Which injuries are probably more common in which foot strike pattern?

Different running forms and different foot strike patterns load different tissues differently. This means that each technique probably has a unique set of specific injuries that they probably increase the risk for compared to a different technique (which is the point I tried to make here).

Exactly what injuries are probably more common with different running techniques? What follows is not really based on any significant evidence (as there isn’t any!), but is based on what limited evidence that there is; my own experiences and observations; my discussion with many others experienced in this; observations and analysis of social media comments, blogs and forums; an understanding of the pathomechanics of injury compared to the mechanics of a particular foot strike pattern and running form:

More common in forefoot and midfoot striking; minimalist running:

More common in heel striking:

Probably less common in forefoot striking/minimalist running, but not sure yet:

Probably less common in heel striking, but not sure yet:

  • Peroneal tendonitis

No clear pattern or consensus:

While each of these injuries can and do happen in all running techniques and foot strike patterns, it is the overall pattern of what injuries are more likely to occur in which technique and the above is the pattern that I observe and the consensus of almost all of those I have talked to about this and what limited published evidence tells us.

I will be the first to change my mind on any of these when the evidence tells me otherwise. Anecdotes and some n=1’s that do not match the above do not contribute much and are not evidence, as I am more interested in the bigger picture.

As always, I go where the evidence takes me until convinced otherwise.

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7 Responses to Which injuries are probably more common in which foot strike pattern?

  1. Alien Booth March 16, 2013 at 5:36 am #

    Finally someone is talking commonsense when it comes to running form. There is no best running form for everyone and there never has been.

  2. sportinjurymatt April 14, 2013 at 10:44 pm #

    When talking about heel strike & associated injury, do you think we should differentiate a heel strike that occurs on a fully extended knee (as a result of an overstride) from one that occurs on a flexed knee (closer to underneath the hips). I only mention it because I still see too many runners of the second category who have been told to modify their footstrike for fear of injury, when in reality (as I see it) a light, momentary heel strike on a flexed knee is not dangerous and often the natural consequence of wearing a shoe with ample rearfoot cushioning. I sometimes wonder if when considering injury, “heel strike” should be replaced with “overstriding”. Keen to hear what you think. Thanks.

  3. Craig April 15, 2013 at 3:59 am #

    Of course; I am probably guilty of oversimplifying things above. .. and that also my be why I not sure on patellofemoral pain yet.

    Basically:
    Heel striking –> greater initial impact loads (tibial stress #); greater ankle plantar flexion moments (anterior tibial muscle problems)
    Forefoot striking –> greater ankle dorsiflexion moments (calf and achilles problems); greater rearfoot eversion moment (post tib probs); greater forefoot dorsiflexion moments (met stress #; top of foot pain).

    In reality the distinction is not that ‘bipolar’ and exist on a continuum. An ‘overstriding’ heel strike will affect the direction of that initial vector at contact (esp relative to knee) and the ankle plantarflexion moments would be even greater.

    As you move from “overtstriding” heel strike to a heel strike under the CoG to a midfoot strike to a forefoot strike, there will be a change in all the joint moments along a continuum.

  4. Blaise Dubois April 18, 2013 at 1:37 am #

    Hi Craig

    More common in forefoot and midfoot striking; minimalist running (transition/short term only)
    – Metatarsal stress fractures
    – Dorsal midfoot interosseous compression syndrome (‘Top of foot pain‘)
    – Posterior tibial tendonitis
    – Posterior tibial tendon dysfunction
    – Achilles tendonitis
    – Calf strains
    – Peroneal tendonitis

    LESS common in forefoot and midfoot striking; minimalist running (use to/ long term)
    – Metatarsal stress fractures
    – Dorsal midfoot interosseous compression syndrome (‘Top of foot pain‘)
    – Posterior tibial tendonitis
    – Posterior tibial tendon dysfunction
    – Achilles tendonitis
    – Calf strains
    – Peroneal tendonitis

    More common in heel striking / maximalist shoe (short term??)
    – Tibial stress fractures
    – Anterior compartment syndrome
    – Patellofemoral pain syndrome
    – ITB syndrom
    – Hip load problem
    – Lower back pain / SI joint problem

  5. Juanolo April 24, 2015 at 12:26 pm #

    Hello Craig:

    I have some questions about Achilles Tendonitis and forefoot strike.

    How you usually treat a runner with Achiles pain? if you increase the drop (8-9 drop to hoka one) or use heel wedges,Does it will make any relief in pain in a forefoot runner?

    Thanks a lot

    • Craig Payne April 26, 2015 at 11:28 pm #

      I most use progressive eccentric loading/

      Heel raises/shoe drop are difficult. The evidence says that heel raises/increased drop decrease load in some and increase in other. We have no way at this stage of how to predict the response, so use with caution.

      With a forefoot striker, a heel raise/increased drop is probably not going to make a lot of difference ..

  6. Karol Vlk June 14, 2016 at 12:22 pm #

    I experienced Posterior Tibial Pain after I slided on gravel road and land badly, ironically when I was experimenting with forefoot strike. During the recovery when I start running I noticed that when I went back to heel striking my ankle didn’t even get sore. I know this is highly anecdotal and not scientific, but every time I try forefoot strike, I feel my inner ankle very lightly sore, but I have no problem with that when I heelstrike even on moderate mileage (50MPW).

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