Does heel striking vs forefoot striking really matter?

–a study conducted of elite runners in a 2004 HM race in Japan (75% were heel strikers and only 1% were forefoot strikers) and they try to relate the findings to sub-elite runners.

–there is “no evidence that heel strikers are more injury prone” than midfoot strikers, but consciously altering footstrike does increase the risk of injury.

–there is “no evidence that midfoot runners are faster or perfrom better than heel-strikers”, but consciously altering running mechanics reduces running economy.

–footstrike moves naturally from heel to midfoot to forefoot as you run faster.

–where your feet land relative to your body is more important than how it lands.

Changing Running Gait To Alleviate Injury



Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms.


The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side.


Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week.


This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints.

Wherefore Heelstrike

I’ve been thinking about his whole forefoot vs heel-strike thing. I’m convinced that the most natural way to run - the way we have evolved to run - is with a fore-to-mid foot strike, under the body’s centre of gravity - see many discussions and demonstrations of this, including Daniel Lieberman from Harvard, Lee Saxby - and others at the Natural Running Center such as Mark Cucuzzella, who I think heads it.

Anyway, the point is that it makes extremely good sense, logically, and experientially: I’ve occasionally just switched briefly to a heel striking pattern for comparison, and I almost can’t believe how horrid it feels - slow, clunky, inefficient, painful…. So, that being the case, why do so many of us run like that instead of using our proper evolved stride? If you look at young kids they run perfectly - vis, my 5 year old son:

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I’ve wondered how it happens that we don’t just keep running like that, and this morning I had an idea that seems to me plausible. As kids we run all the time, often barefoot (if our parents and teachers allow it), and probably unsurprisingly, tend to do it properly. Many of us (in the developed/Western world) become far less active as we get older: we walk, at most. Then when we start deciding we should exercise, what do we start off doing? Walking. On a treadmill, like as not. In cushioned shoes that cut us off from the ground (or treadmill, as the case may be) no doubt.

A proper walking movement is in fact heel to toe, with the heel landing ahead of one’s centre of gravity as well. It’s really quite different from running. So, we start walking. Then we walk faster. In fact, enabled by our cushioned shoes I think we walk faster than we would do comfortably barefoot, because of the heel-striking motion. (Barefoot I find I break into a slow trot at not very quick speed, and find it much smoother and more efficient than walking fast.) The next thing, from that excessively-fast walk, is to break into a run … by speeding up the same movement a little more.

Voila: over-striding heel-strikes ahoy!

I do think a heelstrike has its place: the more I’ve run trails, the more I’ve found that the uneven terrain dictates a lot of flexibility of cadence, stride, landing - everything. There are times when a particular step might land with heel first, but I’ve never found myself doing that in such a way that it’s jarring: it probably follows a shorter step, and a change in the terrain such that there’s just less impact, so the heel is ok. None of that is conscious, by the way, which is why I’m not entirely sure what’s making it work. ;-)

However, for the vast majority of the time, I think forefoot landing is definitely more natural, more efficient, and kinder on your body. Somehow (and I do wonder about the link I’ve proposed here) many of us slip into an inefficient and damaging gait, and I think we need to be very mindful of the way we run, and learn again to do it like a child.

The main suggestion that occurs to me from all of that: start to run (instead of walking) at lower speeds than you think the transition from walking to running should occur. Short strides - don’t worry about looking like you’re mincing along until your cardiovascular fitness allows longer strides and consequent faster pace. We mustn’t run as though its just rapid walking; they’re two very different forms of locomotion.