

You are going to notice pain. 

Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it. 

The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs. 

As I explained this to a runner in the Injured Runners Aid Station, she asked "What really causes the pain?"

What causes most of the pain when you have a metatarsal stress fracture? 

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

A stress fracture in your tibia, or shin bone, is a bad injury. You definitely don't want the crack to grow to the point where it could break. 

The big question is what will make a tibial stress fracture better, faster...crutches or a fracture walking boot? 

When is a fracture walking boot better than crutches for a tibial stress fracture if you're a runner? 

That's what we're talking about today on the Doc On The Run Podcast. 

This episode comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery. 

I was looking at her CT scan and she asked me an interesting question. 

She said, 

“Does it look stable?” 

And I said, “Can't tell.” 

It looks like a non-union. It looks like it’s broken and never healed.

What are the three ways you could tell whether or not a metatarsal fracture non-union is stable without getting an imaging study? 

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

50% of your body weight goes through the big toe joint when you run. So, If you get a fracture in the big toe joint, it can be a serious problem.

One type of fracture in the big toe joint is called an avulsion fracture. 

I was just doing a consultation with a runner who had a phalanx avulsion fracture in the big toe joint. I wanted to show you what it really is and so that you can understand it better and what it might actually mean in terms of your returning to running.

What is a phalanx avulsion fracture in the big toe joint? 

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