Heel Bone Pain After Forefoot Running

Heel bone pain after forefoot running is rare because habitual forefoot runners, especially those who run barefoot, relieve heel bone stress by landing with the foot in a horizontal position, making initial contact on the forefoot first, the heel last.

However, shoe sole angle at touchdown was found to contribute to heel bone pain after running.

Heel Bone Pain After Running
A greater sole angle means the forefoot is lifted higher off the ground at touchdown meaning the foot lands more towards the heel at initial contact. A higher sole angle at touchdown was found to cause heel bone pain after running.

Heel Bone Pain After Forefoot Running

A recent study by Spears et al. found that heel bone pain after running was due to a higher sole angle at touchdown which increased both external and internal stresses on the heel bone.

Increased sole angle at touchdown during running is a result of cushioned running shoes, usually with the greatest amount of cushioning residing under the heel. A forefoot runner wearing these shoes seem to have difficulty landing away from the heel, towards the forefoot. This is due to increased ankle dorsiflexion caused by too much under-heel cushioning.

Overly cushioned running shoes encourage a more posterior landing (closer to the heel) thereby reducing contact area of the foot at touchdown. This means that at touchdown, the foot lands less flat-footed. To prevent heel bone pain after forefoot running, the point of initial contact on the foot needs to be large and farthest from the heel (i.e. the forefoot).

For instance, in the same study, a more flatter foot strike at touchdown, encouraged by running barefoot or in zero-drop minimalist shoes, increased contact area of the foot by 22% which decreased internal compression by 30% on the heel bone.

Heel Bone Pain Running
(A) Shows a heel strike, but a flatter heel strike at touchdown which relieves heel bone stain better than (B) a more prominent heel strike, involving a less flat-footed foot strike resulting in less contact area for impact to distribute over. SOURCE: Spears et al.

In addition, a flatter foot placement where initial contact is farther away from the heel allows the plantar fascia to distribute loads away from the heel, helping reduce the incidence of heel pain.

The Take Home Message

Runners who suffer from heel bone pain after forefoot running most likely have a foot strike landing where the heel intensively interacts with the ground. The best way to overcome this is to run in shoes with a smaller heel and increase the forward lean in your trunk when forefoot running as this helps keep plantar pressure in the front of the foot, away from the heel.

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References:

Spears at el. The effect of loading conditions on stress in the barefooted heel pad. Med Sci Sports Exerc, 2005; 37(6):1030-6.

Tang et al. Influence of trunk posture on lower extremity energetics during running. Med Sci Sports Exerc, 2015;47(3):625-30.

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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