More Injury Risks Linked to Cushioned Heel Running Shoes

You may already know that the higher the heel height of your running shoe, the more likely you are to heel strike, rather than forefoot strike when you run. Heel strike running causes injury partly due to the unpleasant impact force that is produced, which induces high stress on the body.

When the heel is elevated in these shoes, the foot is forced in an ankle plantarflexed position whereby having the heel lifted off the ground in such a way serves as a narrow support base that triggers changes in the natural motion and movement force in the leg during both running and walking (Fu et al. 2016). For example, the knee-joint hyper-flexes at heel strike to manage the intense vertical ground reaction force. Again, the knee is being forced into an unnatural position because different knee joint mechanics are observed in barefoot and minimalist runners whereby the knee flexes, but doesn’t over-flex at touchdown when running barefoot or in barefoot-like running shoes.

Did you also know that cushioned heel running shoes are also linked to knee osteoarthritis?  According to Baliunas et al. 2002, performing athletic activity in heeled footwear significantly increases knee abduction moments, which just happens to be a risk factor for knee osteoarthritis. But the knee isn’t the only part of the leg that is at risk of injury when heeled footwear is worn for running. The ankle is also a potential site of injury.

Cushioned Heel Running Shoes

More Injury Risks Linked to Cushioned Heel Running Shoes

Numerous studies have found that the forced ankle plantarflexion during walking in heeled footwear increases the risk of lateral ankle sprains (Foster, Blanchette, Chou, & Powers, 2012; Stefanyshyn, Nigg, Fisher, O’Flynn, & Liu, 2000). Other researchers have argued that running in heeled footwear causes significant motions in the knee joint which may ultimately increase loading force (Gu, Sun, Li, Graham, and Ren 2013, Gu, Zhang, and Shen 2013, indeed contributing to runner’s knee.

Padded Heel Running Shoes

Other investigations have found that high heeled footwear significantly increases stride lengthen during running. For example, a study by Fu et al. (2016) found that runners took an overly long stride when running in heeled footwear. The researchers also noticed that as running speed increased, so did the runner’s stride length, which may increase the risk of falls and musculoskeletal injuries. Furthermore, the researchers looked more closely at the runners gait and found that the runners increased their stance phase duration time to manage body stability when running in heeled footwear. This means that the runners exerted extra physical effort to stabilize their body when running in heeled footwear. This understanding –that heeled running shoes causes balance impairments — resonates with the high injury rate in recreational runners as most of these runners wear elevated cushioned heeled footwear.

Clearly, a runners’ biomechanics is strongly influenced by footwear. And for those learning forefoot running, many experts truly believe that wearing zero drop minimalist running shoes serve more to provide better landing stability of the foot during running.

Always remember that there is little evidence that excessively cushioned heeled running shoes prevents injury. Which brings us to the recent shift in our thinking about running shoes, that when people run barefoot, they come under the influence of better foot placement awareness and they do not usually display the same harmful impact generations as those who run in conventional running shoes.

More From Run Forefoot:

Why Training Barefoot is Better

Dealing with Shin Splints

How Minimalist Shoes Help Ease Runners Knee

Best Shoes for Forefoot Running


Baliunas, A., Hurwitz, D., Ryals, A., Karrar, A., Case, J., Block, J., & Andriacchi, T. (2002). Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis and Cartilage, 10(7), 573–579.

Foster, A., Blanchette, M. G., Chou, Y.-C., & Powers, C. M. (2012). The influence of heel height on frontal plane ankle biomechanics: Implications for lateral ankle sprains. Foot & Ankle International, 33(1), 64–69.

Fu et al. Lower limb mechanics during moderate high-heel jogging and running in different experienced wearers. Hum Mov Sci, 2016;48, 15-27.

Gu, Y., Sun, D., Li, J., Graham, M., & Ren, X. (2013a). Plantar pressure variation during jogging with different heel height. Applied Bionics and Biomechanics, 10 (2–3), 89–95.

Stefanyshyn, D. J., Nigg, B. M., Fisher, V., O’Flynn, B., & Liu, W. (2000). The influence of high heeled shoes on kinematics, kinetics, and muscle EMG of normal female gait. Journal of Applied Biomechanics, 16(3), 309–319.

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!