I still remember one patient, let’s call her Margaret. She was 67, fit for her age, loved walking her dog every morning along the beach in Sandringham. She came in one day with a dull ache in the top of her foot – no injury, no trip, no obvious reason. It turned out to be a stress fracture, and what shocked her most? It was all tied to something she didn’t even know she had: osteoporosis.
Osteoporosis – or “porous bones” – is often called the silent disease, and for good reason. You don’t feel it creeping in. There’s no warning until something cracks – sometimes literally. It’s a condition where your bones lose density, becoming weak, brittle, and far more likely to fracture under pressure that wouldn’t normally cause damage.
From around the age of 35, we all start to gradually lose bone mass. That’s normal ageing. But in some people, especially post-menopausal women, this natural loss speeds up. Without enough calcium and other key minerals, your bones thin out. And when that happens, even small things – like stepping off a curb awkwardly or twisting your foot on uneven ground – can cause a stress fracture.
In fact, in Australia:
- 1 in 2 women over 60 will have an osteoporosis-related fracture.
- 1 in 3 men over 60 will, too.
Those are huge numbers. And the foot, with its complex structure and the constant pressure it endures, is particularly vulnerable. The bones in your feet are holding you up all day. When they’re not strong enough, something’s got to give.
Stress Fractures: Why They Matter
Stress fractures are tiny cracks in the bone – not as dramatic as a full break, but no less painful. If they go unnoticed or untreated, they can lead to long-term pain, limited mobility, and in severe cases, permanent disability. I’ve seen patients put off seeking help until things got worse. Some even lost their confidence to walk safely at home – and that loss of independence is heartbreaking.
That’s why recognising the early warning signs and understanding your risk is so important – especially if you’re over 60, have a history of fractures, or you’ve been diagnosed with osteoporosis.
Why Feet Take the Fall – Literally
Our feet cop a fair bit, don’t they? Whether it’s pounding the pavement for a morning walk, keeping up with the grandkids at the park, or just moving around the house – every step sends shockwaves through our bones. And when those bones have become brittle due to osteoporosis, the load can be too much.
I often explain it like this to patients: imagine your foot bones as a bridge. If the structure is solid, it can take all the daily traffic. But if the supports are hollowing out from the inside, even light foot traffic can cause it to crack.
The Stress Fracture Hotspots
In people with osteoporosis, the bones most at risk in the foot are:
- The metatarsals – especially the second and third (think ball of the foot).
- The navicular – a midfoot bone that often bears the brunt of poor biomechanics.
- The heel bone (calcaneus) – especially if there’s a history of heel pain or long-term hard-soled shoe use.
I’ve had quite a few patients – especially older women in the Bayside area – come in after ramping up their activity during summer. Suddenly they’re walking more, wearing thin-soled flats or slip-ons, and before long they’ve developed an aching foot that just doesn’t settle. That’s often how a stress fracture shows up: low-level pain that builds slowly, worse with activity, and no dramatic injury to explain it.
What Makes It Worse?
Several things can push already weakened bones over the edge:
- Poor footwear – Hard-soled shoes, worn-out runners or unsupportive sandals (I’m looking at you, thongs).
- Abnormal foot posture – Flat feet, high arches, or anything that causes uneven pressure across the foot.
- Increased activity – Like suddenly walking longer distances or returning to exercise after a break.
- Hard surfaces – Walking on tiles or concrete all day, especially barefoot, adds to the strain.
You’d be surprised how many patients tell me they’re doing laps of Chadstone or strolling the Tan thinking they’re doing the right thing for their health – and they are! But if your bones aren’t ready for it, and your feet aren’t supported properly, it can do more harm than good.
What Causes Osteoporosis? (And Why It Might Catch You Off Guard)
Now here’s the tricky bit — osteoporosis doesn’t always follow the rules. While we know it’s more common in women after menopause, I’ve seen blokes in their 50s and 60s come in with stress fractures who had no idea their bones were thinning.
What causes it? It’s usually not just one thing — more like a slow build-up of risks over time. Some are out of your control, like family history. Others, like how much sun you get or whether you’re moving your body regularly, are fixable.
