By: Dr. Marc Robinson, PT, DPT, Cert. MDT
A Physical Therapist’s Perspective on Heel-Strike vs. Forefoot Strike Running
What is your foot strike pattern while running? Should you run with a forefoot strike or a heel strike pattern?
In this article, I’ll be discussing the research on foot strike patterns to answer those frequency asked questions to improve running performance.
I wonder if Tom Hanks used a forefoot, midfoot, or heel strike while running in the movie Forest Gump.
In the famous scene as he runs away from a group of childhood bullies, Forrest Gump’s leg braces shatter, and he breaks out into a glorious, free-spirited sprint.
Forrest Gump likely chose his most comfortable foot strike pattern at that time. Similar to Forest, you are likely choosing your most comfortable foot strike pattern.
It’s your natural running style.
But, should you change your foot strike pattern to improve your running performance? Is there an advantage in switching from a heel strike to a forefoot strike?
First, let’s define the different types of foot strike patterns.
What are the different types of foot strike patterns?
In the heel strike pattern, the heel contacts the ground before the rest of the foot. Most endurance athletes are habitual heel-strike runners.
A study found that 94% of 1,991 sub-elite marathoners chose a heel-strike pattern. This study investigated a mid-size city population of runners. (1)
Another study looked at 283 elite, international level runners during a half marathon race and found 74.9% used a heel-strike. (2)
As you can see, the heel strike pattern is common among competitive marathoners.
The heel strike is known to create more impact at initial contact compared to the forefoot strike. Studies have identified higher ground reaction force at initial contact compared to midfoot and forefoot strike. (3)
In this video, you can see the spike in force as the heel strikes the ground:
The mid-foot strike is usually characterized by the heel and forefoot contacting the ground at nearly the same time. The mid-foot strikes appears to be a good balance between heel and forefoot striking.
In this video, you can see a comparison between heel strike, midfoot, and forefoot strike running:
Here is a video comparing all three:
The forefoot strike is generally characterized by landing on the ball of the foot before the heel. The lateral border of the forefoot usually makes contact with the ground then the foot slightly pronates or rolls inward.
Side note: You should not try to purposely land on the outside of the foot due to the risk of stress fractures to the 4th and 5th metatarsals. The forefoot strike should occur naturally.
In forefoot running, the heel may contact the ground; however, the contact is minimal.
In this video, you can see the force of the foot striking the ground:
Also, it is interesting to note that several of the best long distance runners in the world use a forefoot strike. Check out this beautiful barefoot forefoot strike at 1:02!
It would make sense to replicate the running form of world-class elite runners, right? Its sounds great in theory, but you are probably not a world-class elite runner.
Although you can learn from watching elite runners, improving your running is not as simple as mimicking their exact movements.
Mimicking their exact running mechanics may lead to increased injuries if you make drastic changes to your running mechanics in a short period of time.
In addition, their 4-minute mile running mechanics are likely different than your 8-minute mile running mechanics. It’s not an apples-to-apples comparison.
Can I Get Injuries with Heel or Forefoot Strike Running?
Yes and yes.
The risks of heel-strike vs. foot strike injuries are based on my analysis of the biomechanical factors involved with those foot strike patterns.
The research does not definitely link these injuries to specific foot strike patterns; however, they have been reported and you should be aware of these potential injuries.
Potential Risks of Heel-Strike Running
During a heel-strike, there is a high level of muscle activity from the muscle in front of the shin called the anterior tibialis. The anterior tibialis helps to raise the foot upward and it helps to prevent the foot from slapping on the ground quickly as the heel strikes the ground.
Overuse of the anterior tibialis can lead to shin splints. Shin splints (medial tibial stress syndrome or MTSS) occur when the muscles, connective tissue, or bone get irritated from too much activity in a short period of time.
It is important to note that shin splint are not only limited to heel strike runners. There are many factors that may contribute to shin splint such as foot strength, foot structure, hip strength, training intensity, etc.
