Doc On The Run Podcast Dr. Christopher Segler

I got a great question from a runner with a sesamoid fracture that turned into a "non-union."
The sesamoid bones are two tiny little bones under the big toe joint. When you break one of the sesamoids, if two pieces of bone do not heal back together, we call a "sesamoid fracture non-union."
In this runner's case, she used a bone stimulator. She wore a fracture boot. She used crutches. But after a year of treatment, the doctor looked at her X-ray and said, “You have a non-union, we should take it out.”
Is it possible to run if you have a sesamoid fracture non-union?
That is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

The primary way I help runners is through telemedicine second opinions. 
I help runners who are not running, who have not been getting better, who are frustrated, and help them figure out what they need to do to get past the injury and back to running. 
Once they are on track and have made lots of progress, they want to know “When should we check in for our next call?”
I feel like I am on track with my running injury, should we book another consulting call or a series of calls to talk about it? 
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

I saw a runner today and I did a cortisone injection to treat her sinus tarsi syndrome.  She asked me a great question. 
She said, “Is the cortizone injection something I am going to need to do every three to six months?”
She had been reading up on corticosteroid injections and had found that some athletes with certain conditions may have injections scheduled every few months.
Should I have serial injections for sinus tarsi syndrome? 
Well, that is a great question and that is what we are talking about today on the Doc On The Run Podcast. 

The most important first step with any athlete who signs up for a webcam second opinion or series of coach coaching calls is to ask, “What is your goal?”  I was lecturing at a medical conference in Wisconsin where I was doing a whole morning session on running injury talks and diagnosis of subtle fracture patterns in athletes. 
What I told those doctors is they have to ask the athlete, “What is your goal?” 
Without understanding your timeline based on your running goal, you cannot make a useful recommendation on treatment on any running injury.
Sitting in that conference room I realized...  Your goal that you have right now could tell me how chronic your running injury really is. 
Don't believe me? Well, that is what we're talking about today on the Doc On The Run Podcast. 

Today, I  had a final follow-up call with a runner who did a series of consultation calls with me to get advice every week. After the series of calls he had improved and was better, but disclosed to me that he felt like he had been depressed.
He thought he might have depression because he realized something had significantly changed in his goal setting. 
He said, “I can't even imagine myself doing races anymore.” Are you depressed because of your running injury?  Well, maybe you are, maybe you are not. I am not a psychiatrist. I am not a psychologist, but that is what we're talking about today on the Doc On The Run Podcast. 

This morning, I was on a second opinion call with a runner who had a couple of different injuries in his foot. 
The main problem keeping him from running was an injury to the collateral ligaments in one of his toes.
"The toe feels weak and unstable." He is understandably worried that the instability is going to cause a problem if he runs.
He was asking me:
“Well, can we surgically repair the ligaments?”
Should I have surgery to repair the collateral ligaments in my toe if I am a runner? 
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.