Heel Strikers Risk of Metatarsal Stress Bone Fracture

A study by Weist et al., examined the effects of muscular fatigue on metatarsal stress bone fracture development in tri-athletes who were heel strikers. The study found that increased fatigue led to alterations in foot rollover which increased peak pressure forces and impulse under the second and third metatarsal head, and under the medial forefoot.

Heel Strike Running Increases Risk of Stress Bone Fracture

Heel Strikers Risk of Metatarsal Stress Bone Fracture

Stress fractures of the second and third metatarsal head are common in recreational runners and most recreational runners are heel strikers.

Heel Strike Running Broken Metatarsals

Rarely do habitual forefoot strikers suffer metatarsal stress fractures. Why?

Unlike forefoot striking, heel strike running involves propelling the body weight forward with the forefoot and toes after foot rollover.

  • The study showed that when fatigued, heel strikers showed a change in pressure distribution patterns of the foot, which increased pressure under the big toe and under the medial forefoot.
  • These adaptations to fatigue while heel striking increases forefoot loading at push-off, causing abnormal remodeling of the metatarsals and increases risk of fatigue fracture.

You would expect forefoot runners to have higher loading in the forefoot because the forefoot initially contacts the ground, but this is not the case.

In forefoot running, plantar pressure is localized under the 4th and 5th metatarsal head, ground-contact time is lower, and fatigue loading is lower because heel-toe rollover does not occur and neither does toe-off.

  • Forefoot loading is less pronounced in a forefoot strike because the foot lands closer to the body than in a heel strike.

In forefoot running, global plantar pressures and forefoot loading is lower since the forefoot is not used to propel the body forward.

  • Think of forefoot running as a controlled, continuous fall – as the body falls forward, the feet get out-of-the-way and flick up behind.

In any case, every runner can use stronger metatarsals, especially forefoot running and barefoot running newbies. Performing basic, strengthening exercises for the feet daily is the best defense against this painful, dreaded injury.

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Weist, R., Eils, S and Rosenbaum, D. (2004).  The influence of muscle fatigue on electromyogram and plantar pressure patterns as an explanation for the incidence of metatarsal stress fractures. Am J Sports Med, 32(8):1893-8.

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

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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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