Foot Pressure Pattern Big Problem for Heel Strike Runners

The map of the foot pressure pattern in heel strike running is different from forefoot running and may be a risk factor for lower leg injury.

From an evolutionary perspective, the human foot has not evolved the capacity to redistribute or counter-balance the excessive plantar loading associated with heel strike running. This is why orthotics are commonly worn by heel strike runners since foot orthoses are somewhat effective at reducing plantar pressure at the heel and forefoot.

Despite the use of orthotics, heel strike runners are still prone to more injury than habitual forefoot runners who run barefoot, or in barefoot-like footwear.

Below describes the lower leg running injuries caused by abnormal plantar loading rates and patterns in heel strike runners.

Foot Pressure Map of a Heel Strike Landing
The direction of plantar loads in heel strike running travels heel—> toe and has injury implications to the lower leg.

Foot Pressure Pattern Big Problem for Heel Strike Runners

The distinct plantar loading pattern in heel strike running contributes to common running knee injuries, such as patellofemoral joint pain. How?

  • In heel strike running, the weight of the body transfers over the entire foot, from heel-to-toe, during stance. Thus, the typical plantar loading pattern in a heel strike landing travels heel-to-toe, with some trouble spots along the way.

All this extra loading exerted on the foot may facilitate greater pronation. As expected, greater pronation subsequently amplifies shock, such as the ground reaction force, on the knee and this is a solid explanation about why runners knee is more common in heel strike runners.

Achilles Injury

Earlier studies have linked plantar loading patterns to Achilles injury in runners. Runners who had more earlier peak force in the lateral heel (i.e runners who had a pronounced heel strike) and a greater center of force on the heel affected Achilles tendon loading that contributed to injury.

Heel Strike Runners Attempt to Mimic Similar Plantar Loading Pattern to Forefoot Running

In forefoot running, the plantar loading pattern starts at the lateral aspect of the forefoot and then spreads out rapidly over the rest of the forefoot, travelling towards the heel while reducing in magnitude. This means that plantar loading becomes more faint the more it dissipates over the foot in forefoot running. And, the heel receives the least amount of plantar loading.

However, researchers made an interesting observation of the nature of the plantar loading pattern in heel strike runners. Most heel strike runners showed an increased lateral loading of the foot (just like in forefoot running) except the loading pattern traveled heel-to-toe, not toe-to-heel.

  • Anatomically, the foot prefers to transfer plantar loading more laterally, but in a toe-to-heel direction to prevent increased loads on proximal structures such as the knee and hip. This is why in both heel strike and forefoot running, initial plantar loads travel more laterally on the foot.

However, the direction of plantar load over the foot determines injury!

The most successful approach to reduce the likelihood of lower leg running injuries is to make sure plantar loading travels toe-to-heel while you run, which is achieved through forefoot running.

Plantar loading pattern of a forefoot strike
In a forefoot strike, the plantar loads starts at the lateral aspect of the forefoot and spreads out over a larger area of the foot.
  • Anatomically, the lateral forefoot provides a larger surface area packed with fat pads and is a better ‘buffer zone” for plantar load dissipation compared to the heel.

And finally, to maximize your forefoot strike, experiment with running barefoot and/or run in pure minimalist footwear to prevent heel strike and the wrong direction of plantar loading distribution.

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Reference:

Dowling et al. Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. J Foot & Ankle, 2014; 7:53

Van Ginckel A, Thijs Y, Hesar NG, Mahieu N, De Clercq D, Roosen P, Witvrouw E: Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture 2009, 29:387–391.

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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