Myth: A Heel Strike is Bad
by Erin Kelly, SPT
Few things divide the running community as much as beliefs about foot strike — or how your foot first hits the ground when you run. And with all the rumors out there, it’s normal to have questions. Like, does heel strike running cause more injuries than forefoot running? Or, will forefoot running make you faster?
We dove into the latest research to find out if there’s a best way to foot strike.
What Does ‘Foot Strike’ Mean, Anyway?
First, let’s break down the different types of footstrike. There are three main methods used to literally ‘hit the ground running’: Forefoot strike, midfoot strike, and heel strike. Forefoot strikers tend to land on the ground with their toes first and maintain an elevated heel, while midfoot strikers land more in the middle of their foot before rolling through to their heel. Heel strikers contact the ground with their heel first before rocking forward to their toes.
Heel striking has a long and complicated reputation. Somewhere along the commercialization of running, it’s been ingrained in our brains that heel striking is bad and makes us more injury prone. And some studies do support this school of thought. But more recent research has found that the “best” way to footstrike may not be a one-size-fits-all model, and instead depends on the runner themselves and where their individual strength lies.
Which Foot Strike Pattern is Best?
The legend of a single “best” foot strike may be just a myth: A systematic review published in 2021 on foot strike technique and its relation to injuries in runners found little evidence to suggest that a relationship between foot strike technique and running-related injuries existed. And although two-thirds of studies included in the review did find a relationship between foot strike pattern and running-related injuries, no single foot strike pattern was to blame.
Instead, each foot strike pattern was associated with its own unique set of injuries. A 2012 study found that cross-country runners who run with a heel strike tend to have more stress reaction injuries than those who forefoot strike, while another study found that heel strike runners were more likely to have knee pain. A third study on runners who heel strike found they were more likely to have hamstring pain compared to non-heel strike runners. A 2021 study found that runners who midfoot strike tend to have more Achilles tendon injuries compared to heel and forefoot strike runners, while posterior shank (or glute) injuries were significantly higher in forefoot strike runners.
So, it’s safe to say that there’s no magical foot strike pattern that will keep you injury-free forever.
It’s also worth mentioning that the 2021 systematic review found that the majority of these studies correlating foot strike to injury were of low evidence. However, it makes sense that certain foot strike patterns may lead to specific injuries due to the amount of load they place on certain parts of your body.
How Does My Foot Strike Impact My Chances of Injury?
Heel strike runners have a higher magnitude and earlier vertical impact peak — or the greatest force seen during initial contact when running — compared to forefoot runners (see chart below). This sudden and jolty initial impact peak (compared to a forefoot striker’s more gradual, smoother loading rate) may be one reason for a higher prevalence of stress reaction injuries in heel strike runners. Heel strike runners also impose higher biomechanical loads on the knee and patellofemoral joints, causing runners to rely on their quads to eccentrically absorb shock and control knee flexion as they land, then rock forward with control from their heel to their toes for push-off. These larger loads may help explain why runners who heel strike tend to have more patellofemoral pain, as well as why hamstring injuries are common in heel strike runners (hamstrings are the antagonist muscle to the quads, and the two muscles must work together to function).
Like the assumption above, one can speculate that midfoot strikers have more Achilles issues due to the kinematics of midfoot running. Researchers from the 2021 study theorized that the landing mechanics of a midfoot strike may place the Achilles tendon at a non-optimal length-tension relationship, overloading the tendon.
As for why forefoot runners tend to suffer more from glute injuries, this may relate to the fact that forefoot runners don’t cycle through their complete range of ankle plantarflexion, so they need to rely more heavily on muscles up the posterior chain (ahem, the glutes!) to complete push-off.
Should I Change My Foot Strike Pattern?
While research on foot strike patterns is still limited, the research we do have available points to the fact that it’s not about a perfect foot strike. Instead, it’s about preparing our bodies to handle the loads and forces that come with the foot strike pattern we already utilize.
So while it’s natural for a heel striker to believe changing their foot strike pattern is an easy fix to mitigate knee pain — as it is for midfoot runners to believe a heel strike pattern may reduce Achilles pain — it may not be as simple as it seems.
A 2017 study published in Journal of Sport and Health Science found no obvious benefits to changing one’s footstrike for the majority of runners. In fact, researchers found that runners who changed their footstrike may actually experience the opposite effect due to stressing tissue in a new running pattern that’s not normally stretched, potentially leading to injury. Researchers also found no evidence that changing footstrike patterns led to improved running economy or decreased vertical impact force.
So, while some runners may still benefit from changing their foot strike pattern, researchers of this study advised against it, especially for recreational runners.
Ok, What CAN I Do?
If you’re injured and suspect your foot strike pattern is to blame, there are still actionable steps you can take.
First, talk to your physical therapist. They may be able to help you change your foot strike in a controlled, gradual way if they deem it necessary. They can also help you develop a strength training program that stresses the muscles you use most for your particular foot strike pattern.
For example, heel strikers tend to rely most on their quadriceps and tibialis anterior, while non-rearfoot strikers (forefoot and midfoot) tend to rely more on the gastrocnemius and biceps femoris (hamstring).
A physical therapist can also help you load your muscles appropriately for the foot strike pattern you already use. Since forefoot strike runners tend to have higher maximum peak force values in all three joints (except the knee), and forefoot strikers tend to have higher loading rates, all runners would likely benefit from a specialized training plan that applies forces and builds load appropriately.
At the end of the day (or the end of the run), it’s important to remember that all runners are different, and no single foot strike pattern will work for everyone. If you’re concerned about your foot strike pattern, talk to your physical therapist today to learn more about how you can pre-hab your way to better runs.