What is the Best Foot-Strike Pattern For Running? (And Why We Miss the Point)

What is the Best Foot-Strike Pattern For Running? (And Why We Miss the Point)

If you run, there’s every chance you’re aware of the heel strike vs forefoot strike debate. For those unaware, there’s no current consensus on which foot-strike pattern is “best“ to decrease injury risk and improve running performance.

There are many well-informed and passionate opinions of course, but we don’t all get along just yet.

However, as an experienced Physical Therapist working directly with running athletes, it seems we might be missing the bigger picture. So much so, that what we’re about to discuss will hopefully change your perspective on heel and forefoot striking forever. 

From what I see clinically, the foot-strike pattern still has an influence on your risk of injury and running performance. However, there’s a laundry list of hidden dysfunction present behind the scenes that’s infinitely more important.

In effect, I think we’re locked in a robust discussion about which foot-strike pattern is best without actually having all the necessary information needed to come to a common conclusion.

So, if I may, I’d love to add my unique perspective to this conversation and shed some light on what’s ultimately important, how it impacts our thinking, and what this means moving forward.

The Heel Striking Debate

Before we begin, let’s take a moment to understand the current playing field.

For a number of years now, the running community has been at loggerheads over the best way for the foot to contact the ground when running. Some believe heel striking is bad, others don’t. Ultimately, this is a quest to realize which foot-strike pattern is the most efficient and presents the lowest risk of injury.

And it’s an important conversation to have considering approximately 92.4% of long-distance runners are expected to get injured each year.

Common Foot-Strike Patterns

This debate is often a two-horse race, however, there are three clearly defined foot-strike patterns.

  • Heel striking
  • Midfoot striking
  • Forefoot striking.
graphic showing difference between feel strike, midfoot strike and forefoot strike patterns in runners

However, considering your foot-strike pattern should not be the main focus in this conversation, let’s keep it simple and just focus on the most obvious two.

Heel Striking:

The classic heel strike pattern sees the heel strike the ground first. This usually occurs with the foot flexed in ankle dorsiflexion. Once contact is made, the rest of the forefoot follows.

It’s estimated almost 90% of distance runners heel strike. And within the context of the debate, this type of statistic is often interpreted two ways:

  • 90% of distance runners can’t be wrong, or
  • 90% of distance runners have a problem. 

As it stands, a convincing argument can be made for each using research, experience, and common sense.

Forefoot Striking:

Alternatively, forefoot striking is where the front half of the foot contacts the ground first with the ankle plantarflexed (foot pointed). Many see this as “running on your toes”.

Interestingly, one of the issues with how we perceive this debate is our classification of forefoot running. Many see it as the “absence of heel-striking”, where in fact, efficient forefoot running may actually include a subtle heel tap. This helps optimize the elastic properties of the Achilles tendon.

So, in effect, when classifying the two, they’re not polar opposites. And it’s an important distinction to make considering some lump any form of heel contact together. 

Brian McKenzie of Power, Speed, Endurance, and an authority on running mechanics has a nice reference for heel tapping:

What We Argue Over

The heel strike vs forefoot strike debate often centers around a few common preconceived ideas:

  • There’s little definitive research to suggest heel striking is bad
  • Shifting from a heel striking to forefoot striking can often cause injury
  • Forefoot strikers are seen to be more efficient runners
  • Forefoot strikers are seen to be at a lower risk of injury
  • People don’t consciously choose to heel strike, it’s often something that occurs “naturally”
  • Heel striking increases the load on the knee
  • Forefoot striking increases the load on the foot and ankle

And these ideas become clearer (or further muddied depending on your point of view) when we look at some of the research:

Research on Heel Striking and Forefoot Striking:

This is by no means an exhaustive appraisal, but see if you can pick up a common theme here.

One systematic review found that switching from a heel-strike pattern to a forefoot pattern decreases the potential for knee injuries, but increases the risk of an ankle injury. Interestingly, a second systematic review found no conclusive evidence to suggest a switch from heel striking to forefoot striking was any more efficient or less risky.

Another study suggests cross country runners who heel strike are twice as likely to experience an injury than those who forefoot strike. However, a different study found no difference in overuse injury rates between heel strikers and forefoot strikers in the military.

Moving along, one study found forefoot striking decreases load through the knee joint, while two others suggest forefoot striking increases the load on the Plantar Fascia, and also the Achilles tendon when compared to heel striking. Contrastingly, two more studies found forefoot striking created the lowest impact force in runners and was effective at reducing factors associated with increased tibial stress.

So as I’m sure you’ve already figured out, there’s so much conflicting information to consider on this topic.

