People love the Pacific Northwest for its beautiful summer days and lush environment. These two come together to make our backyard here in Seattle, a runner's paradise. Today's blog is an answer to a question from a patient wondering if there is an advantage or disadvantage to the different types of footstrikes when running.
There's much contention between what is the right foot strike to adopt. Scientists have conducted countless studies, and people still form their own resolute opinions on how they want to get their steps in.
Running injuries are complex and not necessarily attributed to just one variable. Distance, training volume, muscular weakness, footwear - you name it - can all have a part in the injury picture. Even the trails and terrain you run on plays into the long-term health and integrity of your joints and muscles! This is especially true for runners who have been running for years on end.
Foot strike is just one particular variable.
Today's blog article is to provide you some useful information so that you can make an informed decision if you're thinking about changing your foot strike.
What are the Different Foot Strikes?
Rearfoot
The rearfoot strike is the most common strike found in recreational runners. This strike is defined by the runner contacting the ground with the heel of their foot first as they land. Upwards of 85% of shoed runners experience this running pattern. The foot will also tend to be more in front of the knee and hip with the knee mostly extended.
Midfoot
We define this footstrike as the front of the foot, and the rear of the foot contacting the ground at the same time. Think of it as the center of your foot evenly distributes the weight and shock of the impact across the entire foot. If you are a runner who runs with this footstrike, you likely feel your weight balanced over the entire lower half of your body, including your knees, hips, and ankles.
Forefoot
We define this footstrike as when the front 1/3rd of the foot contacts the ground first, typically at just under the base of the 4th and 5th toes. This footstrike places the shock and impact of the contact of your feet on the ball of your foot. Your heel is not likely to ever touch the ground as you work out.
This footstrike pattern often places the upper half of your body in front of the striking position, which leads to cramps over extended periods of exercise and use. On the other hand, the added momentum can better runners over hills or give an added boost of strength during competitive sprints.
The Debate and the Data
Perhaps you may have heard that many elite runners utilize a forefoot strike with the implied opinion that we mimic the best of the best. But just because it works for them, does that necessarily mean that it works for me?
Some adopt the school of thought that your mind and body naturally choose what's most comfortable and economical for you, and the issue should not be over-complicated. But sometimes I worry that my body has fallen into old habits that could be detrimental throughout my career as a runner.
Some even suggest rearfoot running in a recreational setting.
There's also the naturalist point of view is that humans have evolved to run barefoot and barefoot runners tend to run with a forefoot and midfoot strike. Before the advent of the modern running shoe, most runners in minimal shoes were also found to be forefoot and midfoot strikers.
There can easily be many thoughts and opinions running through your head. Can it be confusing as hell? Yes.
Ground Reaction Forces
The crux of the foot strike issue is how your lower extremity absorbs the impact when you hit the ground as well and turns you around to launch back out for the next step. Many modern studies tell us that there is not a significant amount of difference between the different strike patterns. Some studies even tell us that switching patterns can be more detrimental than staying with the pattern we currently use.
The following is a simple illustration I replicated from a study to highlight the difference in vertical ground reaction forces with rearfoot versus forefoot strike.
The initial impact with the rearfoot strike creates a sharper initial spike, also known as the "impact peak force." This initial spike comes from the sudden load onto the heel, followed by a quick, but a controlled drop of the foot before accepting full weight and progressing forward. Runners who run with a rearfoot pattern place much of the impact pressure on their knees. At the same time, they avoid placing the brunt of the pressure on their ankles.
These impact peak forces are thought to transfer stress through the skeletal system from the heel up. That controlled drop of the foot causes more work to your shin muscle, the tibialis anterior. Furthermore, rearfoot strikers may experience more torque forces at the knee as well. For this reason, rearfoot strikers tend to be associated with more hip, knee, and low back pain along with stress fractures and shin splints.
The initial impact on the heel is estimated to be 1.5x - 2.5x your body weight, but can be dampened a bit by a shoe with proper cushioning in the heel. This impact peak is assumed to be the reason why minimalist runners tend not to be rearfoot strikers as they have no heel cushion on which to rely.
The initial impact with a forefoot strike is a continuous and smooth loading trace. It does not generate a notable impact peak.
