Bone Injuries in Runners and What Role Can a Podiatrist Play in Rehabilitation?

Humans are structurally and functionally developed for running as well as having many health and wellness benefits. Unfortunately, running does carry its risk to develop bone injuries as you will find out.

How does new bone form?

It can happen via two pathways.

The first which is driven by calcium homeostasis or the second pathway which is either a microfracture/microdamage due to applied stress let’s say running or microdamage in a normal physiological response. 


How does someone develop a fracture?

When there is a good balance between new bone formation and bone breakdown through mechanical loads (running) we get a positive adaptation as depicted in the photo below. However, When the skeletal response is unable to keep up with the demands it cannot adapt to the mechanical loads (running) stress fractures can develop which is known as a negative adaptation.




A bone responds to stress on a continuum from a stress reaction to a stress fracture. If the repetitive loading continues then that is when a stress reaction can truly turn into a stress fracture.

What are some risk factors for bone injuries for runners?

  •     Faulty biomechanics where increased forces on a normally aligned lower limb can result in abnormal loading on bone
  •      Training errors such as when a runner increases speed this in turn increases ground reaction forces and increasing duration and/or frequency of running sessions increases bone loading cycles
  •      Muscle status as they are protectors of bone injuries during loading, they attenuate loads reducing impact on bone so if muscles are weakened or dysfunctional potentially leading to increased loading on the skeleton.
  •      Running surfaces and hard surfaces such as asphalt/bitumen increase loading whereas softer surfaces such as grass, rubber and sand have less impact
  •      Not wearing correct shoes and/or orthotics to attenuate ground impact forces
  •      A long history of physical activity can be protective against the development of bone injuries
  •      Female and low energy levels which relate to the interrelationships between energy availability, menstrual function and bone mass -female triad
  •      Low calcium and vitamin D increase chances of bone injury


How Can A Podiatrist Help?

When you come in to see our podiatrists at The Footcare Clinic we’ll take a thorough medical history and will also seek to understand your running goals and training habits.  This information along with a comprehensive gait assessment will help management of your bone injury.

Management is dependent on whether it is a high risk or low risk fracture which on its own can be discussed but rather I will give a broad overview of the continuum of care given of bone stress fracture management.

First diagnoses are made through clinical assessments, imaging and/or further investigation may be needed.

Then we want to allow healing to occur through initial phases of immobilisation, activity modification and load management and this is achieved around 4-8 weeks depending on which fracture site is affected.

After this we can start to look at return to activities and introduce strength and conditioning through graded exposure and start planning a return back to running by addressing risk factors and management of training loads.

If you or someone you know has had a recent bone injury then we would love to help. You can book with any of the podiatrists at The Footcare Clinic online or call our admin team on (03) 9711 7562 and we will be able to answer any questions you may have. 

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