At the end of the day, the point of this is not to support one pattern over the other, but to highlight the lack of consensus. More importantly, I think the research on the best foot-strike patterns, much like us as a community, ultimately misses the point.

Any study or informed opinion hoping to establish a link between foot strike pattern, injury and running efficiency, needs more context than is currently given. The studies may be valid and our opinions unbiased, but many don’t have access to the entire picture with which to make the best decision.

Let me explain why.

Related: Here’s why I’m at odds with Evidence-Based Practice.

What I’ve Come to Understand

As a Physical Therapist, I’m able to work alongside a lot of athletes.

I can take your concerns, look at how you move and figure out what’s letting you down. More importantly, we can address these issues and see what it does for your pain and performance in real-time. It’s something I’m intensely passionate about.

As a result, I’ve developed an elite perspective on what the body craves to function properly, and how this relates to running. I also have an opinion on what I think the best foot-strike pattern is, but I’ll leave that to the end. After all, it’s not the point of this article.

Instead, I’ve come to understand that we just don’t appreciate the modern world’s ability to create hidden dysfunction. Some of the more obvious features like poor sleep, poor diet, and stress create obvious issues like being tired, feeling crap and stressed.

However, there’s a whole world of covert dysfunction we just don’t seem as aware of – and it’s affecting our running. So much so, that these relatively hidden issues should take precedence over our near-obsession with foot-strike patterns.

So, let’s talk perspective and fill in the gaps.

Your Foot Strike Pattern Is Not as Important as What’s Going on Under the Hood.

To highlight what’s important here, consider the way you drive your car.

You could argue that accelerating faster and braking harder should, in theory, put more strain on the car’s moving parts. Intuitively, I think we understand that if two people drive the same model of car differently, we’re less surprised if the more aggressive driver runs into car trouble sooner.

Similarly, we assume that areas of high loading in the body are at greater risk of injury.

However, the problem with this thinking is that we assume the car (and our body) is in perfect condition to begin with. We take the lack of any obvious faults as a sign that everything is mechanically normal.

Yes, things feel like they’re running fine, but what’s really going on under the hood? Is something slowly rusting? Are one of the hoses starting to fray? Is there a buildup of something abnormal slowly but surely setting something else up to fail.

And when something fails, we don’t realize that it’s not the start of something new, but often the last straw. And it’s the same with our bodies.

Many feel pain and injury is the beginning of a problem, but it’s actually the end result. It’s just the point your body fails, or finally decides to let you in on what’s happening.

Interestingly, we regularly service our cars to try and prevent this dysfunction. But we don’t yet look at our bodies the same way. So it’s easy to remain unaware until it’s too late.

With this in mind, it’s no surprise a distance-based, repetitive activity like running can so readily expose this hidden dysfunction. So to blame a foot-strike pattern as being the cause of an injury misses the bigger picture entirely.

And this is where I see the state of the heel striking vs forefoot striking debate. One pattern may, in fact, be better, but both are potentially problematic if we have deeper mechanical issues in play. And until we rectify these hidden issues, how can we possibly know what’s best?

Hidden Mechanical Issues

So what do I mean by these hidden deficiencies?

Clinically, there are a few common issues I see that can set a runner up for injury and sub-optimal performance.

Ankle Joint Stiffness:

Guess what? If like me, you’re a modern, Western human being, it’s likely your ankles are stiffer than they should be. 

Clinically, heeled shoes, flip flops (thongs) and frequent sitting rob us of basic ankle flexibility over time. For example, the size of the heel on your shoe is the exact amount of ankle range you don’t get access to.

Related: Here’s why modern shoes stink for our feet.

Quick Test For Ankle Joint Stiffness

Deep Squat: This is one of the best tests of ankle mobility.

deep squat achilles tendonitis

To do so, stand up tall with your feet straight and then squat down as deep as you can. Your ankles are most likely stiff if any/all of the following occur:

  • Feet turn out
  • Heels lift off the ground
  • Knees track inwards
  • Have a tendency to fall backward
  • Can’t reach the very bottom comfortably.

Clinically, stiff ankles force the body to work around it, fundamentally changing the way we load our tissue. As a result, its one of the biggest hidden mechanical issues for runners (and everyone else to be fair).

This can lead to any number of common lower leg issues including:

  • Shin Splints
  • Achilles dysfunction
  • Flat feet
  • Bunions
  • Calf tears
  • ACL injury
  • Knee arthritis
  • Meniscal tears
  • Patella-femoral joint dysfunction
  • Navicular bone stress fractures
  • Plantar Fasciitis
  • ITB syndrome
  • Poor balance
  • Ankle sprains

Interestingly, research suggests forefoot running may increase the load on areas like the Achilles and Plantar Fascia when compared to heel striking. But if your ankle is stiff, all loading is already dysfunctional by default. So any relative increase may just be better at exposing your body’s ability to buffer this compensation.

