Tips to Avoid Stress Foot Fracture When Running

The cost of heel strike running in minimalist shoes is a stress foot fracture, particularly a metatarsal stress fracture on the 2nd metatarsal head of the forefoot. Interestingly, a running-related metatarsal stress fracture usually occurs on the 3rd or 4rd metatarsal heads of the foot, but rarely on the 2nd, until heel strikers began heel striking in minimalist running shoes during the barefoot/minimalist running boom.

How to Avoid a Stress Foot Fracture When Running
This worst thing a runner can do is heel strike in minimalist shoes because doing so increases peak pressure at the front of the foot.

Tips to Avoid Stress Foot Fracture When Running

A study by Giuliani et al.,(2011) speculated that a metatarsal stress fracture on the 2nd head appears to be the result of maintaining heel strike during running after switching from the standard running shoe to a pure minimalist shoe.

The researchers suggested that runners with a long-standing heel strike running style who transition to minimalism without specific gait retraining (i.e. forefoot strike), has a higher likelihood of sustaining a metatarsal stress fracture on the 2nd metatarsal head.

The study focused on 2 case reports where both runners switched from running in the standard running shoe to the Vibram Five Fingers and maintained daily mileage = Mistake #1. failing to transition gradually.

One runner reported a mild pain on top of the 2nd metatarsal head and continued to run anyway, but with a mildly antalgic gait –an unnatural gait that develops to avoid pain while running. = Mistake #2.  running with an antalgic gait!

In both cases, the runners maintained heel strike while they ran in the Vibram FiveFingers = Mistake #3. heel striking in pure minimalist shoes.

Footwear and Foot Strike Effects Plantar Pressure Patterns During Running

The Vibrams are intended for a forefoot running gait. The advantage of forefoot running in the Vibram’s is that it reduces plantar pressures on the 2nd metatarsal head, orienting these pressures towards the 5th, 4th, and 3rd metatarsal heads at touchdown.

How Runners Can Get a Stress Foot Fracture
M2, 2nd metatarsal head, red-line indicates the plantar pressure distribution pattern of a heel strike landing. M5-M3, blue-lines indicate the area of which plantar pressure is distributed in a forefoot strike landing. Plantar pressures distribute over a larger surface area in a forefoot strike landing and pressure over M2 is minimal.

In heel strike running however, plantar pressures travel in a straight line starting at the heel, traveling up the 2nd metatarsal head which ends up bearing much of the center of mass during stance. In this case, the 2nd metatarsal head takes most of the body weight thereby increasing bone load magnitudes.

The main conclusion is that switching from a cushioned heeled running shoe to a pure minimalist running shoe doesn’t cause stress fractures; the failure to undergo full gait retraining does. How you run affects the stress on your feet and the swift ease of slowly transitioning between two extreme footwear conditions undercuts your risk of fractures also.

More from Run Forefoot:


Giuliani et al. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics, 2011;34(7): e320-e323.

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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