Forefoot landings cause higher torque around the ankle and lower torque at the knee and hip. This means the calves are doing more work as they must lower your heel to the ground and turn right around to push you off your toes. Forefoot strikes are not excluded from injury potential, and those runners are predicted to experience more Achilles tendonitis and foot injuries, which include stress fractures.
Midfoot strikes exhibit behavior somewhere in between both, but more like the forefoot strike. Our bodies will likely adapt and choose the proper striking pattern for the terrain that we are crossing thanks to the wonderous arts of biomechanics.
What's Research Telling Us
It's known that ground reaction forces demonstrate an impact peak in rearfoot strikers. We can logically understand why specific injuries would be associated with one strike versus the other. Still, the research presents mixed results on which is the best footstrike to adopt. Despite all of this research, it still can be confusing!
Oe frequently cited research study suggests that rearfoot strikers are 2x more prone to injury than non-rearfoot strikers. Still, even then, the authors state to use caution in interpreting the results. The characteristics of one group may not translate too well to another. It is always important to figure out which pattern works best for you, your life, and the way you want to be running.
On the whole, current systematic reviews do not support a substantial reduction in injury risk or increased performance when running with a non-rearfoot strike.
My .02 Cents
When there are considerable differences in opinions, I find the best solution is usually in the middle somewhere. If I were a runner looking to change my footstrike, I would adopt a mid-foot strike as it spreads the ground reaction force across the bottom of the foot at impact. This striking pattern also helps to better set up the foot for pushing off without extra motion that must be managed at the ankle by the shin or calf muscles.
If you're a recreational runner that doesn't run more than 2x a week for excessively long distances, I probably would not sweat bullets over your strike pattern. But, if you're an avid or elite long-distance runner, it may be worthwhile making a change, but gradually. By changing to a different strike that your body has not had the time to adapt to, you may be trading one set of problems for new ones.
The Gait Guys are a duo in the chiropractic community that have devoted their entire career to helping people walk and run better. If you're looking to dive deep and learn about foot and leg muscles, foot shapes, and foot strikes, check out the plethora of information they have on their page and podcast.
The Gait Guys tend to lean more toward the midfoot strike. Not just because it's the Goldilocks of foot strike, but because it also helps to accommodate various foot orientations and rigidity that exist in the population.
Where I think you would get the most bang for your buck in regards to running injury protection and performance is to improve your hip strength, mobility and control. Your hips can significantly impact your running performance, so make sure to take a multi-faceted approach when looking to improve your running technique. If you aren't sure how to best mobilize the hips (especially if working from home due to COVID-19), check out my video below:
I often help patients through individualized chiropractic care in Kirkland. This can include working with a good shoe store or podiatrist to help you find the shoe best suited to your running style.
Happy Running!
Bonus Content!
Another great way to increase your performance and recovery is to utilize assisted myofascial release through a foot massage. At Integrity Chiropractic, we asked our very own Kirkland massage therapist Elizabeth Hart, LMP, to put together a follow-along to help you do this with the help of a partner:
References
Mercer JA, Horsch S. Heel--toe running: A new look at the influence of foot strike pattern on impact force. Journal of Exercise Science & Fitness.
Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study. MEDICINE AND SCIENCE IN SPORTS AND EXERCISE. 2012;(7):1325.
Warr BJ, Fellin RE, Sauer SG, Goss DL, Frykman PN, Seay JF. Characterization of Foot-Strike Patterns: Lack of an Association With Injuries or Performance in Soldiers. Military Medicine. 2015;180(7):830-834.
Gijon-Nogueron G, Fernandez-Villarejo M. Risk Factors and Protective Factors for Lower-Extremity Running Injuries: A Systematic Review. Journal of the American Podiatric Medical Association. 2015;(6):532
Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthopaedics and Trauma. 2016;30(3):232-238.
Almeida MO, Davis IS, Lopes AD. Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2015 Oct;45(10):738-55.
Anderson L, Barton C, Bonanno D. The effect of foot strike pattern during running on biomechanics, injury and performance: A systematic review and meta-analysis. Journal of science and medicine in sport Sports Medicine Australia. 2017;(1):e54.