Hanging around ultra-marathon runners has caused me to notice a couple of things. First, these people are crazy. The iconic 26.2 mile marathon distance is hardly considered a warm-up, with races going as long as 50 or even 100 miles. The second thing I noticed is that ultra-runners tend to have a different stride than most, landing each step on the front of their foot instead of their heel.

As a doctor who treats all kinds of runners, I have realized that forefoot strikers tend to have different types of injuries than heel strikers. Here’s how it breaks down: forefoot striking (FFS) tends to result in more pain in and around the ankle and calf but less injury overall, while heel strikers tend to have more knee, hip, and low back issues.

This year I signed up for the Whidbey Island Marathon and for the first time in my life, had to miss an event due to injury. Longer training runs were impossible because of significant right hip pain with each heel strike. This was about the same time that I discovered the correlation between running style and injury type, and about the time I had a conversation with a running friend of mine who told me that he got rid of his hip pain by “running faster” which caused him to land on his forefoot.

The connection between heel striking and impact injuries of the knee and hip was becoming clear, so I decided to change my gait and stop heel striking. If you are going to try this, a word of caution: start slow! Your calves are going to get really really sore. Try short distances to start with, followed by plenty of calf stretching and vitamin C for tissue repair. Running barefoot on turf is a good way to get the feel for it. Start with quick sprints the width of a soccer field (it’s impossible to heel strike when you’re sprinting), then slow down as much as you can while still forefoot striking. It’s going to take some time for your new gait to feel comfortable so don’t get discouraged; it doesn’t look as awkward as it feels! Shoes with a lower drop from the heel to toe will facilitate forefoot striking. Somewhere in the 4mm range is better than the typical 10-12mm common to most running shoes.  After I switched to forefoot striking, my hip pain went away and I am able to run longer distances again. My next event is going to be the Bellingham trail marathon with over 5000 feet of elevation climb during the race. Who’s with me?!!

It’s always nice when research backs up clinical observation. In October of 2007 the International Journal of Sports Physical Therapy published a study that looked at the amount of impact (or “power absorption”) at the ankle, knee, and hip joints during rearfoot striking (RFS), forefoot striking (FFS), and running barefoot. The study found that runners can slash the amount of impact on knees and hips by more than half by simply switching from rearfoot to forefoot striking. FFS with shoes on was very comparable with barefoot running in terms of diminishing impact through the knee and hip.

My clinical recommendation is that people with hip or knee pain, or people who want to run far or often should consider forefoot striking. People with calf strains, achilles tendon problems, or plantar fasciitis should approach transition to FFS with caution, but may experience long term benefit as calf muscles and tendons become stronger. Remember, calf muscles form tendons that wrap underneath your feet and support your arches. Strong calves make for healthy feet. Trail running is another way to decrease joint impact from running. Good thing Discovery Park is right around the corner!