Does A Forefoot Strike Pattern Reduce Injury?

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Introduction

Aerobic exercise, particularly in the form of running, has become more popular with the general population over the last few decades (Lorenz & Pontillo, 2012). Unfortunately, this increase in healthy exercise may come at a cost with up to 80% of runners reporting a lower limb injury (van Gent et al., 2007). These trends mean that preventing running injuries is gaining significant importance  in the world of sports medicine. One touted intervention that is currently in vogue is adapting the runner’s biomechanics to a forefoot strike pattern or barefoot running technique. Therefore, this article will evaluate current evidence for the role of a forefoot strike pattern in reducing injury risk.

What Do We Know About Forefoot Strike Patterns?

Firstly, we know that there are a number of running styles that have been focused on eliminating a heel strike ground contact. These include:

Whilst there are subtle differences between these styles – they all promote a mid to forefoot initial strike.

Previous research has shown that forefoot strike running patterns have the following characteristics (when compared to shod running i.e. wearing shoes):

  • Decreased ground reaction force
  • Decreased ground contact time
  • Decreased step length
  • Higher cadence
  • Lower heart rate
  • Lower perceived exertion (Sqaudrone & Gallozzi, 2009; Jenkins & Cauthon, 2011; Lorenz & Pontillo, 2012)

These characteristics have obvious potential implications for injury management and prevention, considering the role of excessive ground reaction force in the aetiology of overuse lower limb injuries.

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Forefoot Running for Injury Treatment?

This is a topic that has been discussed previously on this site and there are positive initial signs for the use of forefoot running as an injury treatment. Diebal et al. (2012) found that teaching a forefoot running pattern was effective in reducing pain and disability associated with chronic exertional compartment syndrome. The authors’ suggested mechanism was a reduction in eccentric activity of the anterior compartment musculature (primarily tibialis anterior). Read more here.

So, there is evidence for the effectiveness of biomechanical alterations and a forefoot strike pattern in managing an overuse injury… but…

What About Injury Prevention?

Now you would think that given the above evidence i.e. reduced ground reaction forces, lower exertion and also its use in treating a lower limb injury, it would be easy to find some evidence about the value of forefoot running for injury prevention. Unfortunately, despite two reviews having been performed on the subject there is no definitive evidence to prove (or refute) reduced injuries in those with a barefoot strike pattern (Jenkins & Cauthon, 2011; Lorenz & Pontillo, 2012). Whilst both of the previously mentioned studies reviewed the literature and found much information regarding the biomechanical “advantages” there was no information regarding injury prevention.

Clinical Implications of This Research 

Whoa, how unfortunate. This means that a forefoot strike pattern can be implemented only with the knowledge that it is likely to reduce ground reaction forces and perceived exertions of your athletes. There is, however, no definitive or identifiable impact on injury rates (at this stage). If you would like more stellar information on this subject – check out a great presentation by Sports Physiotherapist Brett Kemble (accessed through SportsPodiatrists.com.au) by clicking here. To quote Brett’s presentation, he states the research we currently need is:

A prospective, longitudinal, epidemiological study with habitual barefoot verse shod  running group that standardises training experience, training  dosage, socioeconomic and cultural differences.

What Are Your Thoughts?

What are your experiences with the world of barefoot running and forefoot strike patterns. Have you successfully implemented them in your own clinical practice? I would love for you to let me know in the comments or catch me on Facebook or Twitter.

Promote Your Clinic: Are you a physiotherapist or physical therapist looking to promote your own clinic, check this out.

References

Diebal AR, Gregory R, Alitz C and Gerber JP. Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med 2012 40(5): 1060

Jenkins DW, Cauthon DJ. Barefoot-running claims and controversies: a review of literature. J Am Podiatr Med Assoc . 2011;101(3):231-246.

Lorenz DS, Pontillo M. Is there evidence to support a forefoot strike pattern in barefoot runners? A review. Sports Health 2012;4:480

Sqaudrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009;49(1):6-13.

van Gent RN, Siem D, van Middelkoop M, van OS AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480.

Photo Credit: bark