How to Reduce Ankle Pain While Running? Avoid Heel Striking!

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.

Ankle pain and injury is almost certain in heel strike running because of the constant pressure overloads on the foot causes the ankle to move around in damaging patterns, which does not occur in forefoot running.

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!

Foot Pressure Pattern Big Problem in Heel Strike Runners
Heel strike running is scientifically unproven to prevent injury. One reason is that at heel strike, there’s a burst of high impact pressure at the heel that travels to the forefoot where the area becomes increasingly strained, even in a thickly cushioned running shoe.

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 Heel Strike Running Causes Serious Ankle Injury
Above is a graph showing the trajectory of impact pressure over the foot when the foot moves heel-to-toe (i.e. a heel strike landing) which produced the highest peak impulse pressure on the forefoot and is associated with a higher incidence of ankle sprain. How exactly does a medially concentrated foot pressure pattern lead to an ankle injury during running? As it turns out, a medially concentrated foot pressure pattern is followed by an extremely inverted ankle position during the stance phase of running, placing cumulative stress on the ankle joint. Simply put, there’s a normal range of motion for the ankle during running, but if foot pressure exceeds threshold, the ankle is forced to minimize this impact, but is pushed into extreme positions in doing so.

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.

How to Avoid Sprained Ankle Ligament During Running
Above, shows a typical forefoot strike. As you can see, the foot begins to orient itself more laterally to set-up for a lateral foot strike (i.e. a landing that is closer to the outer edge of the forefoot).

How to Avoid Mild Ankle Sprain When Forefoot Running

Swollen Ankle Ligament From Running

Now let’s take a look at how the elites do it:

Injured Ankle From Running
See how their foot shifts toward the outer-side prior to touchdown? That is because the proper way to land on the forefoot is by striking the ground first on the side of your outer forefoot. This will reduce the potential risk of an injured ankle when running.

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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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!