Forefoot strike running: Do you have enough calf muscle endurance to do it without a cost ?

Below you will find an article on footwear and running. Rice et al concluded that 

“ When running in a standard shoe, peak resultant and component instantaneous loadrates were similar between footstrike patterns. However, loadrates were lower when running in minimal shoes with a FFS (forefoot strike), compared with running in standard shoes with either foot strike. Therefore, it appears that footwear alters the loadrates during running, even with similar foot strike patterns.

They concluded that footwear alters the load rates during running. No brain surgery here. But that is not the point I want to discuss today. Foot strike matters. Shoes matter. And pairing the foot type and your strike patterns of mental choice, or out of natural choice, is critical. For example, you are not likely (hopefully) to choose a HOKA shoe if you are a forefoot striker. The problem is, novice runners are not likely to have a clue about this, especially if they are fashonistas about their reasoning behind shoe purchases. Most serious runners do not care about the look/color of the shoe. This is serious business to them and they know it is just a 2-3 months in the shoe, depending on their mileage. But, pairing the foot type, foot strike pattern and shoe anatomy is a bit of a science and an art. I will just mention our National Shoe Fit Certification program here if you want to get deeper into that science and art. (Beware, this is not a course for the feint of heart.)

However, I just wanted to approach a theoretical topic today, playing off of the “Forefoot strike” methodology mentioned in the article today.  I see this often in my practice, I know Ivo does as well. The issue can be one of insufficient endurance and top end strength (top end ankle plantar flexion) of the posterior mechanism, the gastrocsoleus-achilles complex. If your calf complex starts to fatigue and you are forefoot striker, the heel will begin to drop, and sometimes abruptly right after forefoot load. The posterior compartment is a great spring loading mechanism and can be used effectively in many runners, the question is, if you fatigue your’s beyond what is safe and effective are you going to pay a price ? This heel drop can put a sudden unexpected and possibly excessive load into the posterior compartment and achilles. This act will move you into more relative dorsiflexion, this will also likely start abrupt loading the calf-achilles eccentrically. IF you have not trained this compartment for eccentric loads, your achilles may begin to call you out angrily. Can you control the heel decent sufficiently to use the stored energy efficiently and effectively? Or will you be a casualty?  This drop if uncontrolled or excessive may also start to cause some heel counter slippage at the back of the shoe, friction is never a good thing between skin and shoe. This may cause some insertional tendonitis or achilles proper hypertrophy or adaptive thickening. This may cause some knee extension when the knee should not be extending. This may cause some pelvis drop, a lateral foot weight bear shift and supination tendencies, some patellofemoral compression, anterior meniscofemoral compression/impingement, altered arm swing etc.  You catch my drift. Simply put, an endurance challenged posterior compartment, one that may not express its problem until the latter miles, is something to be aware of. 

Imagine being a forefoot striker and 6 miles into a run your calf starts to fatigue. That forefoot strike now becomes a potential liability. We like, when possible, a mid foot strike. This avoids heel strike, avoids the problems above, and is still a highly effective running strike pattern. Think about this, if you are a forefoot striker and yet you still feel your heel touch down each step after the forefoot load, you may be experiencing some of the things I mentioned above on a low level. And, you momentarily moved backwards when you are trying to run forwards. Why not just make a subtle change towards mid foot strike, when that heel touches down after your forefoot strike, you are essentially there anyways. Think about it.

Shawn Allen, one of The Gait Guys

Footwear Matters: Influence of Footwear and Foot Strike on Loadrates During Running. Medicine & Science in Sports & Exercise:
Rice, Hannah M.; Jamison, Steve T.; Davis, Irene S.

http://journals.lww.com/acsm-msse/Abstract/publishahead/Footwear_Matters___Influence_of_Footwear_and_Foot.97456.aspx

