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:

• 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.

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.

More to Explore at Run Forefoot:

• Thick Heeled Running Shoes Impair Running Form Causing Lower Leg Injury
• Orthotics Influence Ankle Instability in Runners
• Which is the Best Way to Run? Heel Strike vs Forefoot Strike?
• What is Minimalist Running?
• Why Ethiopian Elite Runners Run Differently than Joggers