A functional argument in favor of midfoot striking: putting the research in context.

The human body is a machine with particular characteristics. So is a car. Just like the many different makes and models of cars have slightly different capabilities, human bodies are all different.

But they are not that different. For example, the operational requirements for all cars are very similar: the centrifugal force generated during a turn must not exceed the friction generated by the tires. And they are the same in humans.

But that’s not the way in which much of the medical and sports science literature treats it. Don’t get me wrong: everybody is in agreement on what the individual parts do: the gluteus maximus abducts and extends the hip; the gastrocnemius points the foot, etc. But there is a vast amount of disagreement as to how these parts are supposed to work together. Rather, there seems to be quite a bit of agreement that for the same systemic function (running), the individual parts can be performing wildly varying functions, and yet the system will still be somehow performing correctly.

I am, of course, talking about the footstrike debate. Before I continue, let me be clear that by “heel-striking” I don’t refer to how the foot hits the ground. I refer to the set of gait characteristics that contribute to overstriding by reaching forwards with the leg and striking the ground heel-first. The same goes with the gait characteristics associated with midfoot striking.

I’ve been reading a series of articles that associate different patterns of loading with different stride types. For example, a heel-strike is typically associated with increased loading of the knee, while a forefoot or midfoot strike is typically associated with an increased loading of the ankle and achilles tendon.

Most of the articles that I’ve read tend to conclude that therefore, we should see greater knee injury rates for heel-strikers, and greater achilles injury rates for forefoot/midfoot strikers.

However, that’s a hypothesis. By this I mean that thus far I’ve found no studies that have shown that these hypothesized injury rates actually occur.

The question is this: are all tissues equally amenable to loading? In principle, absolutely not. Buildings often have central support structures to carry the load. So does the body. The question is whether, say, the presence of the achilles tendon—a dense, springy structure capable of storing massive amounts of potential energy (also the largest tendon in the body)—makes the ankle more amenable to loading than the knee.

In principle, it makes sense that the presence of the achilles allows the ankle to be loaded more than the knee. However, this remains to be ascertained by future studies.

For now, what we can say is that the differences in loading associated with one foot-strike pattern aren’t “equal” to another. Because certain structures are paradigmatically employed by the body to support weight, absorb shock, and store potential energy, a foot-strike pattern that offsets loading to these structures will, in general, be more amenable to the overall health and functional performance of the body. Whether experimental research ascertains that the achilles tendon is such a structure remains to be seen.

However, I certainly agree with the general supposition that a stride type that places more emphasis on loading of the achilles tendon (such as midfoot striking) generates a higher incidence of injury for that structure. Across a population, use of a particular structure will almost necessarily correspond to an increase in injury and overuse rates of that structure.

It remains to be experimentally ascertained whether a stride type which offsets loading onto dynamic structures (muscles) and energy storage structures (tendons and fascia), will, across a population of individuals, create lower overall injury rates despite the likely increase in injury rates due to simple use of those structures.

However, we can still make a systemic analysis.

Let’s use the example of an airplane as an analogy: it is much more efficient for an airplane to use flaps, than to not use them. By increasing the total wing surface, flaps allow landing and takeoff velocity to decrease by a significant amount. An increased use of flaps will no doubt mean that, overall, more flaps will become damaged and broken than if flaps weren’t used at all. But because flaps help reduce the speed at which the aircraft lands, using them contributes to a decrease overall structural stress and damage associated with the impact of landing.

You could even make the argument against using flaps by saying that increasing the wing’s surface area will put more stress on the wing housing and the airplane’s airframe. Even though this is the case, making this argument misses the point. The point of the airframe—and especially of the wing structure—is to absorb the increased stresses associated with increasing the wing surface. Flaps should be used during landing regardless of the fact that both stresses to the wing and incidences of damage to the flaps will increase.

Along similar lines, if we posit that a certain body structure has a certain function, such as the achilles as a structure to store mechanical energy, the gluteus maximus as the main driver of hip extension, etc., then, under optimal conditions, the body should preferentially load the achilles upon landing and put the burden of moving the leg on the gluteus maximus. (All of which seems to agree with the findings of this study):

“When compared to RFS (rearfoot strike) running, FFS (forefoot strike) and BF (barefoot) running conditions both resulted in reduction of total lower extremity (leg) power absorption particularly at the knee and a shift in power absorption from the knee to the ankle.”

All of this said, the systemic analysis of the body is simple: in systems thinking, you look at the functions of different parts, in relation to the whole, to ascertain their function. The achilles tendon seems to be primarily a shock absorber. It certainly works that way when jumping—that’s why it’s almost impossible to land on your heels when you’re jumping straight up and down. So, any stride type that uses the achilles tendon as a shock absorber will likely be more amenable to the body.

Until evidence otherwise settles the matter—and only until then—the most reasonable conclusion to make is that a stride type that uses load-bearing structures to carry weight, offsets torque (rotational force) to joints that can rotate dynamically, uses shock-absorbing structures to absorb shock, and employs energy-return structures to return energy, are “better” than stride types that do not. Given the evidence currently in the literature, everything seems to point to (but not prove) the idea that midfoot striking is an example of the former, and heel-striking is an example of the latter.

AN IMPORTANT CAVEAT: The body is a dynamic system, which means that you can think of it this way this way: if you change one thing, such at the angle at which your foot touches the ground, three other things will change along with it. Perhaps you’ll see a change in your forward lean, a change in your hip extension moment, and therefore a change in the loading of a variety of muscles. In other words, you can never change only one thing. If you oversimplify your understanding or implementation of the changes you need to make in order to be faster, more efficient, or less prone to injury, you will end up being slower, less efficient, and more prone to injury.

This is why it’s important to talk about forefoot striking, midfoot striking and heel striking as “types of gait” and not as “types of footstrike:” the angle at which the foot hits influences (and is influenced by) a variety of other factors. My contention (which I believe is also the contention of proponents of midfoot striking) is that for a supermajority of people, the resolution of all of the biomechanic factors surrounding injury, muscle imbalance, power leaks, and resolvable musculoskeletal asymmetries, will result in the adoption of a midfoot/forefoot strike.

Again, whether this is actually the case has not been borne out by research.

I’d love to read what you have to say about this. Please put your comments, criticisms, and questions in the comments.

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