Foot Strike Pattern and Running Injury

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The foot strike pattern during running (heel vs midfoot vs forefoot) is often discussed in the context of which one is better based on injury rates.

Daoud et al (2012)Retrospective review of 52 track runners found the injury rate in the heel strike group was almost double the forefoot striking group.Almost elite level runners.
Kleindienst (2003)Retrospective review of 471 runners that found no difference between rearfoot and forefoot strikers concerning the frequency of injury.German PhD thesis
Walther (2005)Retrospective review of 1203 runners; found no difference in incidence of injury between rearfoot and forefoot strikers in the rate of injury.In German; abstract only
Goss & Gross (2012)1605 runners; reported that traditionally shod runners were 3.4 times more likely to get an injury than a minimalist runnerSelf-selected web based survey. Assume that minimalist runners are more likely to be midfoot/forefoot strikers
Warr et al (2015)342 soldiers; 13% were classified as non-heel strikers; no differences between the injury rates and days lost from injury between the heel strikers and non-heel strikers.Military cohort
Seay et al (2014)1027 soliders; no diffferences in injury rate between heel strikers and non-heel strikers.Conference abstract
Grier et al (2014)1332 soldiers of which 17% were wearing minimalist running shoes; “When controlling for personal characteristics, physical fitness, and a history of prior injury, there was no difference in injury risk in the previous 12 months between soldiers wearing minimalist runners shoes compared to soldiers wearing traditional running shoes“. Conference abstract; Assume that minimalist runners more likely to be midfoot/forefoot strikers
Ryan et al(2015)51 active people in Uganda; no differences in injury rates between different foot strike patterns.
Altman & Davis (2015)Less injuries in barefoot group, but shod group ran greater distances.; so after adjusting for that injury rate the sameProspective study; Assume that barefoot runners more likely to be midfoot/forefoot strikers
Soo Hoo et al (2015)Foot strike pattern was not associated with injury.Conference abstract; ultramarathoners over a 7 day event
Goto & Torii (2022)"Our study revealed that rearfoot strike runners did not have a higher risk of running-related injury compared to that of non-rearfoot strike runners"Retrospective study.
Higher prevalance of Achilles problems in the non-rearfoot group.

Kleindienst, F.I. (2003). Gradierung funktioneller Sportschuhparameter am Laufschuh. Shaker. Aachen, 234-235.
Walther, M. (2005). Vorfußlaufen schützt nicht vor Überlastungsproblemen. Orthopädieschuhtechnik, 6, 34.


  • appears to be an overall no difference in the injury rates between heel strike vs non-heel strike, based on the preponderance of the studies above.
  • not all of the studies have been published in English peer reviewed publications.
  • minimalist/barefoot vs shod was included in the table based on the assumption that minimalist/barefoot runners are more likely to be non-heel strikers, which is not true in all cases.
  • consensus seems to be that while the injury rates are probably the same between heel strikers and non-heel strikers, there are different injuries that are probably more common in each of the different foot strike patterns. This is interpreted as meaning the heel striking is preferable for one group of runners and non-heel striking is preferable for another group of runners, depending on how the different running technique loads different tissues

External Links:
Foot Strike Pattern and Injury Rates (Running Research Junkie)
Its six of one and half a dozen of the other: Rearfoot vs Forefoot striking when running (Running Research Junkie)

Related Topics:
Self-identification by runners of foot type and foot strike pattern | Overuse Injuries With Different Running Techniques | Foot Type and Running Injury

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