Here’s a breakdown that might help:
| Risk Factor | How It Contributes | Aussie Example |
| Ageing (over 60) | Natural drop in bone density | Very common in my over-60s patients who are active but haven’t had a bone density scan since their 50s. |
| Being female | Post-menopause = rapid drop in oestrogen, which protects bones | I often see fractures in women 5–10 years post-menopause, especially if they had early onset. |
| Family history | Genetics can play a big role | If your mum had a hip or wrist fracture, your risk is higher. |
| Low calcium intake | Bones lose strength without enough calcium | Many Aussies cut dairy or go plant-based without replacing calcium. |
| Low vitamin D | You need vitamin D to absorb calcium | We get less D in Melbourne winters. I often test for it in patients with foot pain. |
| Smoking or heavy drinking | These speed up bone loss | Still see it in older generations who’ve smoked most of their life. |
| Certain medications | Steroids, thyroid meds, and some cancer treatments weaken bones | If you’ve been on prednisone long-term, your bones need monitoring. |
| Inactive lifestyle | Weight-bearing exercise keeps bones strong | Especially common after retirement or following an injury. |
| Underweight or eating disorders | Lower bone mass and hormonal disruptions | Less common now, but I still see older adults who were underweight most of their life. |
| Hormonal changes in men | Low testosterone affects bone strength | Often undiagnosed until a fracture occurs. |
Real-World Story
I had a patient in his mid-60s – let’s call him Jim – who took early retirement and moved to the Mornington Peninsula. He’d spent decades sitting at a desk, didn’t walk much, and had never broken a bone. One day he started walking 5km daily along the foreshore. Great for fitness, right? But within 3 weeks, he came in limping. A stress fracture in his navicular. His bone scan later confirmed osteoporosis, likely from years of inactivity and long-term reflux medication that affected calcium absorption.
How Do You Know If You’ve Got Osteoporosis?
The hard part about osteoporosis is that it’s silent. No pain, no stiffness, no warning signs… until something breaks.
That’s why I always say: if you’re over 50 and haven’t had a bone check, it’s time to get it on your radar — especially if you’ve had a stress fracture before or you’re noticing aches that don’t quite add up.
The Early Warning Signs
While there’s often no obvious sign, some subtle hints can raise red flags:
- A dull ache in the feet or legs that worsens with walking
- A stress fracture with no clear injury
- Shrinking height or a stooped posture
- Balance starting to feel off
- Family history of fractures, particularly hip or spine
I once saw a lady who thought her shoes were just wearing down unevenly. Turns out it was her foot arch collapsing due to weakened bones. By the time she came in, she’d already had two tiny fractures.
The Osteoporosis Check: What to Expect
If you’re concerned, here’s what your GP or specialist might order:
Osteoporosis Risk Checklist
| Assessment | Why it matters |
| Bone density scan (DEXA) | This is the gold standard. It checks the thickness and strength of your bones, usually at the hip and spine. |
| Blood tests | These check for vitamin D, calcium, thyroid function, and bone turnover markers. |
| Medical history review | Past fractures, family history, and lifestyle all help assess your risk. |
| Medication review | Some medications (especially steroids or thyroid meds) quietly thin the bones. |
| Fall risk assessment | Balance, muscle strength, and foot stability matter just as much as bone quality. |
You can request a bone density scan through your GP — it’s bulk-billed if you meet certain Medicare criteria like age, previous fracture history, or long-term medication use.
Don’t Wait for the Break
If you’ve had a stress fracture in the past and your GP didn’t check for bone loss, push for it. I’ve seen too many people dismissed because they “didn’t look like the osteoporosis type.” Truth is, it can affect anyone.
Even a mild foot fracture can be a red flag for something deeper. And if you catch it early, there’s a lot we can do to prevent more damage.
Treatment – Rebuilding Strength From the Ground Up
The good news? If we catch osteoporosis or a stress fracture early enough, there’s a lot we can do to help.
When it comes to your feet, treatment has to be multifaceted. It’s not just about healing the fracture — it’s about protecting your bones, improving balance, and making sure you’re not one fall away from a bigger issue.
