Heel strike versus forefoot strike: which is better for you? There is a lot of debate in the running world over foot strike. One of the proposed benefits of a forefoot strike is a decreased risk of injury compared to the heel strike pattern seen in most recreational runners.
A new study out of Finland has been published that supports this idea. The study measured force loads at the knee and ankle of 19 female forefoot strikers and 19 pair-matched females with rear foot strike patterns. Forefoot strikers exhibited both lower patellofemoral joint stress and knee frontal plane moment than rearfoot strikers. The researchers suggested these findings may be one way forefoot striking can reduce the risk of running-related knee injuries.
At the ankle level however, the forefoot strikers showed higher forces on the Achilles tendon. So it’s possible that moving from a rearfoot strike to a forefoot strike only moves the load from the knee to the ankle.
Another recent study, published in the British Journal of Sports Medicine, found that running barefoot decreased patellofemoral joint stress. This study didn’t specifically look at foot strike pattern, but barefoot runners commonly adopt a forefoot strike. I know there are exceptions to this, but from the research that’s been conducted so far it’s safe to say that barefoot runners at the least exhibit more varied foot strike patterns than shod runners.
If forefoot striking shifts the load from the knee to the ankle then it’s reasonable to expect to see less running-related knee injuries.
So far there isn’t much evidence to suggest forefoot strikers get injured any less than rearfoot strikers. My opinion is that forefoot striking poses a lower injury risk, and I also think it’s going to take some time for that to be supported by research. It will take a long time because the minamalist/barefoot running trend only recently brought widespread attention to this topic. Many current runners did not grow up with lightweight, zero-drop shoes. It was only in 2010 when Daniel Lieberman’s study pointed out that habitually barefoot runners tend to forefoot strike, implying that forefoot striking may be a more natural way of running. By natural, I mean the way humans would run without the influence of modern running shoes.
The Case For Forefoot Running
Until research paints a clearer picture, we are left to theorize about what constitutes “better” running form. Here is how I look at the issue:
- Jump straight up and look at how your feet land. On your forefoot.
- Jump forward and land on one foot. How did you land? On your forefoot.
Now why is it that we land this way and not on our heels? It’s because by landing on the forefoot we allow the ankle to absorb some of the force of the landing.
Would you ever consider jumping and landing on you heel? I’ve tried and it’s impossible. My brain won’t let me land from a jump on me heels–and that’s probably a good thing. Landing on the heel would prevent the muscles in the calf from cushioning the impact. The force of the landing would be delivered straight through the heel bone and up into the leg. The heel bone (calcaneous) is not well-suited to cushioning the impact force from a direct landing. The knee, I suspect, handles impact force better when the force is partially absorbed by the ankle.
This relates to running because running is the act of making a small hop from one leg to the other. That small hop is the main difference between running and walking. Over the course of a mile you might land on each foot around 600 times depending on your cadence and the length of your stride. So if you wouldn’t even land one time on your heel when doing a standing jump, why would you even think about doing it 600+ times?!
Enter modern running shoes. Traditional running shoes with large, cushioned heels enable us to bypass that protective part of our nervous system that normally prevents a rear foot landing. The cushioning of the shoe absorbs some of the impact. But as the study cited above showed, there is going to be a greater load on the knee with a heel strike.
I’ve seen it suggested that using a forefoot strike only shifts the injury risk profile from the knee to the ankle. A forefoot strike might reduce knee injuries but then there is the concern about the increased load on the Achilles causing injuries at the ankle. I really don’t see this as the case. The question that needs to be asked is: which structure is better at withstanding loading forces, the Achilles or the knee?
But what about Achilles tendon injuries?
The Achilles tendon adapts well to increased load over time. I view Achilles related running injures more as a result of training error (e.g. inadequate recovery time) than as being caused by forefoot striking. I would actually go so far as to say increased load on the Achilles tendon is a good thing, as long as a runner’s training program is managed wisely. Seeing that many of us spend most of our time walking around on flat surfaces, and in shoes that have some degree of heel elevation, it may be the case that not enough load on the Achilles causes more problems than too much load.
The patellofemoral joint, the interface between the back of the kneecap and the femur, may not adapt as readily as the Achilles when it is subjected to the higher forces placed on it from rearfoot striking. Especially, if those forces are in the form of compression of the joint surfaces. This is why I believe most runners would benefit from moving away from heel striking, even when wearing cushioned shoes. The Finnish study also showed increased frontal plan (side-to-side) knee movement in heel strikers which may be another potential mechanism of running-related knee injuries.
Now there might be some situations when a heel strike would be considered natural, such as running on soft surfaces or at slow speeds. When considering how to reduce running-related injuries I think variability is ultimately more important than establishing a set running form. The body will respond better to being exposed to a variety of different forces rather than being subjected to the same loads repeatedly.
Traditional running shoes encourage a consistent footstrike pattern, which is why I’m in favor of flexible, less structured shoes. For heel strikers looking to adopt a forefoot or midfoot landing, it’s important to recognize that making that transition is going to take time. The body needs to adjust to the new stresses of a different foot strike pattern. In the long run however, I feel making that transition is worthwhile if it means reduce loading on the knees.