Another potential injury that can occur with heel strike runners is compartment syndrome. In compartment syndrome, there is increased pressure in the compartments between muscles. (5)
These compartments are separated by layers of fascia. Fascia is connective tissue which does not stretch. As swelling increases from overuse, the pressure builds up in these compartments resulting in lack of blood flow and oxygen to that area. Acute compartment syndrome can lead to permanent muscle damage.
Potential Risks of Forefoot Strike Running
The forefoot strike increases the demand of the plantarflexors which includes the gastrocnemius, soleus, and Achilles tendon. (6,7). An abrupt switch to forefoot running can potentially lead to Achilles’ tendon injuries.
There are different types of Achilles’ tendon injuries but most injuries result from overloading the tendon. Basically, too much, too soon.
A forefoot strike could potentially cause posterior shin splints. The posterior tibialis muscle plantarflexes the ankle.
Remember, the demand on the plantarflexors increases with a forefoot strike so one may hypothesize that posterior shin splints could develop if the posterior tibialis muscle is overused.
Forefoot running can place additional stress on the metatarsals in the foot which are the small bones in the forefoot.
If your metatarsals are not used to the stress, you can get a stress fracture.
There is good stress and bad stress.
Good stress helps bones to get stronger. Bad stress wears the bone down and leads to stress fractures.
It all depends on the amount of stress placed to the bone in a specific time period.
In addition, it is also possible to get a stress fracture in the tibia from excessive, repetitive use. If you follow proper training guidelines and listen to your body, you will likely avoid these injuries.
In reality, all the injuries mentioned above can occur with any type of foot strike and I’ll repeat that the research does not link these injuries to specific foot strikes.
The Foot is Connected to the Rest of the Body
The foot is the last part of the kinetic chain of movement in the body. Understanding foot strike patterns is complicated enough and we haven’t even discussed how posture, trunk position, and the position of your pelvis can influence foot strike pattern.
Nate Helming, co-founder of the Run Experience has practical information about running on his YouTube channel. He frequently discusses the role of body position with foot strike and urges his viewers to consider a top-down perspective.
From a physical therapy standpoint, I agree with his perspective. We must view the body from a top-down AND bottom-up approach.
In other words, the foot strike position can influence the rest of the body. However, the rest of the body can influence foot strike.
If someone has no control through their core and their low back hyperextends and arms flail, what do you think is going to happen to the foot strike pattern?
The body is smart. It will find ways of maintaining balance. Your foot strike pattern may be a manifestation of your body choosing the best foot strike pattern for you at that particular time.
There may be a reason why you heel strike. If you change your foot strike pattern, you must consider the effect on the rest of the body and vice versa.
Control your body while running because apparently, people may laugh at you. How rude!
What is Barefoot Running?
I feel obligated to address barefoot running when discussing different types of foot strike patterns. If you have contemplated changing your foot strike pattern, you have likely contemplated barefoot running.
Barefoot running experienced a surge in popularity after the song, “Born to Run” was released by Bruce Springsteen in 1975.
Just kidding. I was checking to see if you are still paying attention.
The best-selling book “Born to Run” by Christopher McDougall was published in 2009 which created a biomechanical, physiological, and philosophical debate regarding the benefits of barefoot running.
His book tells the story of his own struggle with repetitive-use injuries as a runner. A common struggle for many runners.
Christopher’s journey to eradicate his own running injuries led him to discover a tribe of barefoot runners in Copper Canyon Mexico who ran exceptionally long distances without sustaining injuries.
Proponents of barefoot running suggest that running with thick, cushioned shoes has led to today’s common injuries.
Since our ancestors ran barefoot, it makes sense we should run barefoot too, right?
Before we make that conclusion, I want to point out the differences between habitual barefoot runners and new barefoot runners.
Just like comparing your running mechanics to a world-class 4-minute mile, elite marathoner, it’s a stretch to make a straight-forward comparison to a habitual barefoot runner.
The foot of a habitual barefoot runner in the canyons of Mexico has adapted to the demands of running without shoes over many years. You may want to think twice before running through a dirt canyon with your baby-soft, bare feet.
The point is your feet need to undergo a slow adaptation to running on new terrain or changing your foot strike pattern.