So the priority should be taking away any covert ankle stiffness, not shifting the blame by altering the foot-strike pattern.

Anterior Hip Restrictions: 

In a similar vein, restrictions at the front of the hip – mainly the hip flexors and deeper joint capsule, can also force tissue to compensate.

An important part of running is maintaining an upright trunk and well-positioned pelvis while extending your hips. But it’s a lot harder to do this if the front of the hip is restricted.

Not only does this force the entire leg to rotate around the issue, but alters the way we load the hips, knees, pelvis, and low back.

We owe this modern legacy to our thirst for sitting. Nothing sucks the flexibility out of the front of your hips like keeping them bent at approximately 90 degrees for hours on end.

Quick Test For Anterior Hip Restriction

Couch Stretch: The Couch Stretch is an aggressive, functional test for anterior hip restriction.

The front of your hips are tight if any of the following occur:

  • You can’t keep your trunk completely upright
  • You have to arch your back
  • Your hips shift to one side
  • It feels horribly tight and uncomfortable
  • You can’t breathe normally

Low Back Dysfunction:

Clinically, two low back features also seem to seriously impact the health and function of the body when running:

  • Low back joint stiffness
  • Poor low back stability

It’s worth noting that poor stability should not be confused with a lack of core strength. One is a measurement of strength, the other is your ability to switch on the right muscles at the right time.

Quick Test For Low Back Stiffness:

Backward Bend: Bending backward is a great way to get a sense of how mobile your lower back is.

To do so, squeeze your glutes and slide your hands down the back of your thighs as you bend backward. In a perfect world, you should make it about halfway down the back of your thighs.

There’s every chance your back may feel a bit rusty, perhaps on one side more than the other.

Quick Test For Core Activation:

Lie on your back with your hips and knees slightly bent. Locate the hip bones at the front of your hips and dig your fingers in, just inside of these bones.

Take a deep breath in and then as you exhale, try to gently draw your belly button in and up towards your spine. If performed correctly you should notice two things.

  1. You feel the muscles under your fingers activate
  2. You can maintain this feeling and still breathe normally.

If you can’t achieve both of these basic skills, then your core muscles are likely not functioning normally. And if they aren’t functioning normally when you’re lying down at rest, it’s unlikely they’ll be anything different when you’re running around being awesome.

Many are surprised to know that issues like gluteal weakness and hamstring tightness are often consequences of poor spinal function. Specific glute and hamstring exercises just aren’t effective long-term unless you also address the root spinal dysfunction as well.

Following a common theme here, most spinal dysfunction can be traced back to the nature of your sitting habits. Sitting and slouching has much to answer for in this space. Bad spinal shapes ask relevant areas to stiffen while also switching off normal core activation.

As you can see, none of these hidden mechanical issues are overly interesting or sexy. They aren’t obvious and often remain hidden unless we specifically go and look for them.

comic strip of heel striking and forefoot striking ultimately being controlled by a number of broader influences

And because of this, many of our conversations about best foot-strike patterns are being had without all the necessary information needed to reach a consensus.

How to Fix These Hidden Issues

Once you’ve identified any hidden handbrakes, addressing them is often relatively simple. Here are some basic things to try for each of the above:

Banded Ankle Stretch:

Find yourself a power band, strong theraband or the inner tube from a bike tire and secure it to something immovable.

Place your ankle in the band and stretch it out as shown below. Make sure to bend your back ankle.

power band ankle stretch

Dose: 2 minutes per side.

Couch Stretch:

Similar to the test above, the Couch Stretch is a must-do exercise for all runners.

Place your knee in the back of a chair (easier) or on the ground up against a bench or wall (harder).

Start horizontal and only come upright as far as you feel comfortable. You should feel this at the front of your hip or thigh.

Use the same band from above in the manner shown below to supercharge the Couch Stretch.

couch stretch with power band

Dose: 2 minutes per side.

Foam Roller / Lacrosse Ball:

When looking for a simple way to free up your spinal joints, very little surpasses a lacrosse ball or foam roller.

If using a ball lie down on the ground or up against a wall and gently let it press into your back. Look either side of your spine and target areas that feel stiff, tight or tender.

The key with this approach is not to roll around, but to keep constant pressure on relevant areas.

lying on a foam roller for osgood schlatter disease

Dose: Spend a minute or so on relevant areas for a total of 10-15 minutes overall.

