Heel Strike Running Injuries: A Femur Fracture?

The type of heel strike running injuries range from shin splints to a femur fracture (worse case scenerio that isnt uncommon!) This is because running with the heel strike provokes the greatest amount of impact forces (as compared to forefoot running) that cultivate into cumulative strain which may not only be incrediibly distressing on the tibia bone, but also on the femur!

The femur is not only the longest bone in the body, but is also the strongest; so how can it become fractured during running if humans were born to run, especially without shoes?  The culprit to blame for such an injury is heel striking during running

Researchers use the shock wave/chronic overload model to examine how heel strike running may contribute to long bone injuries, such as a femur fracture.

Heel Strike Running Injuries: Femur Fracture?

Heel Strike Running Injuries: A Femur Fracture?

The shock wave/chronic overload model adequately explains how long bone fractures are produced when habitually shod runners heel strike: shock loads and propagated shock waves result in chronic overloading which derails the balance between microdamage formation and its removal.

  • At heel strike, the heel strike-transient is produced which is accompanied with shock loads that are measured in the long bones.
  • The shock loads travels up the musculoskeletal system as a propagation shock wave and continues to propagate with each subsequent step during heel strike running.

The fact that a bulk of research has fully addressed how heel strike running causes a femur fracture and established a model to explain the process is convincing that heel strike running is dangerous and should be avoided at all costs.

Heel cushioning is ineffective too because surprisingly low magnitudes of the shock wave was enough to produce chronic overloading.

Long Distance Runners who Heel Strike at Higher Risk

In most cases, a femur shaft fracture develops when a heel strike runner suddenly increases their mileage within a short time.

  • According to Warden et al. long bone injuries are concerning in long distance runners because these injuries are more likely to re-occur, simply because maintaining heel strike is the reason chronic overloading exceeds the capacity of the femur to resist loads.

What are the symptoms of a femur fracture induced by heel strike running?

A study by Manojkumar et al. reported that pain on the upper medial and anterior part of the thigh (front of the thigh) is an indicator, which is consistent with the symptoms Krista Duchene experienced before fracturing her femur towards the end of a half marathon.

Overall, femur fractures are uncommon in runners, but they do happen and the runners who get them are high-mileage heel strikers.

  • Again, a broken femur from running is the direct result of repetitive exposure to chronic overloading which is a function of foot strike pattern, not metabolic conditions, muscle strength imbalances, etc.

Protect the Femur with Forefoot Running

Chronic overloading is the unavoidable consequence of heel strike running. This means the only way to prevent femur fracture development is by switching from heel strike running to forefoot running, shown below.

  • In the same study, Wardne et al. recommended running softer with a higher stride rate, reflecting the characteristics of the forefoot running technique.

Robbins and Waked also reported that habitual barefoot runners (forefoot runners) are not subjected to chronic overloading. From this, the researchers concluded that the feet/legs are inherently durable and therefore, chronic overloading is caused by running in footwear that facilitates a heel strike landing over a forefoot strike landing.

Besides, why would natural selection evolve humans to run with a heel strike? It didn’t. It evolved humans to run with a forefoot strike. Forefoot running is the evolutionary novelty afforded a huge advantage to humans: running without injury.

More From Run Forefoot:

Find out how barefoot running makes you a more resilient runner.

Find the perfect shoe for forefoot running.

Cushioned heeled running shoes linked to all kinds of running injuries.

Find out how increasing proprioception enhances your running form.

If you have any questions, see Run Forefoot’s Facebook page where you’ll see all kinds of tips on forefoot running, barefoot running and footwear. I’ll be happy to help!


Manojkumar et al. Bilateral stress fracture femur presenting with thigh pain. Saudi J Sports Med, 2014; 14(2):172.

Robbins SE, Hanna AM. Running related injury prevention through barefoot adaptations. Medicine and Science in Sports and Exercise 19: 148-156, 1987

Robbins SE and Gouw GJ. Athletic footwear and chronic overloading: a brief review. Sports Med, 1990; 9(2):76-85.

Warden S., Davis IS and Fredericson, M. Manage and prevention of bone stress injuries in long distance runners. J Orthop Sport Phys Ther, 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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