Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Treatment at Balance Foot & Ankle: Foot Emergency Guide →
Osteoporosis: Not Just a Hip Problem
Osteoporosis — the systemic reduction in bone density and strength — is most publicly associated with hip and spine fractures, but its effects on the foot and ankle are clinically significant and frequently underrecognized. Stress fractures in osteoporotic bone occur with minimal trauma; fractures that would not occur in a young healthy skeleton result from ordinary walking or standing in patients with significant bone density loss. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we assess bone density risk as part of evaluating patients with fragility fractures and recurrent stress fractures.
How Osteoporosis Affects Foot and Ankle Fractures
The metatarsals — particularly the second and third metatarsals — are among the most common sites for osteoporotic stress fractures in the foot. Patients with osteoporosis may sustain metatarsal stress fractures from activities as mundane as prolonged walking or household activity — the mileage and intensity thresholds that apply to stress fractures in young athletes don’t apply to fragile osteoporotic bone. Calcaneal insufficiency fractures — stress fractures of the heel bone — occur in severely osteoporotic patients from ordinary weight-bearing and can be bilateral. The ankle — particularly the distal fibula — is another common fragility fracture site in osteoporotic patients.
Recognizing Osteoporotic Fragility Fracture Risk
Clinical red flags suggesting that a patient’s foot stress fracture warrants bone density evaluation: age over 50 in women or 65 in men; history of corticosteroid use (prednisone, dexamethasone — the most common medication cause of secondary osteoporosis); inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis); chronic gastrointestinal malabsorption conditions; minimal trauma mechanism for the fracture; bilateral or multiple simultaneous stress fractures; previous fragility fractures at other sites. Dual-energy X-ray absorptiometry (DEXA scan) is the standard bone density measurement — podiatrists may initiate the referral for DEXA and coordinate with primary care or endocrinology for treatment.
Treatment Implications
Osteoporotic foot fractures heal at the same biological rate as fractures in non-osteoporotic bone — but prevention of the next fracture requires treating the underlying bone density deficit. Calcium and vitamin D supplementation, bisphosphonate therapy, and lifestyle modification (weight-bearing exercise, fall prevention) reduce subsequent fracture risk. From the podiatric perspective: appropriate footwear with shock absorption, custom orthotics to reduce metatarsal peak pressure, and activity modification during fracture healing are combined with systemic osteoporosis management. Contact Balance Foot & Ankle at (810) 206-1402 for evaluation of foot and ankle fractures and assessment of underlying bone density risk.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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When to See a Podiatrist for Osteoporosis-Related Foot Problems
Osteoporosis increases the risk of stress fractures and insufficiency fractures in the foot, sometimes from everyday walking. At Balance Foot & Ankle, Dr. Tom Biernacki evaluates unexplained foot pain in osteoporosis patients, diagnoses occult fractures with advanced imaging, and provides treatment to protect fragile bones.
Learn About Our Fracture Treatment Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-1441.
- Boden SD, Osbahr DC. High-risk stress fractures: evaluation and treatment. J Am Acad Orthop Surg. 2000;8(6):344-353.
- Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis — 2020 update. Endocr Pract. 2020;26(Suppl 1):1-46.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentMore Podiatrist-Recommended Stress Fracture Essentials
Max-Cushion Walking Shoe
Hoka Bondi 9 — maximum shock absorption during stress fracture recovery.
Foam Roller for Recovery
- Patented foam roller design offers a superior, multi-density exterior constructed over a rigid, hollow core
- Constructed from quality materials that won’t break down or lose shape from repeated use
- Includes access to free online instructional video library on foam rolling best practices from the experts at trigger point
- Trusted foam roller of physical and massage therapists, coaches, trainers and athletes
- Original Grid: Standard density, 13 x 5.5 inches, 500 pound weight limit; 1 year manufacturer's warranty
TriggerPoint foam roller — maintains lower-leg mobility during return to activity.
Supportive Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
PowerStep Pinnacle — distributes impact evenly across the foot.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Most foot stress fractures heal in 6-8 weeks of protected weight-bearing — but rushing back to activity can turn a hairline fracture into a full break. Balance Foot & Ankle confirms stress fractures on X-ray or MRI and guides your return-to-running protocol. Don’t guess — we’ll tell you the exact week you can start jogging again.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)