Steppage gait ? Or just a runway model ?  Take the thinking farther.
Today we have a short blog post for you. You may take the topic simply on the surface or cogitate over it and find some deeper epiphanies from the well of knowledge we have tried to present here on our blog for the past 4+ years.  
It is clear that in this video that the model has a consciously driven steppage gait. Meaning, she is lifting her limb/foot via exaggerated hip flexion and knee flexion to clear the foot.  This is often seen unilaterally in a foot drop case where the client has a neurologic lesion that for one reason or another has impaired the client’s ability to extend the toes or dorsiflex the ankle sufficiently to clear the foot (so they do not drag toes and trip/fall).  
But, why is she doing this steppage gait ? It is highly unlikely that she has bilateral lesions.  Sure, she was asked to walk this way by her mentor but again, take it further.  Is there a factor making this gait necessary regardless of the coaching ? 
Obviously the answer is yes or we wouldn’t be doing a blog post on this topic.  She is wearing ridiculously high heels. This is forcing her into an extreme plantarflexed foot and ankle posture. IF she were to swing her leg normally during the swing phase she would drive the foot and ankle into dorsiflexion (a normal gait event) and the long pointed heel would be made more prominent as it was driven forward and downward. This would surely catch on the ground, immediately driving the foot into sudden violent forefoot loading and pitch her into a forward fall.  Yes, you have seen this on the run way videos on youtube, and yes we know you laughed too ! You see, when wearing heels this high, one must deploy a certain degree of steppage gait to clear the heel because ankle plantarflexion is fraught with the risk we just discussed above, the heel is too prominent and will catch. How much steppage (knee flexion and hip flexion to clear the foot) is necessary ? Well, to a large degree it depends on how much of a heel is present.  If you are wearing a small heeled shoe, lets say 1 inch, then a small steppage is necessary.
None the less, there is a bigger problem lurking and brewing underneath when heels are a regular occurrence. Slowly and gradually the disuse of the anterior compartment muscles (Extensor dig., Ext. hallucis, peroneus tertius, tibialis anterior) will weaken and the posterior compartment will shorten respectively. IF left too long, it will result in tightness (yes, there is a difference between tightness and shortness, one is a neurlogical protective mechanism, the other is a more permanent change.) We have said this many times here and in our videos, much of posterior compartment problems (ie achilles tendonitis, Sever’s, Hagglunds etc) are related to a degree of anterior compartment weakness, skill deficits or endurance challenges.  Wearing high heels often will often, but not always, increase this risk. 
If you are an athlete, but someone who wears high heels often, you may have to do extra work to keep your anterior compartment competent on several levels.  Eccentric strength is just as important as concentric in this region. Remember, many gait problems come on slowly, a slow simmering smoldering fire. And remember this last point about heeled shoes, your forefoot is always being loaded initially in ankle plantarflexion, this is not normal and in time this will have a cost in many people.  
One last thing. We are not necessarily talking about dress shoes, although they are a greater culprit.  Many running shoes still have accentuated rear foot stack heights where the heel will be many millimeters above the plane of the forefoot.  Do not discount these shoes as a possible contributor of your problem, remember, physiological adaptation takes time to express into a biomechanical symptom creating problem, and it may take quite some time to resolve your compensations and adaptations.
PS: drive that “cross over gait” lady.  Fools.
Shawn and Ivo
the gait guys

Ankle Dorsiflexion: Even in sprinters who land on the forefoot often heel strike, a retrograde strike if you will.

Many people think of heel strike followed by midfoot/tripod contact phase followed by ankle dorsiflexion, aka ankle rocker.  Heel strike is normal in the walking gait cycle. In some runners, depending on foot type, strength, flexibilty and several other factors, heel strike may be considered normal and may be essential for normal injury free mechanics. However, in recent years we tend to see the media and research investigate a midfoot or forefoot strike pattern. If you have been here with us on TGG for a year or 2-3 you will know we are big advocates of a midfoot strike pattern for several reasons which we will not go into again in this article. (Feel free to SEARCH our blog for MIDFOOT strike articles).  

However, one rarely sees anyone or any source talking about the retrograde heel contact when forefoot strike patterns are used.  Here, in this video, you can see several of these top level athletes who are trying to go forward at top end speed, but who are tapping the heel down on many loading responses. This can be thought of as a retrograde movement and could in a biomechanical way of thinking be considered non-productive. In other words, they are trying to move forward and yet the heel is touching down which is a backwards movement. This point can be argued but that is not the point of this article. The point that we are trying to make is that in order to drop the heel down, and especially if the heel touches, that the runner had better have sufficient ankle rocker/dorsifleixon otherwise the arch may be asked to collapse via excessive pronation (to perform the heel tap) which will drive an internal spin movement when the leg is supposed to be externally rotating to a rigid supinated foot for propulsive toe off. This negative scenario is a huge power leak for a sprinter, or any runner for that matter when they are ramping up speed.  

