The best way to avoid ankle pain and injury while running is by making sure you’re landing properly on your foot when you run, meaning you always want to make sure you’re using a forefoot strike (shown below), not a heel strike.
A fundamental distinction between forefoot strike and heel strike running is the trajectory of impact pressure on the foot is incredibly damaging in heel strike running, but not in forefoot running. This excessive pressure is a major risk factor for a bony stress fracture in the foot, but can be a magnet for ankle injury, too!
The killer piece of evidence came from a 2005 study in the journal Gait and Posture which investigated the bio-mechanical traits implicated in running-related ankle injuries. The study found that runners with a sprained ankle had the highest pressure impulse under the 1st metatarsal head (i.e just under the big toe) and a significantly lower peak pressure impulse under the 5th metatarsal head (i.e. under the 5th toe) as compared with healthy runners. Note that the runners with an ankle sprain were heel strikers.
How you use your feet when you run is a key factor in protecting your ankles whereby the main finding in the study was the pressure distribution on the foot in runners with an ankle sprain was localized under the big toe (1st and 2nd metatarsal heads) where impact pressure reached greater-than-normal levels. This caused the ankle to turn excessively from its neutral line which can not only severely stress the ankle, but stresses the entire leg due to the constant misalignment of the foot and ankle, and sadly, these mechanical entanglements is always a natural component of heel strike running.
Better protection for your ankles while running requires the switch from heel strike to forefoot strike running because the pressure distribution changes, where peak pressure is near the outside edge (lateral) of the forefoot and is dissipated more evenly without creating overpressure hot-spots on the foot. This allows the ankle to maintain postural stability because there’s no excessive impact to manage and compensate for. Its really that simple.
Now let’s take a look at how the elites do it:
To ensure a more controlled, safeguarded ankle, land on the forefoot, but land under the 4th and 5th toes as its not just a normative strike pattern in the best runners in the world, its used in all habitual barefoot runners, too who have the lowest incidences of ankle issues.
So, what’s the way the foot can best interact with the ground when you run? Forefoot strike! Here are more evidence-based reasons forefoot running is the biggest answer to preventing injury and why heel strike running will always be a major source of injury no matter how thickly cushioned your running shoes are!
Willems et al. Relationship between gait biomechanics and inversion sprains: a prospective study of risk factors. Gait and Posture, 2005; 21, 379-387.
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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.
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