With the interest in barefoot and minimalist running continuing to increase amongst the running community and shoe companies, we encounter another widely debated topic: should we land on our forefoot, midfoot or rearfoot?1-3
It becomes a very difficult question to answer for several different reasons. To begin with, many of the textbooks we teach from fail to discuss running biomechanics, which leads many to incorporate walking biomechanics into their evaluation or recommendations of proper running biomechanics.4,5 We even see physicians using orthotics to treat running injuries based on their proposed role for treating faulty walking biomechanics yet one study found that orthotic intervention did not significantly alter rearfoot motion in rearfoot or forefoot strike running patterns.6
Another difficulty we have in determining proper running form is that we have limited studies and scientific research available to base our decisions.7-13 Those on both sides of the discussion may become guilty of selectively choosing articles to explain their approach or position. However, we are seeing more recent studies that are demonstrating reduced injuries and decreased mechanisms of injury related to forefoot or midfoot striking.12
When reviewing what has been published in the past on examining runners in road races, marathons in particular, we find the primary focus of many of these studies is determining how the runners are striking.7,8 They have made no reference to injury patterns or shoe selection, and simply define the number of runners striking in a given pattern. Their conclusions reveal that an overwhelming majority of runners are heel striking more so than forefoot or midfoot striking.
Is this really scientific? If 88.9 percent of runners are heel striking in a given race, is this relevant research and evidence to say that all runners should run this way?8 I would expect them to be heel striking if they were wearing traditional running shoes that encourage heel strike. Although we do not know this information based upon the studies, I would presume the majority, if not all, of the runners were wearing traditional running shoes.
Let’s examine what some of the shoe companies are advocating. Several of the leading manufacturers of running shoes have began creating minimalist running shoes designed to mimic the gait associated with a midfoot or forefoot strike and have advocated that type of strike pattern in their product literature and with online information.13-17
Some shoe companies have even gone as far as creating a flexible or minimalist type shoe and advocating continuing to heel strike.18 ASICS has based its decision on two internal company studies. One was a computer-generated study that purported a 7 percent reduction in energy cost.18 The second study compared forefoot striking to rearfoot striking in humans and found that there were no real changes in the parameters they looked at between these two running patterns.18
ASICS notes it has created a “minimalist-like” shoe that “works with the foot, and not against it” yet the company believes in motion control and not motion enhancement.19 This company specifically recommends its ASICS 33 shoes “for shorter runs or maybe just a few times a week … or some will find it so comfortable that they’ll wear (them) all the time.”20
Now let us return to recent studies. Some of the more recent research has looked at injury patterns in middle- and long-distance runners who have a habitual forefoot or rearfoot strike pattern.9 They concluded that runners who habitually rearfoot strike have twice the rate of repetitive stress injuries than individuals who habitually forefoot strike.
While some of the advocates of running with a forefoot or midfoot strike pattern have been accused of selectively looking at the scientific research, we see that there is not much information available on which to base our decision and what is available from the current literature does tend to favor forefoot striking.9,10 In my opinion, it appears that those who are still in favor of motion control footwear with elevated heels and cushioned soles tend to base their decisions on what the norm has been for the past 30 years. Even when you review strike patterns collected from recreational runners, we see that they are heel striking in traditional running shoes.7,8 One would suspect that to be the case as traditional running shoes encourage heel strike. If we are going to strike on our heels with our knee extended and foot in front of our center of gravity, then we should be wearing a cushioned running shoe.
However, the question arises: Is the cushioned running shoe protecting us? We do know the transient impact force that is present with a heel strike is only approximately 10 percent lower in a cushioned shoe.3 So even though the cushioned shoe is comfortable for our heel, does it protect the rest of our body from harmful repetitive stress? That question has not been answered.
Some of the pioneers in the field of biomechanics use Abebe Bikila as an example to back their opinion that people need shoes to run.21 They tout that Bakila ran a marathon seven seconds faster in his shoes than when he won a marathon barefoot. Is simply running raster scientific evidence in support of wearing a cushioned running shoe? I would hypothesize that if roller blades were available at that time, he would have finished even faster.
Those who demonstrate a willingness to review the literature will see that we do not have sound scientific data to prove one striking pattern reduces injury more so than the other, or that one is more “proper” with respect to form.
What is fascinating to me is that if our bodies were designed to run and have been doing so for many years (not just 40 years), then why do we need to provide cushion, stability and a heel? We live in a society that carries the stigma that a flat foot or high arch can predispose our bodies to injury when this in reality has never been scientifically proven.22
I am not referring to a severe pes planus deformity with chronic arthritic changes or one secondary to severe ligamentous laxity as people with these conditions could probably never even run in a traditional running shoe. I am also not referring to the pes cavus foot types that are associated with diseases such as Charcot Marie Tooth, etc.
As we move forward in our research on shoegear and running form in regard to injury, I will continue to challenge the status quo as we have clearly seen that the current recommendations are not working.
Editor’s note: Dr. Campitelli has disclosed that he is an unpaid Medical Advisor to Vibram USA.
1. Available at http://insider.nike.com/uk/footwear/nike-flyknit-technology-3098/  .
2. Available at http://www.newbalance.com/performance/running/nb-minimus-zero-9-things-y...  .
3. Lieberman DE. What we can learn about running from barefoot running: an evolutionary medical perspective. Exerc Sport Sci Rev. Epub 2012 Jan 17.
4. Root ML, Orien WP, Weed JH, Hughes RJ. Biomechanical Examination of the Foot, Volume 1. Clinical Biomechanics Corporation, Los Angeles, 1971.
5. Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot, Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977.
6. Stackhouse CL, Davis IM, Hamill J. Orthotic intervention in forefoot and rearfoot strike running patterns. Clinical Biomechanics. 2004; 19(1):64-70.
7. Hasegawa H, Yamauchi T, Kraemer WJ. Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res. 2007; 21(3):888-893.
8. Larson P, Higgins E, Kaminski J, et al. Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sciences. 2011; 29(15):1665-1673.
9. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot Strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012; epub Jan 3.
10. McClay I. The evolution of the study of the mechanics of running. Relationship to injury. J Am Podiatr Med Assoc. 2000; 90(3):133-48.
11. Fourchet F, Kelly L, Horobeanu C, Loepelt H, Taiar R, Millet GP. Comparison of plantar pressure distribution in adolescent runners at low vs. high running velocity. Gait Posture. Epub 2011 Dec 26.
12. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010; 463(7280):531-5.
13. Available at http://www.goodformrunning.com/  .
14. Available at http://www.merrell.com/US/en/BarefootConnection  .
15. Available at http://www.vibramfivefingers.com/education/barefoot_running.htm  .
16. Available at http://www.newtonrunning.com/run-better/optimal-running-form  .
17. Available at http://youtu.be/JUdNeFh2SDo  .
18. Available at http://youtu.be/wr72iH6I2rY  .
19. Available at http://youtu.be/-xGwxLTrfF4  .
20. Available at http://youtu.be/bB0AteYZ_ZQ  .
21. Available at http://youtu.be/dTeZRmV0G9E  .
22. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med. 1993; 2(7):773-7.