So, why does this happen ?  Well, for some it can help to load the posterior mechanism, the gastrocsoleus-achilles complex for conservation and power conversion.  It also enables more hip extension and thus more gluteal function. Longer stride means more efficient and greater arm swing which is a huge accessory power source for a sprinter. This also lengthens the stride, they feed off of each other. There are many benefits, if you have sufficient ankle rocker range in the ankle to begin with.  In some runners who do not have the requisite ankle rocker range, you may often see the increased foot progression angle and external limb spin and/or the dreaded adductor twist of the heel (aka  abductory twist of the foot).  These are strategies to get more hip extension and more gluteal function without finding it via the ankle dorsiflexion, where you want to see it.  Remember, the body is a brilliant compensatory and substituter. If the body cannot find a range at one joint it will find it at the next proximal or distal joint. And when that loss is at the ankle, motor patterns options dictate you either find it at foot pronation or hip extension.

Maybe, just maybe we should have called this blog article “Can you hold the foot tripod all the way through the stance phase, even through retrograde heel touch down ? If you cannot, trouble could be on the horizon. ”  But that is a really dumb title.  

Shawn and Ivo

the gait guys

Podcast 34: Chimp feet, Marathon Monks & Statin drugs

podcast link:

http://thegaitguys.libsyn.com/podcast-34-chimp-feet-marathon-monks-statin-drugs

iTunes link:

http://thegaitguys.libsyn.com/podcast-33-heart-beats-toe-walking-crawling

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

 1.Did Rock Climbing Help Us Start Walking Upright?   By Shaunacy Ferro A new theory suggests humans became bipedal so that we could scramble up rugged terrain.
http://www.popsci.com/science/article/2013-05/did-rock-climbing-help-us-start-walking-upright?src=SOC&dom=tw

2. http://en.wikipedia.org/wiki/Kaih%C5%8Dgy%C5%8D

The Running Marathon monks of Mt. Hiei

The Kaihōgyō is a set of the ascetic physical endurance trainings for which the Japanese “marathon monks” of Mt. Hiei are known. These Japanese monks are from the Shugendō and the Tendai school of Buddhism, a denomination brought to Japan by the monk Saichō in 806 from China.


3. http://www.runnersworld.com/general-interest/do-you-have-chimpanzee-feet

Do you have Chimpanzee feet ?

About 8% of people tested by Boston University researchers had midfoot flexibility of the sort that apes use to climb trees, according to a study published in the American Journal of Physical Anthropolgy.

4. Statins Linked With Risk of Musculoskeletal Injury

Michael O’Riordan

http://www.medscape.com/viewarticle/805369?src=wnl_edit_medn_wir&spon=34

http://archinte.jamanetwork.com/article.aspx?articleid=1691918

Can Statins Cut the Benefits of Exercise?

By GRETCHEN REYNOLDS

http://well.blogs.nytimes.com/2013/05/22/can-statins-curb-the-benefits-of-exercise/

http://www.ncbi.nlm.nih.gov/pubmed/23583255

5. Shoes: The Primal Professional.com

http://theprimalprofessional.com/products/pre-order-the-primal-professional

http://well.bradrourke.com/2013/05/my-new-primal-dress-shoes/

6. Hallux valgus and lesser toe deformities are highly heritable in adult men and women: The Framingham foot study

Marian T. Hannan
http://onlinelibrary.wiley.com/doi/10.1002/acr.22040/abstract;jsessionid=99975015C3EE5678E6351273C2CD42A0.d02t04

7. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers

Kulmala, Juha-Pekka; Avela, Janne; Pasanen, Kati; Parkkari, Jari

http://journals.lww.com/acsm-msse/Abstract/publishahead/Forefoot_strikers_exhibit_lower_running_induced.98324.aspx

8. Why Where You Land On Your Foot Isn’t That Important

http://www.kinetic-revolution.com/why-where-you-land-on-your-foot-isnt-that-important/

