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Toe vs Heel strike: Injury Risk in Runners

When we observe runners, there are just so many variations in running technique and patterns. The length of the stride, body lean, amount of bending at each joint, the first point of foot contact and the arm swing are just a few of the places where we can notice the differences. Heel striking is one of the most criticised biomechanical variations in running. It is said that a heel to toe pattern impedes the forward motion of the runner and wastes more energy than landing on the forefoot. The first thing to get out of the way is that it’s not necessary that everyone who lands on their heel places it ahead of the body and that everyone who lands on the forefoot does so right under the body, which makes it invalid to connect the two factors.


Forefoot Strike

Technically there are three types of foot strike patterns: forefoot, rearfoot, and midfoot strike. The mechanics of the midfoot strike have more common features to the rearfoot strike and hence both of them will be considered under the umbrella of 'rearfoot strike'. A forefoot strike has higher demands of force from the calf and the foot muscles. Rearfoot strike increases the load on the muscles on the front of the leg and foot, which are responsible to pull the toes and the feet up. Usually these patterns are developed over time and become a preference. A runner rarely voluntarily picks a style of running and is often not even aware about it.

The textbook version of an ideal running foot strike is a forefoot contact leading to the entire foot on the floor which ends with the heel being pushed off first followed by the toes. You must be thinking about how you run, but let me tell you, with the sheer number of runners in this world, a majority will not tick all the boxes for ideal biomechanics. And that is just fine. We will specifically see how any particular foot striking pattern affects the overall injury risk.

From an anatomical standpoint, heels are not equipped to absorb forces during running, whereas the midfoot and forefoot have a complex biomechanical function that is very efficient with shock absorption, as can be experienced with running. The plantar fascia and the arches of the foot also work to make running easier. The smaller muscles of the foot are also activated greatest in the forefoot strike providing more stability to the arches. Thus the forefoot pattern has a greeter potential to be efficient by absorbing forces and releasing the stored elastic energy.

Rear Foot Strike (the two leading runners)

In a study investigating impaction, the rearfoot strike has been found to sustain twice the impact forces as compared to the forefoot strike. Correcting a forefoot strike has shown to reduce the forces and thus the injury risk. There are a few injuries and conditions like patellofemoral pain syndrome, anterior compartment syndrome that have been linked with the rearfoot strike. Studies have demonstrated that a change in running patterns from rearfoot to forefoot strike has benefited people with the previously mentioned injuries to such an extent that an invasive intervention (surgery) could be avoided. The pain measures were also significantly reduced.

A transition can be done by real-time feedback, and can be more accurately monitored with minimal footwear. It is also more practical to conduct this transition on a treadmill. What has been consistently observed is that these patterns, once learnt, can be followed appropriately through long durations without a need of re-evaluation. Since the transition requires minimal footwear and the forefoot strike is more calf driven, runners need to gradually go through the process. This is needed to avoid the risk of overuse injuries.

There is no need to be alarmed. Just because you have read this article does not mean you will have to change the way you run. There are ways to first analyse the pattern and then transition if necessary. Your best bet will be to consult a specialist in this matter to look into your case specifically.

The surface that you run on can also affect your risk of injury. Here's how.
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