Part 2: Running Injuries, Heal Striking vs. Forefoot Striking

This information is taken from Dr. Peter Attia’s interview with Irene Davis Ph.D, The Evolution of the foot, running injuries, and minimalist shoes. The link to the complete podcast is below which I encourage you to listen to…while you’re running! 🙂

The first major literature on running injuries came out in the 1970s. In most running injuries, the issue does not root from the area of pain 

For Example, Shin splints are one of the most common injuries in runners.

This is caused by landing on the heel which results in overuse in the tibialis anterior, the muscles on the front part of the lower leg to help slow down the forefoot impacting the ground.   We will cover heel striking in more detail below. 

These muscles assist in raising the foot off the ground towards the knee and assist in lowering the foot back to the ground. Because of the smaller size, the tibialis anterior is more prone to fatigue and overuse that can result in shin splints. There are many factors (outside the scope of this post) that contribute to running injuries such as knee valgus and hip instability to name just two.

Running is a daily activity (like walking) that the human body should be able to endure within reason. Carrying excess weight, weak muscles of the feet and the hip, as well as poor footwear, can all make the running experience unpleasant. 

Heel vs. forefoot striking

Forefoot striking, or landing on the ball of your foot, is difficult in traditional running shoes.

Can you imagine if we had shoes for hands and you had to wear tight mittens all the time?  That’s what’s happening to your feet when they are crammed into a point with most traditional running shoes.  This makes it more difficult to spread your toes and use the ball of your foot.  The body has no choice but to land on its heal.

So why is it that landing on your heel can cause problems down the road? 

Landing on the ball of your foot shifts the load to the ankle and calf which helps spread out the force of impact.

  • One study has shown that the heel has a relatively low pain threshold that doesn’t extend far beyond the level of force generated during walking—suggesting that we have evolved to be forefoot strikers.  Landing on your heel without any cushion hurts!
  • Other studies have shown that it is footwear that encouraged many of us to become heel strikers
  • Dr. Davis Irene believes that we are adapted to be forefoot strikers and that this is why we have a long Achilles tendon
  • One advantage of heel striking is that it allows for a longer stride and therefore greater speed. This may be a reasonable argument on softer surfaces. However, many of us run on the road or a harder gravel trail which can lead to injuries when heel striking. 

Landing on your heel also shifts the load to the knee. The knee is also another area often treated for running injuries.  As we noted in Part 1, when your foot hit’s the ground, the landing force is 2.5 to 3 times your bodyweight. At the knee, this force can be 7 times your bodyweight.  Studies have shown higher rates of force transfer to be associated with running injuries. 

The danger is that you may fall into the vicious cycle of land harder due to the false safety of cushioning and arch support

Dr. Davis talks about the dangers of wearing a popular brand Hoka.  Studies have shown that people create a greater landing force in the HOKA shoe. She gives an analogy that you can hit harder with a boxing glove more than you can bare-fisted. The increased cushioning gives a false sense of security that encourages a harder landing

She believes the modern running shoes created a heel striking revolution leading to more injuries than ever. 

Summing it up, based on Dr. Davis’s research, here’s what she recommends:

  • Heel striking leads to a more rapid rate of vertical force development
  • Forefoot striking in minimalist shoes decreases the rate of force development

Forefoot striking in a cushioned shoe results in the following: 

  • It promotes landing with more plantar flexion (forefoot more pointed towards the ground), which exposes the Achilles tendon to greater stress.
  • It also promotes landing on the outside of the foot, which causes an increase in lateral forces. This tends to result in problems in both the Achilles and peroneal tendons

When considering what shoes to wear, look into the following:

  • Forefoot striking should be done in minimalist shoes.  Slowly make the transition from walking to short distance running.  Consult an expert to help you progress accordingly. 
  • If you chose to remain a heel strikers should wear cushioned shoes
Please reference the entire podcast below.  I believe you will find it fascinating.

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