New barefoot runners will probably use a forefoot strike to avoid a potentially painful landing on the heel.
However, it is important to note that forefoot running and barefoot running are not synonymous.
Habitual barefoot runners can use a forefoot, midfoot, or heel strike.
A study by Hatala et al. looked at 38 habitual barefoot runners and found the majority preferred a heel-strike or mid-foot strike pattern. (8)
The same study also found their foot strike patterns were influenced by other variables such as running speed, training level, running distance, and running frequency.
The practical takeaway from this study is that barefoot runners do not always choose to run with a forefoot strike.
If you want to start running barefoot, realize you are changing multiple variables at the same time. You are likely changing your foot strike pattern, stride length, cadence, posture, among other biomechanical factors.
The important take home message is to educate yourself on proper running mechanics and allow time for your body to adapt. At the end of this article, I’ll provide several practical tips to help you.
If you need more guidance, then hire a running coach, meet with a physical therapist, or other professional who can help you make the transition to barefoot running without getting injured.
How Does Shoe Selection Influence Running?
Different type of shoes can influence your foot strike pattern. I’m going to discuss two types of shoe styles on opposite ends of the spectrum: Thick, Cushioned Shoes (Stability Shoes) vs. Minimalistic Shoes.
Thick, Cushioned Shoes (Stability Shoes)
Traditional running shoes have a thick cushion at the heel and throughout the sole of the shoe. Initially, most people believe these cushioned shoes would absorb the shock as the heel strikes the ground thus reducing injury.
However, proponents of barefoot running argue that thick, cushioned shoes may lead to increased injury.
One hypothesis is that a cushioned heel may give someone a false sense of security and result in someone over-relying on the shoe to absorb shock.
The cushioned heel can enable one to over-stride and land abruptly on the heel consequently “slamming on the brakes” to their forward progression.
Not the way nature intended us to run.
Saucony Guide ISO
Over-striding may be main culprit for an abrupt heel strike. It may be more advantageous to focus your effort on increasing your stride frequency (taking more steps per minute) rather than focusing so much on changing your foot strike pattern.
A study in 2011 showed that increasing stride frequency (steps per minute) reduced the load to the hip and knee joint while running. The results of this study indicate that increasing the numbers of steps per minute has potential to help you reduce common injuries and run pain-free! (9)
In addition, these types of shoes tend to provide substantial stability to the foot which may be good if you have a flexible or pronated foot. These shoes can be beneficial if you experience plantar fasciitis or foot pain because they support the foot and allow painful structures in the foot to rest.
They may not be the best if you are trying to strengthen your foot muscles since these shoes can restrict and inhibit the natural movement of your bare foot.
A running shoe store should be able to help you select a shoe based on your foot type and goals.
Barefoot running enables the feet to interact with the ground which stimulates receptors and muscles in the foot. Running with minimalistic shoes can mimic the benefits of barefoot running while providing some protection to the foot.
Minimalistic shoes are characterized as having little cushion on the sole to mimic barefoot running. Most minimalistic shoes have little arc support. If you take the shoe in your hand and fold it in half, you will notice that the shoe folds easily.
The lack of stability in a minimalistic shoe will cause you to rely on your foot’s intrinsic stability and strength. Any transition to barefoot running or using minimalist shoes should be gradual to allow time for your baby-soft, barefoot to strengthen and adapt.
People who walk or run barefoot feel that their feet “wake up.” There are numerous sensory endings in the feet which provide valuable feedback to the body to improve posture and balance.
Barefoot running or wearing minimalistic shoes can stimulate these sensory receptors more than thick, cushioned stability shoes which inhibit the interaction of the foot with the ground.
Running with minimalistic shoes such as Nike Free or Vibram Five Finger Shoes encourages someone to land “softly” on the forefoot to avoid a painful landing on the heel.
It is debatable whether minimalistic shoes can reduce the risk of injury; however, it seems like there is potential to reduce injury if one transitions appropriately to wearing minimalistic shoes.
It is also interesting to note that Vibram USA is settling a $3.75 million class-action lawsuit for allegedly making false claims that Vibrams Fivefingers shoes can reduce injuries and strengthen foot muscles without basing those claims on sufficient research. (10)
So, based on the research, can we make the following statements?
