Another potential injury to add to the long list of injuries strongly associated with heel strike running is tarsal tunnel syndrome which is a repetitive strain injury that occurs when the posterior tibial nerve (a nerve innervating deep within the calf and extends into the foot) becomes compressed (nerve entrapment), causing burning or tingling pain in the ankle, foot and sometimes the toes.
What is it about heel strike running that may increase the risk of tarsal tunnel syndrome?
A 1993 study in the journal Sports Medicine traced the condition to the repetitive ankle dorsiflexion (forefoot lifts up) at heel strike which was the direct source that caused compartment pressure to increase and exceed normal inside the tunnel.
In order to land heel-first when running, the front of the foot lifts back (ankle dorsiflexion) prior to touchdown. At touchdown, the foot still remains in a dorsiflexed position (shown above), but the foot is also positioned well ahead of the center mass (upper body). This positional arrangement causes an unusually prolonged brake force, drilling the entire weight of body onto the foot for an extended period of time which also generates heavy compressive loads on the foot, ankle and shin and compartment pressure in the lower leg rise to levels that increase arterial spasm, capillary obstruction, arteriovenous collapse and venous outflow obstruction. In this condition, nerve entrapment can easily occur.
This is why heel strike running may be of little help to prevent lower leg injuries because of the additional loads on the lower leg as compared with forefoot running which may be better for this purpose.
In forefoot running, there’s less brake force loading through the foot and leg because landing with a forefoot strike alone engages less dorsiflexion and greater ankle planterflexion (shown below) which seems to help pin down an initial foot strike position that is closer to the center of mass. The resultant effect of this is an automatic removal of an impact spike as well as stark reductions in the impact responsible for pushing compartment pressure to the limits of capacity inside the tarsal tunnel.
All in all, the research is becoming more clear that foot pain and leg cramps during running may be strongly under the influence of how the foot lands on the ground and that forefoot running is a key enabler of mechanics that account for reducing the pounding of the feet, helping you stand an even better chance at avoiding injury as compared with heel strike running.
If you’ve enjoyed this article, you’ll love my content over at my YouTube channel, here, where I go into more detail about the evidenced-based facts on the performance and injury preventative advantages of forefoot running vs heel strike running.
Aminoff MJ. Tibial and sural neuropathies. In : Electromyography in Clinical Practice. 3 rd Ed. Churchill Livingstone. P 479-492.1998.
Colak et al. Comparison of nerve conduction velocities of lower extremities between runners and controls. J Sci Med Sport, 2005; 8(4):403-410.
Jackson DL, Haglund B. Tarsal tunnel syndrome in athletes. Am J Sports Med 1991;19:61- 65.
Lorei MP, Hershman EB. Peripheral nerve injuries in athletes.Treatment and prevention. Sports Med 1993; 16(2): 130-47.
Murphy PC, Baxter DE. Nerve entrapment of the foot and ankle in runners. Clin Sports Med 1985;4(4):753-63.
Novacheck TF. The biomechanics of running. Gait & Posture 1998;7(1):77-95.
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.