How to Prevent Bone Injuries From Running

The best way to prevent running-related bone injuries of the lower extremity is by monitoring your foot strike during running, making sure that you land on your forefoot and avoid initial contact directly on the heel.

Bone Injuries

How Forefoot Running Prevents Bone Injuries Compared to Heel Strike Running

In running, the amount of bone deformation contributing to bone stress depends on the loading magnitude [1], which in turn is directly influenced by foot strike whereby a heel strike landing relates to higher rates of loading compared to forefoot running.

Over the past decade, evidence has mounted suggesting that in forefoot running, the impact transient of the ground reaction force and mechanical overloading are significantly reduced, thereby cutting down on the risk of repetitive bone strain and injury.

  • Strain, is a function of bone stress [2]. The factors in forefoot running that reduce bone strain on the lower leg are high cadence and foot strike position close to the center of mass [3].

In heel strike running however, bone strain is greater at touchdown because the center of mass is farther behind foot strike position, which increases joint and bone compression, and increases strain on the longer bones [4].

Heel strike running increase bone stress
Initial foot strike position in heel strike running increases bone strain, especially at faster running speeds and over long distances.
  • Because of the high vertical ground reaction forces and peak accelerations of heel strike running, heel strike runners have a greater risk of experiencing abnormal loading and bone strain.

Also, the loading in heel strike running may exacerbate bone stress in runners with maligned limbs who would otherwise benefit from forefoot running due to the less loading factor.

Running uphill may also pose problems for a heel strike runner as it may affect the load-bearing capacity of the bone, accelerating bone strain and micro-damage accumulation.

(Click here to read more on the differences between forefoot running and heel strike running).

Forefoot Running Reduces Bone Strain on Long Bones

In long distance runners, common sites of bone stress injuries are the long bones, specifically, the tibia, femur, and fibula.

In heel strike running, the tibia, femur, and fibula are preferentially loaded whereas in forefoot running, the only site of bone loading is on the small bones of the feet, that’s it [4]. (I would rather break a small bone in my foot than my femur which is why a prefer forefoot running over heel strike running).

(Click here to learn more about injuries related to heel strike running).

The Take Home Message

If you are worried about bone injuries, consider forefoot running as it lightens the load applied to the long bones, creating optimal conditions for the ability of the bone to resist deformation.

Click here to learn forefoot running and protect yourself from injury!

More From Run Forefoot:

Ethiopians Not Genetically Gifted Runners

Forefoot Strike Running and Arch Function


Dropping the Heel in Forefoot Running

Forefoot Running Shoe Reviews


[1]. Brunker et al. Stress fractures: a review of 180 cases. Clin J Sport Med, 1996; 6:85-89.

[2]. Hamil et al. Variations in ground reaction force parameters at different running speeds. Hum Mov Sci, 1983; 2:47-56.

[3]. Milner et al. Biomechanical factors associated with tibial stress fractures in female runners. Med Sci Sports Exerc, 2006; 38:323-328

[4]. Warde, SJ., Davis, IS and Fredericson, M. Management and prevention of bone stress injuries in long distance runners. J Orthop Sports Phys Therapy, 2014; 44(10):749 – 817.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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