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. 

Non-steroidal anti-inflammatory drugs (or NSAIDs for short), like Ibuprofen and Naproxen, what we call  are extremely popular with runners because they get rid of lots of aches and pains. 

We often think inflammation results from hard exercise, so it stands to reason a non-steroidal anti-inflammatory will actually help after a long run.

I don't normally recommend runners take NSAIDs as a part of a training routine.

But there are a couple of alternatives that I would recommend over non-steroidal anti-inflammatory drugs.

What's better to take than non-steroidal anti-inflammatory drugs for a stress fracture in a runner? 

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

I had a call with a runner who asked me an interesting question about the difference between a mild stress fracture and a serious stress reaction in a runner. She wanted to know if the difference was based on the amount of tenderness or pain that she had. 

Although it stands to reason that the more tenderness, the more pain you have, the worse it must be. However, that is not really what differentiates a mild stress fracture from a serious stress reaction. 

What's the difference between a mild stress fracture and a serious stress reaction in a runner? 

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

If you get gout, it's going to be painful. It hurts because you get so much uric acid buildup in your bloodstream that it starts to crystallize, forming little bitty needle shaped crystals in the joint.

They are pointed, they're sharp and they are poking the tissue on the synovial tissue inside of the joint, and it hurts. 

When is the worst time to check for gout with a blood test? 

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

Every runner who has heel pain wants it fixed. 

A lot of us think about this in the way that we fix automobiles. The alternator goes out in your car, you go get a new one put in. Your battery dies, you go get a new battery. But your foot doesn't work this way. So unfortunately, when you have surgery, you're trading one problem for another.

I have done endoscopic plantar fascia release surgeries, but not on any runners for more than a decade. Why do you think that is? 

Can an endoscopic plantar fascia release surgery get me back to running faster? 

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

If you have a tear in the plantar fascia, you probably know what a frustrating injury it can be. If you think it's better, and you're going to start running, one of your big questions is probably, 

“How do I avoid a second tear in the plantar fascia?” 

That's a great question and that's what we're talking about today in the Doc On The Run Podcast. 

If your doctor said you have gout, you might have heard about a gout specific diet. 

A gout diet is not a specific diet in terms of a plan. It's avoiding foods that are high in purines that can contribute to high blood levels of uric acid.

What is the most ignored part of a diet for somebody who's a runner and thinks they have gout? 

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

Don't ever forget that when you get a running injury, the goal is not to heal the injury. The goal is to get back to running. 

If you heal the injury and you get so weak and so stiff, that you wind up getting another overtraining injury, that is a failure. 

The thing you have to really think about as you're returning to running isn't just about the possible other injuries you could get but incomplete healing.

The goal is to always strengthen everything as much as possible without obviously causing a real injury to the specific injury that got you in the fracture walking boot, on the crutches or thinking about canceling your race. 

Today on the Doc On The Run Podcast, we're talking about partial credit versus pass or fail with running injuries. 

Why would you want to add stress? 

We're not talking about psychological stress. We're not talking about the stress of a screaming baby or a boss yelling at you. 

We're talking about stress on the tissues that will actually stimulate a healing response that makes them stronger later, just like working out. 

If you're an injured runner who's getting back to running, you need to add stress systematically. 

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