Part 2

Last post we saw that research has not proven barefoot running to be better in general than running with shoes. If you are used to a particular running style and it is working for you it is questionable how worthwhile a change would be. However, research does find some more clearcut changes that can be made to help stop recurrence of injury or reduce injury risk. This second post will look more at changing the foot-strike to either help treat injury or reduce the risk of re-injury, particularly if the injury has occurred more than once before. 

The basic strike patterns of the foot in running.

Research has shown that:

Fore-foot strike (FFS) places more load on the ankle, whereas rear-foot strike (RFS) places more load on the hip and knee¹.

If you have looked at the running assessment page of my website, you will have seen the statistic that 70% of running injuries are caused by training error². Here are two examples of a training error that could cause injury:

1. Changing foot-strike when no issue/injury existed
2. Changing foot-strike when it was appropriate

Now you may be thinking, wait-a-minute, if it is appropriate to change foot strike how can it be a training error? Well, it could be a training error if the change was made in the wrong manner. In this example, even if an appropriate change, it could cause injury if the runner just woke up one day and grossly changed their pattern! The same could be true in our assessment of barefoot running: it may not be inappropriate, but if you suddenly switch from always wearing shoes to always going barefoot, your feet could quickly be injured!

From rear-foot to fore-foot

So, we come to the most important point of these two posts. When making changes either to your shoes (or lack thereof) or foot-strike, we need to consider the idea of moving along a continuum. If I have knee pain when running, I might need to move along the continuum from RFS towards FFS gradually. This is necessary to allow the body’s tissues (muscles, tendons, ligaments, bones) time to adapt. When you don’t allow the body this time, you can develop issues such as muscle strains, tendonitis, ligament sprains, and stress fractures. For example, if you move too quickly from RFS to FFS you could easily develop achilles tendonitis.

Research has shown that by increasing strike-rate you can move along the continuum from RFS to FFS³. However, this should be done slowly. We have to listen to our bodies making sure we do not experience significant pain or worse, run through pain during the changes we make. Because everyone’s bodies are built and respond to change differently, it is also not easy to prescribe a standard protocol to follow.

The above example on how to change foot-strike is certainly not the only way to manage an injury or stress to a part of the running body.  Changes to foot-strike as well as other options, particularly in the presence of injury, should be made under supervision. As a Physical Therapist, I would only recommend specific changes after a thorough analysis, which would involve a full physical examination and video running assessment. If you feel that a change in foot-strike might be for you, I would be happy to help you determine whether making such a change is appropriate for your situation.

Reference List

1) Stearne SM, Alderson JA, Green BA, Donnelly CJ, Rubenson J. Joint kinetics in rearfoot versus forefoot running: implications of switching technique. Med Sci Sports Exerc. 2014;46(8):1578-87.

2) Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987;15(2):168-71.

3) Forrester SE, Townend J. The effect of running velocity on footstrike angle–a curve-clustering approach. Gait Posture. 2015;41(1):26-32.