Forefoot Running Reduces Leg Compartmental Syndrome in Heel Strike Runners

Forefoot running reduces compartmental syndrome of the lower leg by encouraging a favorable foot strike position resulting in less ankle dorsiflexionhigher step rate, lower ground reaction force and adequate weight shift transfer on the foot.

How Forefoot Running Helps Compartmental Syndrome

Forefoot Running Reduces Leg Compartmental Syndrome in Heel Strike Runners

Correlational data suggests that heel strike runners are more susceptible to leg pain, particularly chronic exertional compartment syndrome (CECS) compared to other styles of running.Heel strike running causes leg pain

CECS results in lower leg pain that escalates with running duration and is actually a condition exclusive to running. However, reports of CECS are rare in forefoot strikers and barefoot runners, who are also forefoot strikers.

In recent studies, forefoot running was a tremendously effective tool for improving CECS symptoms in heel strike runners.

A recent study by Diebal et al., published results that gels with the research about the positive effects of forefoot running on reducing leg pain.

The participants in the study were heel strike runners with anterior CECS which increased in severity after running 1-Km. The pain resulted in the cessation of running and symptoms subsided after 5 – 10 minutes of rest.

As an intervention strategy to reduce CECS symptoms, the participants were trained to adopt the forefoot running technique with the aid of drills that reinforced the mechanics of a forefoot strike landing. Most of the drills in the study were from the Pose Method of Running and included:

  • foot taping and pulling the foot up to increase flight time and decrease ground contact
  • pressure and weight shifting to improve perception of landing and to reduce peak pulses on the foot
  • mental cues such as “land quietly” to reduce the ground reaction force
  • falling forward to prevent braking
  • the EZ Run Belt developed by Joe Sparks to aid in self-correction of running gait and helps prevent over-striding

The researchers found that the participants returned to running pain-free after adopting the forefoot running technique.

The researchers also noted that two of the participants who could not run 1-Km without symptoms before intervention could now run 4 and 5-Km with greater ease.

What was it about the forefoot running technique that eliminated CECS?

Forefoot running produces significant changes in the body’s ability to interact more safely with the ground compared to heel strike running. The higher step rate and lower ground reaction force reduces shock on the lower leg in forefoot running.

Moreover, other work has pointed out that reduced eccentric muscle activity of the anterior leg compartment musculature, associated with forefoot running, may prevent anterior compartment pressures from accumulating.

In contrast, heel strike running seems to be a risk factor for CECS as initial contact on the heel is the most forceful aspect of running gait and the ground reaction force is greater with a marked impact spike that is not seen in forefoot running.

The study confirms that this type of training with respect to the forefoot running technique, reveals that running is not hard on the body. And as scientists learn about the protective properties of forefoot running, they are discovering ways to produce better results which may lead to improvements in symptoms in much less time.

More From Run Forefoot:


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.

Gershuni et al. (1984). Ankle and knee position as a factor modifying intracompartmental pressure in the human leg. J Bone Joint Surg Am,66:1415-20.

Tsintzas et al.(2009). The effect of ankle position on intracompartmental pressures of the leg. Acta Orthop Traumatol Truc,43:42-8.

Tweed, JL and Barnes, MR. (2008). Is eccentric muscle contraction a significant factor in the development of chronic anterior compartment syndrome? A review of the literature. Foot, 18:165-70.

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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