Medical + Podiatry = Your Best Defence
Here’s a breakdown of how we approach it at Well Heeled Podiatry — alongside your GP or specialist:
| Treatment Approach | Details & Practical Tips |
| Calcium & Vitamin D Supplements | If you’re not getting enough through diet or sunshine (hello Melbourne winters), supplements can help rebuild bone strength. |
| Medication (from your GP or specialist) | Includes bisphosphonates or hormone therapies that slow bone loss. |
| Custom Foot Orthoses | Designed to reduce pressure on the exact fracture site and correct abnormal foot posture. We manufacture these in-clinic after a biomechanical assessment. |
| Supportive Footwear | Swap thongs and flats for shoes with cushioning, grip, and stability. I often recommend brands like Ascent, Revere, or some Asics walking shoes. |
| Balance + Proprioception Program | Our in-clinic rehab focuses on ankle control and balance retraining. Think standing on one foot, wobble board work, and safe strength building. |
| Strengthening Exercises | Tailored programs to build foot, ankle, and leg muscle — helps reduce falls and supports the bone. |
| Walking Aids (if needed) | Temporary use of a cane or walker may be recommended after a fracture to avoid repeat injury. |
I once treated a retired nurse named Joan from Brighton who fractured two metatarsals just from stepping down awkwardly off her porch. After healing, we focused on foot strengthening, balance retraining, and a complete footwear overhaul. She went from feeling nervous about walking on her own to confidently doing her daily loop around Dendy Park.
What made the biggest difference for her? She said it was the confidence boost — knowing her feet were supported and her bones were on the mend.
Our Approach at Well Heeled Podiatry
We go beyond just “patching things up.” For every patient with foot-related osteoporosis issues, we offer:
- On-site 3D scanning and custom orthotic design
- Footwear education tailored to your daily life
- One-on-one rehab plans focused on what you actually do — gardening, walking, stairs, shopping
- Regular follow-ups to adjust as your foot mechanics improve
We also communicate directly with your GP, endocrinologist, or specialist so nothing falls through the cracks.
Prevention – Protecting Your Feet and Bones Before They Crack
Prevention is where the real magic happens. You don’t have to wait for a fracture to start taking your bone health seriously — in fact, the earlier you act, the more control you have.
At Well Heeled Podiatry, I always tell patients: “strong bones start with smart habits.” And yes, that includes what you put on your feet and how you move every day.
Quick Checklist: Are You Supporting Your Bone Health?
| Prevention Tip | |
| ☐ | Have you had a bone density scan in the last 5 years (if you’re over 50)? |
| ☐ | Do you get at least 20 minutes of sun exposure most days (without sunscreen for vitamin D)? |
| ☐ | Are you doing weight-bearing activity 3–5 times per week? (Think walking, dancing, light resistance training) |
| ☐ | Do your shoes have cushioning, support, and grip? |
| ☐ | Are you eating enough calcium-rich foods daily (like dairy, almonds, leafy greens, or fortified plant milks)? |
| ☐ | Have you had your vitamin D levels tested recently? |
| ☐ | Are you avoiding hard floors barefoot at home? (Tiles and floorboards can be brutal on older feet) |
| ☐ | Have you had your foot posture assessed by a podiatrist? |
Even checking 5 or 6 of these puts you ahead of the game. And if not — don’t stress. Small changes make a big difference.
Your 4-Week Bone Strength Starter Plan
This is something I give to many of my patients after a fracture — but it works just as well for prevention.
Week 1: Know Your Numbers
- Book a bone density scan if you’ve never had one.
- Get your vitamin D and calcium levels checked by your GP.
- Keep a log of your walking and standing time.
Week 2: Check Your Feet
- Bring in your current shoes for an assessment.
- Get a podiatry foot posture evaluation (we offer this in-clinic).
- Start simple calf raises and single-leg stands daily (10 seconds per leg).
Week 3: Fuel Your Bones
- Add one calcium-rich food per meal.
- Spend 10–20 minutes in the morning sun.
- Consider a supplement if levels are low (chat with your GP first).
Week 4: Build Resilience
- Begin a supervised balance and strength program if needed.
- Replace worn-out footwear.
- Start short outdoor walks on even surfaces with good footwear.
Osteoporosis doesn’t have to be a scary diagnosis — but ignoring it can be. Especially when it affects the feet, which are literally carrying the weight of your world. If you’ve had a stress fracture, unexplained foot pain, or you’re worried about your bone health, let’s get ahead of it.
I’ve helped hundreds of patients just like you feel stronger, steadier, and more confident in their bodies again. With the right support, education, and care plan, you don’t have to live in fear of the next step.
Book an appointment at Well Heeled Podiatry, and let’s get you moving — safely, comfortably, and without fear of fractures.