Core Activation Exercises:

The important thing here is to understand that it’s up to us to engage these muscles during daily activities and exercise. Ordinarily, our core muscles should do their job automatically, but modern sitting habits can seriously deactivate them.

Once comfortable with understanding how to consciously activate your core muscles from the test above, make sure to do so as often as you can remember throughout your day.

Maintain good activation (20% of max) when standing or picking something up. Do it while you work or workout.

These muscles need to be bracing your spine as often as possible to help re-program good habits.

Dose: Obsess over it, but aim to touch on this 10-15 times a day. Vary your activity for the best result.

In a similar vein, we also need to address the cause of these hidden issues if we are to conquer them long-term.

5 Quick Tips to Combat the Modern World:

  1. Don’t sit if you don’t have to. Prioritize standing and moving around.
  2. When sitting, prioritize a good position. It’s the same as a good standing posture.
  3. Support a good sitting position with a rolled-up towel. Make it a part of the furniture.
  4. Consider making your next pair of shoes one with a smaller heel. Better still, go barefoot more often.
  5. Avoid flip flops/thongs. Go for a self-securing sandal instead.

So as you can hopefully appreciate, any and all talk about the best foot-strike pattern is incomplete without looking under the hood of a runner. Everyone is different, but not really at the same time. We all live in the same modern world, and likely exposed to the same potential roadblocks to normal function.

And this helps us frame a few other common misconceptions within the foot-strike debate.

Why Your Best Running Technique May Not Be the One That Comes the Most Naturally to You

A somewhat recent study summarizes a strong point made about the best foot-strike pattern.

It suggests your best foot-strike pattern is the one that comes the most naturally to you. And this does make sense – your body should move how it’s supposed to by default.

But as you can now hopefully appreciate, for someone who doesn’t actively think and purposefully practice running a certain way, your default pattern is highly likely to be the sum of any hidden compensation.

It may certainly ‘feel’ normal, but the body will always take the path of least resistance. It won’t move through a stiff ankle, it’ll just work around it. 

So in a sense, just allowing your body to move the way it wants to, neglects the fact that it may be compensating for something else. And this isn’t a viable long-term strategy.

In a perfect world where things like sitting and heeled shoes don’t exist, we wouldn’t need to have this conversation. But from what I see clinically, this is far from a perfect world.

On the flip side, if we eventually agree on the best foot-strike pattern, we shouldn’t shy away from it. Even if it feels “unnatural” in the beginning. In this instance, clearing the hidden dysfunction should normalize the experience a lot faster.

So if you’re unaffected by the modern world, your default foot-strike pattern is probably a great expression of your anatomy. However, for the rest of us, our default pattern is more likely the one our body has developed to best handle any musculoskeletal dysfunction.

Why Switching Foot-Strike Patterns Can Be Lethal, But Shouldn’t

Similarly, we can use this broader perspective to re-frame another common discussion point about foot-strike patterns – that switching may create a new injury.

What’s important to understand here is that switching foot-strike patterns is unlikely to create a new problem on its own. Instead, it’s more likely the new pattern has exposed some hidden dysfunction previously buffered by the original one. It’s essentially shifting the blame.

At the end of the day, our priority at the beginning should not be forcing a switch from one foot-strike pattern to the other but addressing the underlying mechanical deficiencies. Once these have been identified we can then make any necessary changes from a more normal foundation.

Ramifications For Research

One final point to make here regards the impact of these hidden deficiencies on research results.

If not accounted for, does the presence of covert ankle, knee, hip and low back dysfunction cloud the validity of previous research in any way?

From what I see clinically, it might. It potentially becomes harder to know whether a study’s results are true, or impacted by each participant’s own hidden dysfunction unless addressed beforehand.

Furthermore, if research does find a genuinely real effect, how can we possibly know?

Ultimately, these basic hidden mechanical faults have the potential to bring everything previously debated into question. And with this in mind, I think there is an answer to this debate out there somewhere. However, we may not quite yet be in a position to see it.

What is the Best Foot-Strike Pattern

By now, you can hopefully appreciate the need to change our perspective on the heel strike vs forefoot strike debate. Our priority should be solving any hidden issues before even thinking about which pattern best.

Having said that, I have come to understand that one pattern may, in fact, be a better expression of normal human function than the other.

So, to cut to the chase, my thoughts on the best foot-strike pattern are as follows:

Forefoot striking appears both inherently natural and a more efficient mechanical way to run than heel striking – in those who are conquering their underlying dysfunction.

