Forefoot Running May Prevent Impact-Related Injury as Compared with Heel Strike Running

When it comes to preventing impact-related injuries, research shows that forefoot running has an impressive record of producing better results than heel strike running. For instance, forefoot running naturally projects only a very narrow set of impact forces on the body and it also helps shape safer mechanics, such as reduced stride length and increased cadence which are impact-protective variables linked to better outcomes in preventing impact-related injuries, such as long bone stress injuries.  

Forefoot Running May Prevent Impact-Related Injury as Compared with Heel Strike Running

A re-affirmation of the safeguarding effects forefoot running has on the body comes from a new study that gives more full weight of the impact-protective nature of forefoot running, making the case even stronger that forefoot running may actually be significantly safer than heel strike running.

According to a 2019 report in the Journal of Sport and Health Science, switching from heel striking (high impact landing) to forefoot striking (low impact landing) during running may have the most positive influence on reducing injurious impact loads as compared with heel strike running with a higher cadence (also known as step-rate: the number of times the feet strike the ground per minute whereby 170-200 steps per minute during running is associated with low-impact landings). In other words, because heel strike running naturally produces more impact variables than forefoot strike running, the real potential for a heel strike runner to have a better shot at avoiding an impact-related injury is to switch to forefoot strike running, rather than increasing cadence while remaining a heel strike runner.

Here are the nuts and bolts of the study:

The researchers compared the intensity of certain impact force variables as well as the short and long-term biomechanical effects of increased run cadence and the adoption of a forefoot strike running style in heel strike runners. Specifically, the study involved 39 healthy recreational runners who were habitual heel strike runners and ran with a low cadence, were randomized into a cadence-retraining (while heel strike running was retained) group or a forefoot strike running group.

All runners performed 4 weeks of strength training followed by 8 sessions of gait-retraining using auditory feedback. The forefoot running group was provided with minimalist footwear (the Inov-8 BareXF 210) as part of the intervention because the lack of under-heel cushioning enables a minimalist shoe to help promote a forefoot strike with greater ease during running.

The cadence-retraining heel strike running group were instructed to increased their preferred run cadence by 7.5% with the use of auditory feedback via a metronome. These runners were also provided with conventional neutral cushioned running shoes (the Inov-8 Road Claw 275) because these runners were not instructed to change their heel strike pattern and thus needed protective under-heel cushioning since a heel strike pattern generates more impact at touchdown than a forefoot strike pattern while running. Note that run cadence can be increased without changing foot strike pattern, which is what was observed in the current study. From this, the researchers compared the effects of these gait-retraining parameters on the production of the impact forces and vertical loads closely tied to causing most common running-related injuries.

Their analysis showed a clear relation between forefoot striking during running and a significant reduction in vertical average load rates (VALR) and vertical instantaneous load rates (VILR) whereby the forefoot running group demonstrated a near 50% reduction in overall distressing impact loads and most exciting, they showed a 41.7% reduction in VALR and VILR, respectively, at the 1-month follow-up!

Most directly responsible for the reductions in these impact variables in forefoot running was in large measure, due to the activation of the calf musculature which was found to increase the deceleration time of the vertical velocity after ground-contact (1). Put another way, the calves act as a natural shock absorber and ankle stabilizer in forefoot running whereby after initial ground-contact is made on the forefoot, the heel drops down to the ground which results in an uptick in calf muscular activation as the calves play a key role in not only in effectuating shock absorption but creates a stronger, more stable connection of the foot with the ground.

Fundamentally, it’s the forefoot-to-heel (1-3) movement path of the foot in-conjunction with the help of the calves locking in stronger ankle stability as well as helping to diffuse impact more fully, that enables the landing foot to swiftly glide onto the ground with minimal jarring force and impact amplification. This is how pounding of the feet is reduced as well as damaging rises in impact loads.

By extension, the increases in engaging muscular activation of the calves immediately after touchdown in forefoot running, translates into a smoother rise to a single peak vertical ground reaction force (shown on the graph below) which also reflects the direct effect forefoot running has on scaling back pain-inducing stress loads, thus may do a better job at preventing the lower leg from overheating as compared with heel strike running (2).

Above is a figure from the study, shows the classic vertical ground reaction force that’s always generated in both forefoot and heel strike running and is the curve identifying the point of interest as well as the range over which the load rates were calculated. The major difference between the two is: (A) Sample curve with defined impact peak, typical of a heel strike strike landing pattern; (B) Sample curve with no impact peak (i.e. smoothed curved), typical of a forefoot strike landing pattern. The VALR is the average slope along the shaded region, and the VILR is the peak slope between any 2 successive points within the bracketed region.

Hugely significantly, the study’s additional data also revealed that forefoot striking during running automatically prompted a higher cadence by bringing into line, more quickly, a shortened stride whereby a natural by-product of enforcing a higher run cadence is reduced stride length, and of course, reduced impact loading. This is precisely why the forefoot running group accomplished the same type of impact load reductions as the cadence-retraining heel strike running group. This is because forefoot striking while running naturally makes the foot more well-positioned closer to the center of mass (upper body) at touchdown, thereby keeping stride length within a shorter range which is another chief component in preventing higher rates of loading on the leg. Basically, there are double benefits to forefoot running: it increases cadence because it shortens stride length, both of which are low-impact parameters in running and is where injury prevention progress can come from.

It’s also worth noting that these findings fit strikingly well with what was already known such that many studies have found that increased cadence is a natural by-product of landing with a forefoot strike during running. A case in point, a number of studies have demonstrated that in order to make initial ground- contact with the forefoot during running, the landing foot is naturally brought in closer to the center of mass and sufficiently restricts the leg from swinging too far ahead of the body, shown above. The net effect of this is the margins of impact intensity and duration are narrower.

Comparatively, the cadence-retraining heel strike running group demonstrated only minor reductions in impact load rates (14.7% VALR, 9% VILR) that also did not reach significance in the short-term, suggesting that upping your cadence while heel strike running may not sustain as well as switching from heel strike to forefoot strike running in efforts to make the most positive difference in bringing much needed impact-protection, long-term.

Knowing all this seems like a particularly good time to strongly affirm that foot strike pattern directly affects cadence, stride length and most especially, impact production during running. Based on the combined evidence, makes it clear that forefoot runners may be far less likely to over-stride and pound the feet into the ground and therefore, may be more likely to leave impact-related injuries behind as compared with heel strike runners.

Forefoot running is more than just a particular style of running, its a running style that sustain well as it warrants more proactive footing where the legs are less burdened by excessive impact and loading rates, giving you the confidence that when you run forefooted, you are operating from a fuller range of mechanical safeness and ultimately, can make you more prepared and tolerant in enduring longer, harder, faster miles.

If you’ve enjoyed this post, you’ll love my YouTube channel, here, where I provide more scientific content on the health and performance benefits of forefoot running, especially barefoot running.

References:

(1) D.L. Goss, M.T.. Gross. A review of mechanics and injury trends among various running styles US Army Med Dep J (2012), pp. 62-71. ePub (ePub)

(2) C.D. Samaan, M.J. Rainbow, I.S. Davis Reduction in ground reaction force variables with instructed barefoot running J Sport Health Sci, 3 (2014), pp. 143-151

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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

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