“A forefoot strike is better than a heel-strike.”
“Elite runners use a forefoot strike.”
“Forefoot strike leads to fewer injuries than heel-strike.”
“Heel-strike is bad for you.”
These statements may have portions of truth; however, they are not supported by research.
Running advice should be based on a multitude of factors and context is key. Recommendations that benefits one person can potentially harm another person.
Here are a few of variables which can influence running mechanics, foot strike, and injury:
In addition, here are several intrinsic, biological factors that may contribute to an injury:
Wow, that’s a lot information to process. As you can see, there are many variables that can influence running-related injuries and answers to running questions are not a simple “yes/no” or “right/wrong” response.
At the end of the day, it comes down to proper training. The human body is capable of incredible adaptations but adapting too quickly can lead to injury.
In Summary (Foot Notes)
Over 28 million people run weekly in the United States. (11) An estimated 56% of recreational runners get injured annually. (12) Running injuries are common, and it is important to understand the influence of foot strike patterns to run pain-free.
The body doesn’t like big changes in a short period of time. The body will respond better to small, incremental changes to your running mechanics instead of drastic changes.
With the guidance of a running coach or professional, you can make the switch from heel-strike to forefoot strike safely; however, you have to accept responsibility for the risks involved.
Likewise, if you decide to switch from a forefoot strike to heel strike on your own, you have to consider the risks and benefits of your decision.
Like most choices in life, you can use your best judgement based on past experiences, the current research, and expert recommendations.
Ultimately, you choose which steps you want to take.
Here are 5 guidelines to help improve your running mechanics:
Please Note: These are generic guidelines. Individual recommendations will vary.
1. Kasmer, M. E., & Liu, X. (2013). Correlation of foot-strike pattern and performance in a mid-size city marathon. Gait & Posture,38. doi:10.1016/j.gaitpost.2013.07.194
2. Hasewaga H, Yamauchi T, Kraemer WJ. Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength and Cond Res. 2007;21:888–893.
3. Lieberman, D. E., Venkadesan, M., Werbel, W. A., Daoud, A. I., D’Andrea, S., Davis, I. S., . . . Pitsiladis, Y. (2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature,463(7280), 531-535. doi:10.1038/nature08723
4. Goss, D. L., & Gross, M. T. (2011). A Survey of Running Styles, Shoe Selection, and Injury Trends. Medicine & Science in Sports & Exercise,43(Suppl 1), 691. doi:10.1249/01.mss.0000401915.98164.fb
5. Compartment Syndrome - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/
6. Shih, Y., Lin, K., & Shiang, T. (2013). Is the foot striking pattern more important than barefoot or shod conditions in running? Gait & Posture,38(3), 490-494. doi:10.1016/j.gaitpost.2013.01.030
7. Kulmala JP, Avela J, Pasanen K, Parkkari J. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers. Med. Sci. Sports Exerc. 2013;45:2306–2313.
8. Hatala, K. G., Dingwall, H. L., Wunderlich, R. E., & Richmond, B. G. (2013). Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations. PLoS ONE,8(1). doi:10.1371/journal.pone.0052548
9. Heiderscheit, B. C.; Chumanov, E. S.; Michalski, M. P.; Wille, C. M.; Ryan, M. B., Effects of Step Rate Manipulation on Joint Mechanics during Running. Medicine & Science in Sports & Exercise 2011, 43 (2), 296-302.
10. Vibram Agrees to Settle Class Action Lawsuit. (2016, December 14). Retrieved from https://www.runnersworld.com/newswire/vibram-settles-class-action-lawsuit
11. Schubert, A. G., Kempf, J., & Heiderscheit, B. C. (2013). Influence of Stride Frequency and Length on Running Mechanics. Sports Health: A Multidisciplinary Approach,6(3), 210-217. doi:10.1177/1941738113508544
12. Van Mechelen W. Running injuries. A review of the epidemiological literature. Sport. Med. (Auckland, NZ) 1992;14:320–335.