Heel Strikers Show Knee Cartilage Inflammation After Marathon

After running a marathon, heel strike runners showed knee cartilage inflammation, particularly at the medial tibial plateau.

Hesper et al.,(2015) used an MRI-related technique called T2 mapping to assess changes in articular cartilage of the knee in non-professional heel strike runners, before and after a marathon.

Heel Strike Runners Show Knee Cartilage Inflammation After Marathon


Heel Strikers Show Knee Cartilage Inflammation After Marathon

The results showed a considerably lower cartilage T2 value in the medial tibial plateau of the knee which may indicate early signs of knee cartilage degeneration due to the repetitive high-impact joint loading of heel strike running.

Moreover, Mosher et al. reported lower T2 values in the femoral cartilage after 30 minutes of running and was assumed to be from the reduction in cartilage matrix volume due to pressure-induced cartilage compression. How does this happen?

  • At heel strike, the knee is unbent while the ankle is positioned ahead of it, resulting in a separation of distance between initial foot strike position and the center of mass (i.e. the torso/head). This separation of distance results in sudden braking which increases compression on the knee.

In the current study, the researchers also found that the patellofemoral joint and the medial compartment had the highest changes in fluid shifts within the articular cartilage which in turn, may increase vulnerability to cartilage degeneration due to high-impact repetitive loading.

This finding is consistent with other work which found heel strike runners to be more prone to patellofemoral joint stress than forefoot strike runners. And, in recent studies, forefoot running was used to treat patellofemoral pain in heel strike runners and yielded outstanding results.

Forefoot Running Protect Knee Cartilage
Maximum knee extension is eliminated in forefoot running which is better on the knee-joint.

In running, changes to the knee cartilage architecture is often load-dependent where heel strike running produces the greatest loads on the knee compared to forefoot running. Forefoot running enhances the ability to manage knee-joint loads via eliminating maximum knee extension.

More From Run Forefoot:


Hesper et al. Quantitative T2* assessment of knee-joint cartilage after running a marathon. Euro J Rad,
2015, 84, 284-89.

Mosher et al. Change in knee cartilage T2 at MR imaging after running:a feasibility study. Radiology, 2005;243, 245-9.

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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