Achilles Tendon Injuries in Runners

Achilles tendon injuries in runners is not uncommon, sadly. Because heel strike running leads to greater rearfoot movements during stance, it’s no surprise that it causes Achilles heel inflammation. However, some runners who switch from heel strike running to forefoot strike running, may experience an Achilles sprain and this could be due to the fact that you are still using certain heel strike mechanics, such as raising the front of your foot too much before touchdown, to run forefoot.

Achilles Injury
To avoid Achilles tendon injury when forefoot running, keep your forefoot down upon and at touchdown, as shown above.

Raising the front of your foot before your foot strikes the ground while running (as shown below) is known as ankle dorsiflexion and is implicated in causing a tight painful Achilles tendon.

Heel Strike Running Causes Achilles Sprain
Ankle dorsiflexion is a common mechanical movement of the foot in heel strike running and may increase tension on the Achilles tendon, leading to pain and swelling.

Achilles Tendon Injuries in Runners

Runners with a greater ankle dorsiflexion range of motion at touchdown have a greater likelihood of suffering an Achilles injury.

Too much ankle dorsiflexion range of motion during running is a heel striking trait, and should not be used when forefoot running. A study by Donoghue et al. (2008) noticed that in barefoot and shod-running, runners with an Achilles injury lifted their forefoot back upon and at touchdown.

Though much of the role of increased ankle dorsiflexion in Achilles injury remains poorly understood, a prospective investigation by Mahieu et al. (2006) reported that greater dorsiflexion excursion was also strongly linked to Achilles tendon overuse injury.

How to avoid Achilles injury from forefoot running
Repeatedly lifting the forefoot at touchdown (left) increases ankle dorsiflexion range of motion which has been identified as an intrinsic risk factor for Achilles overuse injury. To limit ankle dorsiflexion range of motion, relax the ankle so that it becomes plantar-flexed relative to the ground at touchdown (right).

The researchers discovered that subjects with significantly higher ankle dorsiflexion range of motion were more likely to suffer an Achilles injury.

  • Their findings reflect the fact that increased ankle dorsiflexion increases strain on the gastrocnemius which leads to a greater susceptibility to Achilles injury.

Avoid Forefoot Lifting at Touchdown

Naturally in forefoot running, especially when running barefoot (shown below), the toes reflexively lift up, but not the entire forefoot like it does in heel strike running.

Achilles Tendon Injuries in Runners
When running barefoot, the toes naturally pull up to avoid the foot from tripping over them. The rest of the forefoot remains pointed down or parallel with the ground upon and at touchdown. This will help reduce tension from the Achilles tendon.

So, to avoid Achilles injury in forefoot running, relax your forefoot (the dorsiflexors) by not lifting the forefoot before the foot strikes the ground. A benefit to reducing ankle dorsiflexion at touchdown is that it delivers more strength to the plantar-flexors. This is important because decreased plantar flexor strength is another intrinsic risk factor for Achilles injury.

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References:

Donoghue et al. Lower limb kinematics of subjects with chronic Achilles tendon injury during running. Res Sports Med, 2008;16:23-38.

Mahieu et al. Intrinsic risk factors for the development of achilles tendon overuse injury. Am J Sports Med, 2006; 34(2):226-234

Bretta Riches

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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