Why Heel Strike Running is Bad for the Lower Leg

How you land on your foot when you run has enormous implications for lower leg injuries whereby heel striking is the only foot strike landing known to cause chronic exertional compartment syndrome (CECS), which is a painful condition, resulting in throbbing pain that radiates throughout the lower leg, but resolves as soon as running stops. This pain also increases with running distance and intensity.

Heel Strike Running and Chronic Exertional Compartment Syndrome
More research is showing running-related CECS is directly connected to heel striking. This is because landing with a heel strike was found to spark higher-than-normal levels of the ground reaction force which in turn caused the lower leg to be heavily bogged down with increases in intramuscular pressure, making CECS a looming problem for this running style.


Strong evidence for the CECS/heel strike running relationship is grounded in the higher magnitudes of impacts that are uniquely generated at touchdown. These impacts spark dangerous rises in pain-triggering intramuscular pressure in the lower leg, and is what CECS is.

To get a clearer picture of the exact way heel strike running is the only cause of CECS is landing heel-first was found to generate unusually high levels of the ground reaction force. This caused soft tissue compartments in the lower leg and foot to vibrate at a higher frequency, beyond a tolerable limit which in turn prompted swelling and pain throughout the lower leg (Friesenbichler et al 2011, Wakeling et al., 2002).

Why Heel Strike Running is Bad for The Lower Leg vs Forefoot Running
Increased intramuscular pressure beyond the threshold in the lower leg is preceded by swelling of soft tissue compartments due to prolonged exposure to high vibrational frequencies produced by a higher dose rate of the ground reaction force that’s uniquely generated at heel strike during running.

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Such clear and convincing evidence demonstrates that to avoid damaging rises in intramuscular lower leg pressure, running with a heel strike is of little help because of the accompanying unusual mechanical stress on the lower leg. Not to mention,  the hard evidence and anecdotal reports show that heel strike running has no preventive effects on CECS as well as runners knee and lower back pain. 

Why Forefoot Running is Better Than Heel Striking

For obvious reasons, the first course of action in preventing running-related CECS is to keep the ground reaction force at a lower, more tolerable level, since all running styles produce this force, but heel strike running produces too much of it. However, forefoot running was found to be the most helpful in achieving and maintaining safer levels of the ground reaction force that actually brought FULL resolve of CECS (Diebal et al. 2011)! 

Essentially, the most novel solution known to date to prevent running-related CECS is to reduce the ground reaction force whereby eliminating initial ground-contact on the heel (heel strike) and instead make initial ground-contact on the forefoot (forefoot strike), plays the most powerful role in literally curing CECS ( Nigg,1997).

Is Forefoot Running a Cure for Running-Related Chronic Exertional Compartment Syndrome?
If CECS is plaguing your running, you can fully avert the nagging condition with forefoot running! How? The science is settled that the mechanics that are activated when making initial ground-contact on the balls of the foot (forefoot strike), not the heel (heel strike) during running, was found to work best in keeping the ground reaction force sustainably low, within a safer range. Forefoot running is really all that is needed to greatly improve the odds of avoiding CECS for good!

Need more persuasive proof on this?

Study after study has found heel strike runners who suffered from CECS showed remarkable improvements in symptoms after adopting the forefoot running technique ( Diebal et al. 2011), because:

  • Forefoot running not only dramatically lowered the ground reaction force, it also eliminated the rapid spike in impact pressure that is naturally present in a heel strike landing, suggesting that running with a heel strike is all that is standing in your way of fully resolving CECS, and that running with a forefoot strike makes more efficient use of your entire stride that removes the big currents in impact that fuels CECS.  

But, instead of switching from heel strike to forefoot strike running, can’t a heel strike runner just wear thicker cushioned running shoes? The answer to this will shock you!

When it comes to preventing injury, much of the focus has always been on running shoes as the first-line therapeutic strategy, but are any of us runners any less injured despite running in shoes with massively thick cushioning? No.

One thing all runners can agree on is that all the advancements in running shoe technology has produced a worrisome trend in that an overwhelming majority of runners still injuring at a high rate! Of course, there are numerous reasons for injury, but running shoes dont reduce injury. In fact, running shoes seem to be an imperfect solution for preventing injuries, including CECS. 

What’s more concerning, certain types of footwear, namely thick cushioned running shoes, contributes to CECS by encouraging a more forceful heel strike during running!

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Its important to remember that material properties of a running shoe (i.e. thick underfoot cushioning and an elevated padded heel) powerfully influences foot strike pattern. For example, the thickly padded heel in most traditional running shoes pushes the foot too far ahead of the body at landing, while encouraging harder-hitting heel strike, and a lot of injuries stems from this. 

Unfortunately, the thicker the heel of a running shoe, the more likely you’ll land more hard on your heel, which will keep feeding chronic lower leg pain. Consider a flatter, thinner and more flexible shoe, like minimalist shoes, to help keep you off your heels and help you land accurately on your forefoot.

The Take Home Message

Its only until recently that a big bright line has linked foot strike pattern to CECS, and that forefoot striking helps you secure safer, impact-protective mechanics needed to prevent damaging levels of intramuscular lower leg pressures.

Lastly, CECS isn’t the only injury caused by heel strike running that forefoot running perfectly prevents. Here’s a long-list of injuries linked to heel strike running that forefoot running was proven to resolve.

If you’ve enjoyed this post, you’ll love my YouTube video here, where I show why forefoot running is better than heel strike running at every level! 


References:

[1]. Diebal et al. (2011). Effects of forefoot running on chronic exertional compartment syndrome: a case series. Int J Sports Phys Therapy, 6(4):312-21.

[2]. Nigg, BM. Impact forces in running. Current Opinion in Orthopedics (1997); 43-47.

[3]. Friesenbichler B., Stirling, LM., Federolf P and Nigg BM. Tissue vibration in prolonged running. J Biomech(2011);44(1):116-20.

[4] Wakeling, JM and Nigg, BM and Rozitis, AI. Muscle activity damps the soft tissue resonance that occurs in response to pulsed and continuous vibrations. J of Appli Physio(2002);93(3):1093-1103

[5]. Wakeling JM., Pascual SA and Nigg BM. Altering muscle activity in the lower extremities by running with different shoes. Med Sci Sports Exerc (2002); 34(9):1529-32.

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Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!