Myth Busting Monday: Heel Striking

One day I was walking with my brother and was fed up with hearing the sound of his feet dragging and shuffling along like someone who had foot drop. "Can you pick up your feet??" I asked. "Try walking heel - toe." And that is when I found out my own brother (sorry to throw you under the bus, Jonathan) had fallen victim to the anti-heel strike misinformation. He told me that in high school, a coach had told him that heel striking was bad and not only had he applied that to running, but walking too! Now, I haven't heard of another runner going so far as to apply the "no heel striking" to walking before, but I have had plenty of clients, while explaining their current pain or injury, bashfully "admit", "Well, I'm a heel striker," as if it were a dirty crime they had committed. Well, the heel strike slander stops here! Read on to find out why foot strike position is low on the list of gait mechanics that I am worried about.

Hoenig et al., 2020

What is heel striking?

When talking about initial contact, the phase of gait where your foot first lands on the ground, we define foot strike by the part of the foot that lands first. Typical foot strike patterns, from back of foot to front, are heel/rearfoot, midfoot, and forefoot. Heel striking means landing on, you guessed it, the heel, followed by the forefoot; midfoot striking is landing with both the front and back of the foot at the same time, often on the outside border of the shoe; and forefoot strikers land on their toes, often followed by the heel, or sometimes with no heel contact.

Does heel striking cause injuries?

There are research articles that connect heel striking with certain injuries, such as knee and lower leg/foot bone stress injuries. This is because of the increased loading that occurs through the tibia (shin bone) when landing on the heel or rearfoot. However, it is important to note that other foot strike patterns do not absolve you from injury risk! They are just associated with different flavors of injury risks. Forefoot strikers have increased incidence of plantarfasciitis, Achilles injury, and calf pain. It is also important to note that most studies assessing a link between foot strike and injury are retrospective, meaning that they look at people with injuries and then assess what foot strike they use, instead of prospective which would assess foot strike and follow for injury.

Who heel strikes?

The type of initial foot contact that is made can be dependent on speed. Typically, people will run with more of a forefoot strike when they are sprinting, and adjust to more of a rearfoot strike when running longer distances. Foot strike can even change throughout a run! Elite runners are less likely to heel strike, but there is inconclusive evidence that forefoot striking is associated with improved performance. Kasmer et al. 2016 found that about 94% of runners in a marathon heel strike, so if you are a heel stiker, you are not alone!

What really matters?

When assessing running gait, instead of focusing on initial contact position of the foot, I assess for stride length. Landing too far in front of your body is called over striding. In a rearfoot striker, overstriding often involves landing high on the heel with a straight knee, leg extended way in front of the body. Forefoot strikers can also over-stride, similarly reaching forward with leg out stretched and toes extending well in-front of the trunk.

There are two key problems with over striding:

1) landing with your foot too far in front of your body acts like a brake. Your body has to control the rest of the body (read, use extra muscle force) to move the rest of the body forwards over the stance leg, and then overcome all of that slowing down energy to push off. The closer you land to underneath your trunk, the less energy needed to slow things down, less strain on your hamstrings, calves, and glutes, and more energy to use pushing forwards!

2) Over-striding is often seen with a straighter knee position. Think of landing a jump on straight, locked out knees. That wouldn't feel great, right? Landing with a bent knee allows the muscles of the leg to absorb some of the impact from landing vs the force going straight through the knee joint, which overall feels better and protects the knees.

Should I change my foot strike?

If the first 75% of this blog post wasn't enough to convince you otherwise, no, do not try to manipulate your foot strike, especially if it's just on a whim. In general, if you are not having pain, we probably don't want to manipulate your gait. If you are having pain, it could be warranted to make small gait modifications. There is some data to suggest the adopting a forefoot strike can help runners with anterior knee pain. However, as a running physical therapist, I would prefer to look at the whole picture of strength, muscle control, and the entire gait cycle to see if there are other modifications we can make before altering foot strike. This is where a Running Gait analysis with a trained professional can give you more detailed suggestions than Dr. Google.

In conclusion, heel striking isn't the problem you may have been led to believe that it is! It's important to look at the whole picture of running gait, not just how the foot lands.

Happy Running,

Dr. Elizabeth Karr PT, DPT, OCS

References:

Chen H, Sun D, Zhang Q, Liu Q, Bíró I, Gu Y. Biomechanical differences between habitual forefoot and Rearfoot strike running: A systematic review. Advanced Exercise and Health Science. 2024;1(4):241-247. doi:10.1016/j.aehs.2024.11.004

Hoenig T, Rolvien T, Hollander K. Footstrike patterns in runners: Concepts, classifications, techniques, and implicationsfor running-related injuries. Deutsche Zeitschrift für Sportmedizin. 2020;71(3):55-61. doi:10.5960/dzsm.2020.424

Kasmer ME, Liu XC, Roberts KG, Valadao JM. Foot-strike pattern and performance in a marathon. Int J Sports Physiol Perform. 2013;8(3):286-292. doi:10.1123/ijspp.8.3.286