We’re challenging Christopher McDougall, the author of the famous book Born to Run, to mortal combat and trial by science. This book and its ideas about footstrike and footwear went completely viral in the running world when they were first published in 2010. And despite repeated dismantling by the scientific community, they’re still here to make us overthink everything. In this article, we’ll answer the question “does heel striking cause running injuries?” once and for all.
Every runner has heard some version of the following statement: “we evolved without shoes, and we evolved to run, and shoes make us run weird and bang our heels on the ground, and that causes injury. SO if we get rid of the shoes or make the shoes more natural we’ll stop heel striking, and if we stop heel striking, we won’t get any more injuries!” I heard this on a jog in 2013, and next thing I knew I was trying to explain to my girlfriend why my new toe shoes and new prancing forefoot strike were medical necessities.
Is heel striking OK when running?
Weirdly enough, my new footstrike and new shoes didn’t fix anything. I still had aches and pains. I wasn’t all of the sudden invincible. So, I bagged my assumptions and decided to go where the evidence took me. The more scientific literature I read, the more I learned that the magical thinking in Born to Run is mostly an example of the “appeal to nature” fallacy. This is the often-false idea that if something is natural, then it must be good for you. Plutonium, cyanide, and excess nose hair are 100% natural too.
Contrary to what the book and forefoot strike advocates suggest, there is no evidence supporting one “natural” way for a runner to use their foot. Consider these two seemingly radical findings:
Children who grow up barefoot are more likely to heel strike (read the study)
20%-50% of trained barefoot & minimalist shoe runners heel strike (read the study)
People just use their feet differently when running. Somebody who types with two fingers might beat you in a typing contest and write a better blog than you could. There just isn’t one right way to do it. So yes, heel striking is natural, and normal, fine, and OK. Studies (1,2) even suggest it might be more efficient in terms of running economy (gasp).
The relationship between foot strike and injury
Does heel striking cause injury? Here’s what the evidence says.
Running is a zero sum game in terms of force. No matter what shoes you wear, your body needs to move through space and your center of gravity needs to remain above the ground. To do this you need to create enough force to bound to the next stride and absorb enough force to avoid face planting on the pavement. Foot strike changes the way that force moves through your legs (study), but (mostly) because of Newton’s third law, it cannot reduce the total amount of force involved.
Forefoot striking may move force from the ankles and feet up to the knees and hips. That might lead to a change in the kind of injuries a runner gets, but it is highly unlikely to alter the number or their severity.
It’s not as simple as heel strikers get injured, and forefoot strikers do not.
After aggregating all the evidence on the subject, the British Journal of Sports Medicine defiantly advises that non-injured runners should NOT transition to a forefoot strike to reduce their risk of injury (their recommendation). The best quote: “transitioning to a non-rearfoot strike pattern to reduce injury risk or improve running economy is not supported by evidence.”
The one (study) that suggests heel strikers get injured more often only looked at 52 NCAA D1 cross country runners over 5 years. The study did not account for differences in footwear, sleep, nutrition, or additional factors like strength training. Also, the scientist in charge has written widely on minimal shoes being a miracle cure. These dubious findings have not been replicated. There are no miracle cures.
How can we use this knowledge to run healthy in the future?
Here’s the main thing for all of us runners to take home: it’s not as simple as heel strikers get injured, and forefoot strikers do not. We can’t boil down injuries to such simple and easy causes. Everything from your training volume, to your pace, to your shoes, to the specific tissue capacity & history of each muscle and joint, to sleep, to food, to your current personal relationships, to your stress at work influence your likelihood of injury. How your foot hits the ground is just one in a giant list of things to think about, and you shouldn’t think about it too much!
Anecdotes aren’t worth much in the game of science, but we just want to end on a high note. Steve Prefontaine was a heel striker. He never missed a day of practice to injury in four years at Oregon, and he ran without fear.
If we focus on the big stuff like smooth changes in training load, strengthening our bodies, and pulling back when necessary, then how our feet hit the ground will be the last thing we need to fear.