How Cushioned Running Shoes Cause Acute Metatarsal Fracture

When you are running, especially with a heel strike, in running shoes with cushioning, plantar pressure is altered, leading to an increased pressure in the forefoot which may increase your risk of an acute metatarsal fracture.

How Cushioned Running Shoes Cause Acute Metatarsal Fracture

Raised heel running shoes may contribute to metatarsal stress fracture development by:

Cause of Bone Fracture in Foot During Running — Above, shows the plantar pressure distribution pattern in a heel strike which beginnings at the heel (top) at heel strike and travels down the mid-line of the foot as the mass of the body rolls over the heel, over the arch, and onto the forefoot where plantar pressures is transferred to the MTP and 2nd metatarsal head. SOURCE: Lieberman, et al. Harvard University.

increasing plantar pressures in the forefoot, particularly in the big toe

increasing plantar pressure in the medial forefoot was found to cause abnormal movement of the first metatarsophalangeal joint (MTP, or big toe), which may also influence bunion formation if running in narrow footwear (here’s how to prevent bunion growth)

accumulating peak pressures on the MTP joint may influence fatigue fracture

hyperextension of the hallux thereby decreases joint stability

After heel contact, the foot rolls from heel to toe, carrying the mass of the body over the arch and onto the forefoot where plantar pressure on the MTP joint significantly increase.

similar predictions have been made with respect to the effect of excessive plantar pressure on the MTP joint as this area is anatomically less stable and more susceptible to fracture compared with the 3rd, 4th, and 5th metatarsals

Most elite distance runners land on the forefoot in the order of 5th – 4th -3rd metatarsal heads as this portion of the forefoot may be better adept for distributing plantar pressures.

Forefoot Strike Plantar Pressure Distribution Pattern When Running — Above, shows the plantar pressure distribution pattern in a forefoot strike. Initial contact is made under the 5th metatarsal head where it is distributed over the 4th, 3rd, and 2nd metatarsal head as the rest of the foot comes in contact with the ground. This landing pattern may do a better job attenuating impact at foot-strike than landing directly on the heel. SOURCE: Lieberman, et al. Harvard University.

Shoes with minimal cushioning and a zero heel drop may discourage a runner from heel striking and thus may prevent inappropriate plantar pressure loading in the forefoot:

the outer-side of the forefoot is the area that makes initial contact with the ground in a forefoot strike and has been shown to be more anatomically adept at distributing plantar pressures than the heel when running (shown below right)

landing on the outer part of the forefoot, that is, underneath the 3rd, 4th, and 5th metatarsal heads may allow for a much softer landing than landing on the heel

The Take Home Message

It seems as if minimalist footwear is doing the opposite of what runners have been taught: that runners should be very careful running by wearing thick, cushioned footwear.

Now, it is becoming widely accepted that minimalist footwear may actually promote safer, more ‘natural’ running providing a runner switches from a heel strike running pattern to a forefoot strike running pattern, which might be worth the effort as forefoot running is associated with less impact and joint loading.

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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.

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How Cushioned Running Shoes Cause Acute Metatarsal Fracture