Based on decades of evidence and facts (references below article), heel strike running clearly is the primary cause of many injuries, especially knee and hip joint injuries because heel striking produces the kind of impact that the body and thick cushioned running shoes cannot fully absorb.
To understand how heel strike running is very harmful to the body, studies use computational models that incorporated soft tissue structures, anatomical geometry and impact formulations to quantify the boundary of impact loads at heel strike.

We already know that the majority of running related-injuries are created by repetitive trauma impacts and joint overloading, making certain conditions, such as knee osteoarthritis and bone fracture more likely to occur.
Firm evidence supports the idea that impact generation depends on foot strike pattern whereby Kaplan and Heegaard (2000) found a problem with the current research on impact-related injuries in heel strike runners. They noted that most computational models only examined the support-phase of running, not the touchdown phase, which makes it more challenging to understand the interactions of the impact peak and muscular actions in heel strike running.
- Incorporating the touchdown phase of heel strike running is vital because at heel strike, a measurable burst in collisional impact, also called the ‘impact peak’ is generated, but is not generated in a forefoot strike landing (see here what a proper forefoot strike looks like).
Because the impact peak at touchdown is strongly related to repetitive stress injury, forefoot runners are often excluded from studies on these injuries for the reason that forefoot running generates no measurable impact peak (Lierberman et al., 2010). Heel strike runners on the other hand, are studied exhaustively to understand the role of the impact peak in degenerative joint progression.

Kaplan and Heegaard demonstrated just how health-harming heel strike running is:
- The researchers developed a model that incorporated tangential and normal compliances to investigate the ground reaction forces during the impact period of heel strike running.
Illustration from the study showing the double leg pendulum model (left) and the second model (right) used to investigate the effects of the impact peak on joint forces. In a heel strike landing, the knee-joint completely unbends and locks out, and at the same time, the shin is angled ahead of the knee and the upper body, creating an initial foot strike position too far ahead of the center mass (torso). This mechanical arrangement puts more stress on the entire body because it creates a long over-stride that results in too much stop and go or a prolonged brake force, which is another impact variable equally frequent and accounts for many injuries in heel strike running that is also dramatically reduced in forefoot running.
- The researchers used the double leg pendulum model to examine the ground reaction force and a second model was used to examine the ground reaction forces at the front of the foot while the back foot maintained contact in heel strike running.
The researchers demonstrated that at heel strike, impulsive forces were greater than impulsive external forces, indicating a higher collision force between the body and the ground at touchdown.

Unsurprisingly, their data was inline with loads of earlier work that showed the ground reaction forces were greater than body weight during heel strike running. From this, the researchers inferred that high loading at heel strike, coupled with muscular action responses amplified joint reaction forces at the knee and hip. Their data is of considerable clinical relevance because the knees and hips are highly susceptible to degenerative joint disorders in runners who are heel strikers.
Ultimately, when it comes to sustainably protecting the knees, hips and bones from injury when running, forefoot striking has been shown to be the most effective at preventing the kind of impacts that injure these areas.


The Take Home Message
When it comes to preventing injuries in heel strike running, the primary focus has always been on cushioned running shoes, but we are also coming to learn that thick cushioned running shoes amplify the impacts of heel strike running, resulting in more injury (read more here on that). Its going to take modifying your foot strike from a heel strike to a forefoot strike to sustainably reduce the kinds of impacts that cause injury. This is why forefoot running can enhance what you already have as a runner, keeping you training more and injured less. Better yet, its not just the hip and knees that forefoot striking, forefoot running does more to protect the shins and lower back than heel strike running. Read more on that here!
If you’ve enjoyed this post, you’ll love the content on my YouTube channel, here, where I show why forefoot running is safer and faster than heel strike running.

References:
Davy, D.T., Audu, M.L., 1987. A dynamic optimization technique for predicting muscle forces in the swing phase of gait. Journal of Biomechanics 20, 187 } 201.
Kaplaan ML and Heegaard JH. Energy-conversing impact algorithm for the heel strike-phase of gait. J Biomech, 2000; 33: 771-775.
Lieberman, D.E., Venkadesan, M., et al., 2010. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463 (7280), 531–535.
Radin, E.L., Yang, K.H., Riegger, C., Kish, V.L., Connor, J.J., 1991b. Relationship between lower limb dynamics and knee-joint pain. Journal of Orthopaedic Research 9, 398 } 405.
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