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Bone stress injuries, commonly referred to as stress reactions or stress fractures, are caused by overuse and are prevalent conditions in athletes. These injuries are often seen in sports with high cumulative skeletal loading such as running, athletics, gymnastics, basketball, cricket, or soccer. The main injury pathophysiology is an imbalance between bone microdamage formation and its removal and replacement. A detailed medical history and clinical examination are important for diagnosis, with magnetic resonance imaging representing the gold standard for radiographic confirmation. Treatment and return-to-sport decisions should be individualized and based on injury location, severity, aspects of sports participation, and patient preferences. Initial management includes activity modification, protected weight-bearing, immobilization, optimizing nutrition (caloric intake, dietary calcium, and vitamin D supplementation), and in a few cases surgery. Following initial treatment, progressive loading and return-to-activity are initiated. Overall, a high rate of return-to-sports can be expected. Numerous risk factors that alter bone loading or bone health have been described and their identification is a crucial step towards prevention of future injury.Key Words: Stress Reaction, Stress Fracture, Bone Overuse

The footstrike patternof an athlete is understood as the way the foot touches the ground. Over the years, several definitions and techniques to classify and quantify footstrike patterns have been described. Therefore, this narrative review summarizes the existing classifications of footstrike patterns, gives suggestions for further use of these classifications, and provides a summary of the relationship between footstrike patterns and the occurrence of overuse injuries. Footstrike patterns are classified by using nominal (e.g. forefoot strike, midfoot strike, rearfoot strike) or continuous variables (e.g. footstrike angle). Possible assessments include visual, video-based, 3D-biomechanical, force plate-based or inertial measurement unit-based analysis. Scientists, coaches, and clinicianscan choose between different methods to analyze footstrike patterns in runners. All approaches to classify footstrike patterns have advantages and limitations. In certain situations, it might be beneficial to combine these methods. Despite great efforts in analyzing footstrike patterns, relationships between footstrike patterns and running-related injuries are mostly unclear at present. Based on the current literature, causal links to overuse injuries, recommendations to change running technique, and other simplifications solely based on the footstrike pattern must be considered critically. KEY WORDS: Running, Biomechanics, Overuse Injuries

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