I have recently had a rash of runners with navicular fractures. 

The navicular is a bone that is right on the top of your foot, in front of your ankle and it's also at the apex of your arch.

Navicular fractures are scary because doctors often recommend surgery. 

There are four times when you might really need to have surgery for a navicular fracture and in this episode, we are going to talk about why. 

What are the four times a navicular fracture might need surgery? 

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

I was on a second opinion call with a runner. She developed a stress fracture in her accessory navicular bone.

If that wasn’t enough, she then started having pain in her arch in the tendon that pulls on her big toe. That tendon is called the Flexor Hallucis Longus Tendon, or FHL Tendon. 

Can an accessory navicular stress fracture cause flexor hallucis longus tendinitis in a runner?

Well, the short answer is yes, and I am going to explain how in today's episode of the Doc On The Run podcast.

Jones fracture is a scary injury if you are a runner.

If you have been diagnosed with a Jones fracture and want to start running sooner, you must understand the severity.

Can a bone scan help you tell the difference between a Jones fracture stress reaction and a styloid stress reaction in a runner?

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

If you get a stress fracture in the fifth metatarsal, there are a couple of reasons why you might want to sleep in a fracture walking boot.

Your goal is to keep the total amount of stress applied to that stress fracture under your threshold for healing, throughout the entire 24-hour period. 

Why should I sleep in a boot for a fifth metatarsal stress fracture? 

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

If you get a metatarsal stress reaction or a metatarsal stress fracture your doctor may order medical imaging to figure out how bad it really is. 

Your doctor's goal is to really figure out if it is a stress reaction or is it a stress fracture.

What is the difference when it comes to medical imaging using a bone scan versus an x-ray when you are looking for a second metatarsal stress fracture in a runner?

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

You have a couple of options when you get injured. 

One option is to wait so long that you know for a fact it has to be healed enough that it can withstand the forces of running. 

The other option is to move that timeline faster and make things happen a lot quicker. The only way to do that is by testing. One of the things you can test with is a test run. 

A runner asked me how long her first test run should be, if she had been two weeks since the injury actually had happened.

Let us say you have been injured and you take a couple of weeks off. How long should your test run be? 

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

Whenever you consciously give your brain direction, your subconscious brain will go to work to achieve it.

Your subconscious mind is not just controlling things that you want to happen but it's controlling things that you don't want, too. 

If you focus on negativity, if you focus on your injury getting worse, you will probably get worse.

So, the question is can you take this aspect of your brain and controlling your subconscious mind and use it to your advantage when you are trying to heal and get back to running?

Can simply thinking about healing make your running injury heal faster? 

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

Which do you think is worse, a stress fracture or a stress reaction? 

Well, since a fracture is a crack and a reaction is just inflamed and irritating, you probably think stress reaction. However, it's not true. Sometimes stress reactions take longer than stress fractures to heal in runners.

Why can a stress reaction take longer than stress fractures to heal in a runner?

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

I was just on a call with an injured runner who is about to go out for a test run. 

She is very excited because she is going to get either a yes or a no on deciding if the tissue in her foot that is been healing is strong enough to withstand a little bit of running at a medium pace for a short distance. 

This is an important test because if it hurts, obviously no running, right? You got to wait some more. But because you want to get a yes, you want to make sure that your chances of getting the yes are as high as possible. 

The way that you do that is you protect the foot as much as possible. So, the shoes you should use for your test run really do matter a lot. 

If you are going to go out and try a test run after you have been injured, what kind of shoes should you wear? Cushioning shoes or stability shoes? 

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

What if you were ramping up for several years to run 100 miles, but then you got tendinitis?

If you start getting pain because you have been doing lots of hill repeats, you could get irritation of the FHL tendon and specifically the tendon sheath that surrounds it where it bends around the back of the ankle. One of the treatment options is to inject it with corticosteroids. 

So, this runner called me and wanted to know whether or not it would be a good idea for her to inject the tendon sheath with cortisone before her trail race. 

If my FHL tendon is inflamed and irritated, should I inject the tendon sheath before my 100-mile trail race? 

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