Heel Strike Running Causes Femur Fracture. Forefoot Running Doesn’t.

There’s very clear evidence heel strike running is significantly more force-intensive and injurious than forefoot running. In fact, heel strike running is most directly related to severe injuries, such as a femur fracture, because landing heel-first when running produces an impulse wave found to increase stress on the long bones, namely the shin and femur, as compared with forefoot running, which was found to effectively break the flow of this heavy impact.

Does Foot Strike Matter When Running?
Heel strike runners (above left) show an impact peak force (burst in high impact) and forefoot runners (above right) do not. This force accounts for femur fracture in runners, whereas forefoot striking results in a contact with the ground that’s so brief that many impact variables are not fully produced, or even produced at all!

Case in point, elite distance runner, Krista Duchene –who is a heel striker– broke her femur towards the end of a half-marathon, but with incredible determination to finish, she did just that, achieving third place. Thankfully, Duchene’s femur was repaired with a plate and three screws. A similar scenario happened to Kenesia Bekele who adopted a heel strike running style when he transitioned from the track to the marathon on the roads. After dealing with endless injuries, Bekele modified his heel strike to a mid-foot/forefoot strike landing, and he has had more success than ever.

Heel Strike Running Causes Femur Fracture
Bekele (above left) and Duchane (above right) ran with a hard-hitting heel strike whereby both runners eventually sustained a femur fracture, an injury seen only in heel strike running, but rarely, if not ever, does this injury occur in forefoot runners.

Why does heel strike running produce this bone-breaking impulse wave, and forefoot striking doesn’t?

  • The impulse wave generated at heel strike is the result of abrupt braking of the foot with the ground which is the result of an over-stride and a torso posture that is too far behind initial foot strike position, whereby the magnitude of the heel strike-impulse wave was found to be the prime culprit for stress fractures of the long bone [1-3].

What is more, fatigue that accompanies the end of a long distance run reduces the shock attenuation capacity of the soft tissues, bones and articular joint cartilages, thereby amplifying the impact pulse at each heel striking step.

But, can a heel strike runner wear thicker cushioned running shoes to absorb this kind of impact?

What remains a key issue is heel strike running in thick cushioned running shoes results in a more intense degree of the downward force of the heel with the ground, meaning the thicker the amount of cushioning under the heel, the more a runner plows their heel onto the ground [4,5]. Therefore, heel strike running in thickly cushioned running shoes results in even more repetitive loading and stress reactions on the bones, which is why you can’t always fall back on cushioned running shoes thinking that they provide protection from impact when in fact they cause the heel to land harder. However, always remember you can adopt the forefoot running style, which is used by most top elite runners, including world record holders, because of its unmatched capacity to reduce shock and impulse waves [6].

  • Warden et al. 2014 found that structural fatigue in the leg bones can be prevented by instructing the runner to land softer, with a higher step rate, which are only engaged by landing with a forefoot strike.

The inherent impact-protective nature of forefoot running is in its ability to enable a larger foot-contact area which increases surface area to aid in even impact distribution, while correcting stride imbalance, such as over-striding, over-pronation, low cadence and longer contact-time. 

In addition, forefoot running improves the position of your upper body (which is also your center of mass) by enabling your torso to lean forward via greater knee flexion at landing and reduced stride length, shown below:

Black Friday at FitnessFactory.com!

How to Fix Lower Back Pain From Running: Fix Your Foot Strike!
Forefoot striking (above left) results in better leg swing and upper body posture control, preventing the torso from tilting back, while preventing over-striding vs heel strike running (above right)

Forefoot striking is critical for correcting upper body posture and improving foot positioning at touchdown, enabling the torso to tilt forward, while enabling the foot to land closer to under the knee and center of mass. All these mechanical outputs ultimately results in far less impact on the bones, while allowing you to run with better economy! Read more here!

References:

[1]. Daoud et al., Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc, 2012; 44(7):1325-34.

[2]. Sasimontonkul, S., Bay, BK and Pavol, MJ. Bone contract forces on the distal tibia during the stance of running. J Biomech, 2007:40(15):3503-9.

[3]. Warden et al. Management and prevention of bone stress injuries in long-distance runners. J Orthoped Sports Phys Ther, 2014; 44(10):749-817.

[4]. Nigg, BM and Morlock, M. The influence of lateral heel flare of running shoes on pronation and impact forces. Med Sci Sports Exerc, 1987; 19(3):294-302.

[5]. Kersting, UG., Kriwet, A and Bruggemann, GP. The role of footwear-independent variations in rearfoot movement on impact attenuation in heel-toe running. Res Sports Med, 2006; 14(3):117-34.

[6]. Sellers et al., Evolutionary Robotic Approaches in Primate Gait Analysis. Intern Journ Primate, 2010; 31(2):321-338.

[7] Zhou et al., Effect of different of contact angles during forefoot running on the stress of foot bones: a finite element simulation study. Front Bioeng Biotechnol. 2024; 12:1337540

WalkingPad Easter Sale

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!