Heel striking appears to be yet another compensatory pattern dictated by poor mechanics. It’s unfortunately supported/perpetuated by the unnatural characteristics of things like sitting and heeled shoes in the modern Western world. I agree that shifting someone from the classic heel strike pattern to a more forefoot strike is an advantageous goal. But you can’t guarantee a smooth transition unless working hard on your hidden low back, hip and ankle deficiencies.

Once these issues are clearing, we can then have an adult conversation about which pattern is best for you. And from what I see clinically, most will prefer to move away from heel striking eventually.

Especially when you consider the following ideas.

3 Compelling Reasons to Support Forefoot Striking

Once your hidden dysfunction has been cleared, there are four important points to consider intellectually that support an eventual move to forefoot striking.

1. Children don’t seem to heel strike at an early age. 

If you watch early school-age kids running around, it’s interesting how rare heel striking is… in the beginning.

This is supported by a study that found rearfoot striking is less prevalent in kids 6-16 years than the adult population.

Furthermore, it seems that a subsection of older kids do heel strike.

From what I’ve come to understand clinically, this may have everything to do with increased exposure to sitting and heeled shoes from school.

Those who cannot buffer these changes seem to break off and diverge down the heel striking path. Those who sit less, wear flatter shoes or do an activity that prioritizes normal function (martial arts, running clubs, etc) seem less impacted and more likely to remain forefoot strikers.

2. Heel striking doesn’t work while barefoot. 

If you take off your shoes and go for a run, it’s really hard to heel strike barefoot. This suggests the body is wired to move a certain way when barefoot.

For me, the fact our body will default to a more forefoot strike pattern when we release our “shoe-shackles” speaks volumes.

Clearly, our modern world makes being barefoot more difficult, but asphalt, social etiquette, hygiene, and fashion shouldn’t distract us from the bigger picture. That is that being barefoot is inherently normal and it encourages forefoot striking.

Similarly, this concept suggests heel striking can only really exist in a world supported by modern shoe technology. And this is a little concerning when you consider this very same technology is often directly responsible for much of our hidden ankle dysfunction.

3. You can’t classically heel strike at speed

Following on from this, it’s much harder for your heel to strike the ground first and run fast, regardless of your footwear.

And this makes sense. It’s far more efficient for the body to favor a running technique that is stable at all speeds. This way it can scale itself up and down as needed.

It makes less sense for a body that values efficiency to have one foot-strike pattern for slow jogging and an entirely different one for pace.

So not only is it hard to heel strike when barefoot, but it’s also hard to do at speed.

From my perspective, there are a few natural factors that support forefoot striking as the body’s optimal pattern in an ideal world. It’s just more important to identify and address any hidden dysfunction first.

Frequently Asked Questions 

What is heel striking when running?

The classic heel strike pattern is where the heel of the foot contacts the ground first before the rest of the foot when running.

Is heel striking proper running form?

Heel striking is the most common running pattern among the general public. So by definition, it is normal. However, there’s a lot of natural evidence to suggest it is not as optimal as forefoot striking. Young kids don’t start out heel striking and it’s also very hard to do and run at speed. Similarly, heel striking is uncomfortable to do when barefoot, the most natural state for the foot.

Is heel striking bad?

Depending on your perspective, heel striking can be bad or not so bad. The debate around it’s worth ultimately comes down to whether you feel it’s the most efficient and safe way to run. Interestingly, the question we need to ask is not whether heel striking is bad, or whether forefoot striking is better. Instead, we need to ask what hidden dysfunction behind the scenes is compromising our movement.
Once this is cleared, heel striking should not be seen as bad, but perhaps “less good” than forefoot striking.

Conclusion

As you can hopefully now appreciate, the current debate around the best foot-strike pattern needs some serious context. It’s an important consideration if attempting to decrease your risk of injury and improve running performance, but there’s far more to consider here than we seem to realize.

If your low back, hip, and ankle aren’t functioning normally, it’s hard to pin your issues on anything else. It’s also hard to appreciate these root problems if you aren’t looking for it.

So if you have a strong opinion on the best foot-strike pattern, please take a step back and consider what’s actually going on under the hood. If this debate is ultimately about solving injuries and improving running performance, we have to care more about these deeper issues. Otherwise our opinions, research, and perspective on the heel striking vs forefoot striking debate may continue to miss the point.

What hidden dysfunction have you found that’s contributed to your aches and pains when running? What are your thoughts on the best foot-strike pattern? I’d love to hear about your experiences below!

If you are coping with any running-related dysfunction, consider booking in for an online Physiotherapy consultation.

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