Run Right: Decoding Foot Strike Patterns for Injury-Free Running

Foot strike patterns have been a focal point of research in running biomechanics due to their potential impact on running-related injuries (RRIs). Understanding how foot position influences injury risk can guide runners and clinicians in optimising performance and reducing injury prevalence (Lieberman et al., 2010).

Types of Foot Strike Patterns

Foot strike patterns are categorized into three main types: rearfoot strike (RFS), midfoot strike (MFS), and forefoot strike (FFS). RFS, where initial contact occurs on the heel, is most common among recreational runners, with a prevalence of up to 69% in some populations (Daoud et al., 2012). MFS involves a flat landing that distributes load evenly across the foot, while FFS engages the ball of the foot during initial contact, often seen in faster runners or those using minimalist footwear (Goss & Gross, 2012).

Biomechanics and Injury Risk

RFS runners experience higher vertical impact forces due to heel-first landings, increasing stress on knees and hips. This pattern is associated with repetitive stress injuries such as patellofemoral pain syndrome and iliotibial band syndrome (Daoud et al., 2012; Hollander et al., 2017). In contrast, FFS reduces impact peaks by engaging calf muscles and the Achilles tendon but may increase the risk of Achilles tendinopathy or calf strains (Lieberman et al., 2010). MFS balances impact forces across the foot and reduces vertical stiffness, potentially lowering injury risk; however, research on its direct correlation with RRIs remains limited (Van Gent et al., 2007).

Factors Influencing Injury Risk

Ground reaction forces differ between RFS and FFS runners. RFS amplifies localised tissue loading due to higher impact peaks, while FFS shifts stress to the ankle and Achilles tendon (Lieberman et al., 2010; Hollander et al., 2017). Footwear also plays a role; shoes with a high heel-to-toe drop exacerbate RFS-related injuries by increasing braking forces and altering limb mechanics. Minimalist shoes may encourage FFS but increase strain on the Achilles tendon (Goss & Gross, 2012).

Evidence from Research

Studies reveal that RFS runners have significantly higher retrospective injury rates compared to non-RFS runners. Prospective studies report that 52% of runners experience RRIs annually, with RFS being a significant contributor due to its biomechanical effects (Daoud et al., 2012; Hollander et al., 2017). Habitual FFS runners demonstrate reduced injury rates, likely due to lower vertical impact forces during ground contact (Van Gent et al., 2007).

Practical Implications

Gait retraining can help transition from RFS to MFS or FFS but should be done gradually to avoid overloading tissues unaccustomed to new stresses. Strengthening calf muscles and Achilles tendons can mitigate risks associated with FFS while improving efficiency. Additionally, lightweight shoes with lower heel-to-toe drops may promote better sensory input and encourage non-RFS patterns, potentially reducing injury risk.

Foot strike patterns play a pivotal role in running biomechanics and injury prevalence. While RFS is more common, it is associated with higher rates of repetitive stress injuries compared to FFS. Clinicians should consider individual biomechanics, training history, and footwear when advising runners on optimal foot strike patterns for injury prevention.

References

Daoud, A. I., Geissler, G. J., Wang, F., Saretsky, J., Daoud, Y. A., & Lieberman, D. E. (2012). Foot strike and injury rates in endurance runners: A retrospective study. *Medicine & Science in Sports & Exercise*, *44*(7), 1325–1334. https://doi.org/10.1249/MSS.0b013e3182465115

Goss, D. L., & Gross, M. T. (2012). Relationships among self-reported shoe type, footstrike pattern, and injury incidence in rearfoot- and forefoot-strike runners using minimalist footwear. *Journal of Sport Rehabilitation*, *21*(4), 350–357. https://doi.org/10.1123/jsr.21.4.350

Hollander, K., Heidt, C., Van Der Zwaard, B., Braumann, K.-M., & Zech, A. (2017). Long-term effects of habitual barefoot running and walking: A systematic review on health outcomes. *European Journal of Sport Science*, *17*(7), 930–939. https://doi.org/10.1080/17461391.2017

Lieberman, D. E., Venkadesan, M., Werbel, W. A., Daoud, A. I., D’Andrea, S., Davis, I. S., Mang’Eni R.O., & Pitsiladis Y.O.(2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners.*Nature,*463(7280),531-535

Van Gent R.N.et.al(2007) Incidence lower extremity running injuries systematic review.*British Journal Sports Med.*