By Luther Chiew (Physiotherapist)
Premier Sports Medicine
Changing from a heel strike to a forefoot strike does not automatically reduce running injuries. Different foot-strike patterns shift load to different parts of the leg. A change may help a selected runner, but forcing every runner onto the forefoot can increase demand on the calf, Achilles tendon and bones of the foot.
Need help with recurring running pain? See our Running Injury Clinic assessment and treatment.
Quick takeaways
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There is no single foot-strike pattern that suits every runner.
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Heel, midfoot and forefoot striking each change where load is absorbed.
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Research has not shown that changing foot strike alone prevents injuries.
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A sudden technique or minimalist-shoe change can create a new load spike.
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Running changes should address a clear clinical reason and be introduced gradually.
What is foot strike?
Foot strike describes which part of the foot contacts the ground first.
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A rearfoot strike lands on the heel area first.
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A midfoot strike lands with the heel and forefoot close together.
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A forefoot strike lands on the ball of the foot before the heel lowers.
Many recreational runners use a rearfoot strike, especially at easier speeds. The pattern can change with speed, footwear, fatigue, hills and the surface.
Is heel striking bad?
No. Heel striking is common and is not proof of poor running form. Studies show biomechanical differences between strike patterns, but a difference in force or joint movement does not automatically mean a runner will become injured.
A rearfoot strike may place relatively more demand around the knee in some measures. A forefoot strike generally increases demand at the ankle, calf and Achilles tendon. Changing the landing pattern moves load; it does not remove load.
This matters when a runner already has calf, Achilles or forefoot symptoms.
Can forefoot running prevent injury?
Current reviews do not support prescribing forefoot running to every runner as an injury-prevention strategy. Research comparing non-rearfoot and rearfoot patterns has not found clear proof that one produces a lower overall injury rate.
A 2021 systematic review found insufficient evidence to link one foot-strike technique with a consistently different injury rate. The quality and methods of the available studies also varied.
The sensible question is not “Which strike is best?” It is “Would changing this runner’s technique help with this specific problem?”
When might a foot-strike change be considered?
A clinician may test a change when the current pattern appears relevant to symptoms and the runner can tolerate the new load. Examples may include selected cases of knee pain or lower-leg pain.
The change should be tested during running and judged by symptom response, comfort and the effect on the rest of the body. It should not be based on appearance alone.
A change may be unsuitable when a runner has Achilles, calf or forefoot pain, low calf capacity, or an upcoming race that leaves little time to adapt.
What are the risks of changing too quickly?
A runner who has used one pattern for years has adapted to it. Moving rapidly towards a forefoot strike can raise demand on the calf, Achilles tendon and metatarsal region.
The same issue applies when moving suddenly into minimalist shoes. A sudden change in footwear can alter demand on the calf and foot. Introduce unfamiliar shoes gradually and adjust the rest of training while you assess the response.
Avoid changing shoes, strike pattern, weekly distance and speed at the same time. You will not know which change caused a flare.
Is cadence more important than foot strike?
Cadence is the number of steps taken each minute. A small increase can shorten stride length and alter forces at the hip, knee and ankle. It may also change foot-strike angle.
Research shows that step-rate changes affect biomechanics, but there is not enough evidence to say that changing cadence prevents injuries for every runner. Cadence is one option to test, not a target number everyone must reach.
What can a running assessment show?
Treadmill video can show step rate, stride position, trunk movement and how a runner responds to a cue. It cannot diagnose an injury from video alone.
A runner-specific assessment may combine the video with symptom history, recent training, footwear changes, strength and capacity testing. The aim is to decide if a technique change is relevant and how to introduce it without shifting too much load elsewhere.
Premier’s Running Injury Clinic:
https://premiersportsmedicine.com.au/classes-programs/running-injury-clinic/
Common questions
Should every runner aim for 180 steps per minute?
No. Cadence varies with height, speed and experience. A fixed target ignores the individual runner.
Does overstriding mean heel striking?
Not necessarily. Overstriding describes where the foot lands relative to the body and the way braking occurs. Runners can overstride with different strike patterns.
Should you change foot strike when buying new shoes?
Not automatically. Test one change at a time and allow time for the calf and foot to adapt.
Can gait retraining help pain?
It can help selected runners when the chosen cue matches the presentation. Evidence remains stronger for changing biomechanics than for preventing every type of injury.
References
Anderson et al. Benefits and risks associated with changing foot strike:
https://pubmed.ncbi.nlm.nih.gov/31823338/
Burke et al. Systematic review of foot-strike technique and running injury:
https://pubmed.ncbi.nlm.nih.gov/34527750/
Almeida et al. Biomechanical differences between foot-strike patterns:
https://pubmed.ncbi.nlm.nih.gov/26304644/
Anderson et al. Step rate, injury, performance and biomechanics:
https://pubmed.ncbi.nlm.nih.gov/36057913/
If running pain keeps returning or is stopping you from progressing, book a Running Injury Assessment with Premier Sports Medicine:
https://premiersportsmedicine.com.au/classes-programs/running-injury-clinic/
About the author
Luther Chiew is a physiotherapist at Premier Sports Medicine with an interest in running, sports and overuse injuries. His background includes strength and conditioning, and he holds a Bachelor of Applied Science and a Master of Physiotherapy Practice from La Trobe University.
Read Luther’s practitioner profile.
Clinical content reviewed and approved by Luther Chiew, Physiotherapist.
This article provides general education. An individual assessment may lead to different advice.
