How Forefoot Running Prevents Tibial Stress Fracture

Unlike heel strike running, forefoot running prevents tibial stress fracture because the position of the lower leg at touchdown creates a less intense interaction strength between the tibia and the ground. Because the tibia aligns vertically at touchdown in forefoot running, tibial acceleration in the vertical and anteroposterior directions are minimal [1], thereby reducing repetitive stress on the lower leg.

  • Past reports have also shown that high power tibial acceleration frequencies –a risk factor for tibial stress fracture– were lower in forefoot running than in heel strike running [2].

Therefore, forefoot running has clear clinical relevance because the net change in tibial accelerations may cancel-out force variables that cause tibial stress fracture.

How Forefoot Running Prevents Tibial Stress Fracture
Forefoot running, the opposite of heel strike running, reduces pressure off of the tibia, reducing the risk of fracture.

How Heel Strike Increases Tibial Stress Fracture Risk

In heel strike running, tibial shock accelerations are greater because the tibia tilts at touchdown which increases anteroposterior axis acceleration [3], bearing a strong similarity to the mechanisms underlying tibia stress fracture development in joggers.

Similarly, a tilted tibia at touchdown when running causes the center of mass to crash head-on with the stance leg [4], and therefore unleashes compressive forces on the tibial shaft. In many shod runners, this impediment persists because standard running shoes makes it difficult to avoid heel strike during running. One idea however, is that during barefoot running, nature manages to prevent shock from building up inside the tibia by enforcing a forefoot strike over a heel strike landing.

How Forefoot Running Prevents Tibial Stress Fracture
Forefoot striking (right) ,involves a vertically aligned tibia at touchdown compared with a heel strike landing (left), which involves a tilted position of the tibia at touchdown. Although the differing tibial positions may look subtle, deviating from a vertical alignment at touchdown when running results in a high predictability of greater tibia shock and injury.

More Ways Forefoot Running Prevents Tibial Stress Fracture

One study found that a vertical position of the tibia at touchdown constituted a lesser fraction of tibial shock absorption in forefoot running than in heel strike running [1], implying that forefoot running projects less shock on the tibial –this may be because the calves help draw impact away from the shin bone as the researchers found that high pre-activation of the calf musculature increased shock attenuation. A forefoot strike landing also involves a more compliant ankle joint, providing further impact reduction on the tibia during ground contact [4].

The Take Home Message

The findings provide unprecedented insight into the influence of foot strike on tibial fracture in runners. Ever since the barefoot/minimalist running boom, researchers have made some strides in explaining why the strong force behaves as it does in heel strike running. Yet with decades of research, we have not filled in the missing pieces to create a strategy of how heel strikers can run safely, suggesting that forefoot running may have cracked the essential mystery of how to run injury-free.

More From Run Forefoot:

Pronation –  It’s really important to talk about why runners overpronate because overpronation is actually very prevetable

Barefoot Running Technique – Find out why barefoot runners dont heel strike

Bad Running Shoes – Understand that heavy running shoes zap the steam out of your legs.

MinimalistRunning Shoes for Elderly Runners – Discover why elderly runners may benefit best from barefoot style running shoes

Reviews on Forefoot Shoes – Check out my reviews on barefoot running shoes that will surely boots your forefoot running form and performance.


[1].  Giandolini et al. Foot strike pattern and impact continuous measurements during a trail running race: proof of concept in a world-class athlete. Footwear Sci, 2015; 7(2):127-137.

[2]. Gruber, A.H., Boyer, K.A., Derrick, T.R., & Hamill, J. (2014). Impact shock frequency components and attenuation in rearfoot and forefoot running. Journal of Sport and Health Science

[3]. Giandolini, M., Arnal, P.J., Millet, G.Y., Peyrot, N., Samozino, P., Dubois, B., & Morin, J.B. (2013). Impact reduction during running: Efficiency of simple acute interventions in recreational runners. European Journal of Applied Physiology, 113(3), 599 -609.

[4]. Lieberman, D.E., Venkadesan, M., Werbel, W.A., Daoud, A.I., D’Andrea, S., Davis, I.S., . . . Pitsiladis, Y. (2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, 463(7280), 531-535.

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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