2 Factors that Cause Exercise Induced Compartment Syndrome

Running is fun, but not when your legs hurt. Running with a heel strike landing is by far one of the best ways to cause lower leg pain and even the occasional tibia stress fracture.

In runners who heel strike, there are 2 factors that may increase their risk of exercise induced compartment syndrome:  full knee extension coupled with full ankle dorsiflexion at touchdown.

Exercise Induced Compartment Syndrome

2 Factors that Cause Exercise Induced Compartment Syndrome

Landing with a heel strike when running (shown below) is an underlying mechanism that increases anterior compartment pressures of the lower leg when using a heel strike running style.

Shin Splints Compartment Syndrome
How Heel Strike Causes Compartment Syndrome of Lower Leg. (1) Full knee extension and (2) full ankle dorsiflexion upon and at touchdown.

At initial heel contact, there is greater activation of the dorsiflexors which contributes to the rise in anterior compartment pressure at each step

Moreover, in heel running, greater anterior- posterior braking forces and vertical ground reaction forces are higher at touchdown compared to forefoot running. The braking and ground reaction forces exacerbate the rise in compartment pressure of the lower leg during heel running.

In contrast, Diebal et al. found that forefoot running completely eliminated compartment syndrome of lower leg because of less ankle dorsiflexion and higher knee flexion at touchdown (shown below).

Compartment Syndrome Lower Leg
Compartment Syndrome of Lower Leg Reduced with Forefoot Running. (1) Higher knee flexion (more knee bend) and (2) Less dorsiflexion, also known as increased plantarflexion, upon and at touchdown

Ultimately, higher plantarflexion (i.e. less dorsiflexion) at touchdown in forefoot running provides the most solace for the lower leg. Because humans did not evolve to heel strike during running, the high compartment pressure responses are generally lifelong if the runner continues to heel strike.

More on the Benefits of Forefoot Running:

Prevents Injury

Improves Performance

Strengthens the Arch

Better Achilles Tendon Function

30+ Best Shoes for Forefoot Running


Divert C, Mornieux G, Baur H, Mayer F, Belli A. Mechanical comparison of barefoot and shod running. Int J Sports Med. 2005;26(7):593-598.

Gershuni DH, Yaru NC, Hargens AR, et al. Ankle and knee position as a factor modifying intracompartmental pressure in the human leg. J Bone Joint Surg Am. 1984;66(9):1415-1420.

Kirby RL, McDermott AG. Anterior tibial compartment pressures during running with rearfoot and forefoot landing styles. Arch Phys Med Rehabil. 1983;64:296-299.

Zifchock RA, Davis I, Hamill J. Kinetic asymmetry in female runners with and without retrospective tibial stress fractures. J Biomech. 2006;39(15):2792-2797.

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!

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