Vitamin D Deficiency and Foot and Bone Health: What Podiatrists Need to Know

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Vitamin D deficiency — defined as serum 25-hydroxyvitamin D (25-OHD) below 20 ng/mL — affects an estimated 40–70% of Americans and has significant implications for foot and ankle health that extend well beyond simple bone density concerns. Vitamin D plays a fundamental role in calcium absorption, bone mineralization, muscle function, immune regulation, and pain modulation — each of which directly impacts podiatric conditions including stress fractures, Charcot neuroarthropathy, wound healing, plantar fasciitis, and generalized musculoskeletal pain. Podiatrists are increasingly involved in identifying vitamin D deficiency as a contributing factor in patients with unexplained stress fractures, chronic tendinopathy, and poor wound healing.

Vitamin D and Stress Fractures

Vitamin D deficiency impairs calcium absorption and bone remodeling, reducing bone mineral density (BMD) and increasing stress fracture risk. Multiple studies demonstrate that military recruits and athletes with vitamin D deficiency have significantly higher stress fracture incidence — a 2.4-fold increased risk in one prospective military cohort. Patients presenting with metatarsal, navicular, or fibular stress fractures without clear training load error should have serum 25-OHD and PTH measured. Correction of vitamin D deficiency before return to activity accelerates stress fracture healing and reduces refracture risk. The target serum 25-OHD for bone health optimization is 40–60 ng/mL — substantially higher than the minimum sufficient threshold of 20 ng/mL.

Vitamin D and Muscle Function

Vitamin D receptors are expressed in skeletal muscle, where 1,25-dihydroxyvitamin D (the active metabolite) regulates calcium handling in muscle contraction. Vitamin D deficiency produces proximal muscle weakness, reduced muscle fiber diameter, and impaired neuromuscular coordination — contributing to falls risk in elderly patients. Low 25-OHD is independently associated with reduced plantar flexion strength and ankle instability in older adults. Correction of vitamin D deficiency in deficient elderly patients (supplementation to above 30 ng/mL) improves muscle strength and balance, reducing falls incidence by up to 20% in randomized trials.

Vitamin D and Chronic Tendinopathy

Emerging evidence links vitamin D deficiency to tendon pathology — vitamin D receptors are expressed in tenocytes, and in vitro studies demonstrate that vitamin D deficiency impairs tenocyte proliferation and collagen synthesis. Observational studies report significantly lower 25-OHD levels in patients with Achilles tendinopathy and plantar fasciitis compared to asymptomatic controls. While causality is not established, correction of vitamin D deficiency is low-risk and potentially beneficial in patients with chronic recalcitrant tendinopathy.

Vitamin D and Wound Healing

Vitamin D modulates inflammatory cytokine production (reducing pro-inflammatory IL-6 and TNF-α), stimulates antimicrobial peptide synthesis (cathelicidins and defensins) in keratinocytes, and promotes keratinocyte migration during wound re-epithelialization. Diabetic patients — already at high risk for vitamin D deficiency from impaired renal activation of vitamin D and reduced sun exposure from limited mobility — have significantly impaired wound healing that is partly attributable to vitamin D deficiency. Correction to above 30 ng/mL is recommended as a component of wound healing optimization in diabetic foot ulcer management.

Vitamin D Screening at Balance Foot & Ankle

Dr. Biernacki at Balance Foot & Ankle screens for vitamin D deficiency in patients with recurrent stress fractures, chronic tendinopathy refractory to standard treatment, and chronic wounds with impaired healing — coordinating supplementation recommendations with the patient’s primary care provider. Call (810) 206-1402 for a comprehensive musculoskeletal foot evaluation that addresses systemic contributing factors.

Recurrent Foot Pain or Slow-Healing Wounds? Consider Vitamin D.

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Vitamin D & Foot Bone Health in Michigan

Vitamin D deficiency is linked to stress fractures, poor surgical healing, and bone pain in the feet. Our podiatrists screen for deficiency and optimize bone health as part of comprehensive foot care.

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Clinical References

1. Shibuya N, Jupiter DC, Gao Y, Havens BM. Bone mineral density and vitamin D levels in foot and ankle surgery: a cross-sectional study. J Foot Ankle Surg. 2016;55(4):710-714.
2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-281.
3. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741-749.