Footstrike Hemolysis (March Hemoglobinuria)

ExitCare ImageRepeated force (trauma) to the foot, such as with distance runners, can cause the breakdown of red blood cells(hemoglobin) in blood vessels. This is known as footstrike hemolysis, or march hemoglobinuria. Many factors affect the breakdown of red blood cells, such as hardness of the running surface, high body temperature, and increased frailty of older red blood cells. For most people, the extent of damage to red blood cells is mild, and the body can compensate. However, sometimes, the body cannot compensate. In these cases, the destruction of red blood cells results in abnormally low levels of hemoglobin (anemia), iron deficiency, or blood in the urine (hematuria). Diagnosis is usually made by measuring the serum haptoglobin level or by demonstrating that blood is present in the urine, within hours or days of intense exercise.


  • Usually, no signs or symptoms.

  • Decreased red blood cells, due to lack of iron (iron deficiency anemia).

  • Blood in the urine.

  • Increased reticulocyte count (immature red blood cells, reticulocytosis).

  • Decreased number of red blood cells, due to destruction (hemolytic anemia).


  • Hard running surfaces.

  • Worn out running shoes.

  • Inherited red blood cell problems (hereditary spherocytosis).


  • Worn out running shoes.

  • Hard running surface.

  • Running long distances.

  • Sometimes, aerobic dancers and triathletes.

  • Elite athletes.


  • Do not allow running shoes to wear out.

  • Use insoles with shock absorbers, to reduce impact.

  • Run on softer surfaces.

  • Change running technique.

  • Do not rapidly increase running program.

  • Running in cooler temperatures may reduce severity of the condition.


Footstrike hemolyses will not typically affect your health. Athletes are expected to return to play after diagnosis, with little adjustment of activity. In rare cases, footstrike hemolyses may cause a person to become anemic, and then treatment may be needed.


  • Hemoglobinuria (blood in urine).

  • Iron deficiency anemia (low iron content in body, results in no red blood cells being made).

  • Hemolytic anemia (anemia caused by breakdown of red blood cells).

  • Usually, no complications.


Medicines are not used to treat footstrike hemolysis, but may be needed to treat associated complications.


  • Activity is not often restricted, if other aspects of exercise can be treated.

  • If severe, a period of rest or cross-training may be advised.

  • Sudden increases in running should be discouraged.

  • Running in the heat may be discouraged.


No changes in diet are known to be effective.


  • You experience a change in your capacity to exercise.

  • You are found to have an unexplained anemia on a laboratory test.

  • There is a change in the color of your urine.

  • You have a history of red blood cell problems and have increased fatigue, chest pain, or feel your heart beat rapidly.