Podcast 34: Chimp feet, Marathon Monks & Statin drugs

podcast link:

http://thegaitguys.libsyn.com/podcast-34-chimp-feet-marathon-monks-statin-drugs

iTunes link:

http://thegaitguys.libsyn.com/podcast-33-heart-beats-toe-walking-crawling

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

 1.Did Rock Climbing Help Us Start Walking Upright?   By Shaunacy Ferro A new theory suggests humans became bipedal so that we could scramble up rugged terrain.
http://www.popsci.com/science/article/2013-05/did-rock-climbing-help-us-start-walking-upright?src=SOC&dom=tw

2. http://en.wikipedia.org/wiki/Kaih%C5%8Dgy%C5%8D

The Running Marathon monks of Mt. Hiei

The Kaihōgyō is a set of the ascetic physical endurance trainings for which the Japanese “marathon monks” of Mt. Hiei are known. These Japanese monks are from the Shugendō and the Tendai school of Buddhism, a denomination brought to Japan by the monk Saichō in 806 from China.


3. http://www.runnersworld.com/general-interest/do-you-have-chimpanzee-feet

Do you have Chimpanzee feet ?

About 8% of people tested by Boston University researchers had midfoot flexibility of the sort that apes use to climb trees, according to a study published in the American Journal of Physical Anthropolgy.

4. Statins Linked With Risk of Musculoskeletal Injury

Michael O’Riordan

http://www.medscape.com/viewarticle/805369?src=wnl_edit_medn_wir&spon=34

http://archinte.jamanetwork.com/article.aspx?articleid=1691918

Can Statins Cut the Benefits of Exercise?

By GRETCHEN REYNOLDS

http://well.blogs.nytimes.com/2013/05/22/can-statins-curb-the-benefits-of-exercise/

http://www.ncbi.nlm.nih.gov/pubmed/23583255

5. Shoes: The Primal Professional.com

http://theprimalprofessional.com/products/pre-order-the-primal-professional

http://well.bradrourke.com/2013/05/my-new-primal-dress-shoes/

6. Hallux valgus and lesser toe deformities are highly heritable in adult men and women: The Framingham foot study

Marian T. Hannan
http://onlinelibrary.wiley.com/doi/10.1002/acr.22040/abstract;jsessionid=99975015C3EE5678E6351273C2CD42A0.d02t04

7. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers

Kulmala, Juha-Pekka; Avela, Janne; Pasanen, Kati; Parkkari, Jari

http://journals.lww.com/acsm-msse/Abstract/publishahead/Forefoot_strikers_exhibit_lower_running_induced.98324.aspx

8. Why Where You Land On Your Foot Isn’t That Important

http://www.kinetic-revolution.com/why-where-you-land-on-your-foot-isnt-that-important/

A visual demonstration of 3 different foot strike patterns. Lets test some of what you have learned here at The Gait Guys over the last few months.

On the readers left, blue shirt Bib 232:
 The left leg appears to have all joints stacked at this viewer angle (knee is vertically over the foot, hip is over the knee). What we love here is that the foot profile (look at the black sole of the shoe) is parallel to the ground, it is hard to believe that it won’t strike as such. The medial and lateral aspects of the foot should strike flush and simultaneously. This is a neutral foot and is very likely without valgus or varus forefoot typing.  The tibia looks pristine and straight without any torsion, at least from this limited perspective. He also looks to be striding nicely, it seems to appear (albeit this is reaching from this head on view) that the foot will strike below the body mass, this may be because he subtly appears to be leaning forward, again hard to see on this view.

Middle runner, white shirt:  We see some problems here.  First of all, it appears (and again, this is reaching from a front on view) that this runner is striding out with the foot beyond the body mass and will likely heel strike, he also seems to be in more backward lean that the Blue Bib Man but again hard to tell on a frontal view. We also see that the foot is pitched in inversion (note the outward tip of his foot compared to the man in Blue) quite aggressively which will facilitate a strong excessive lateral heel and/or forefoot strike pattern.  You can also see that drawing a line through the length of the long bones (tibia and femur) that they are in alignment, they are even in alignment with the 90 degree perpendicular to the forefoot inverted angulation.  This clearly represents our classic “cross over gait” which was first brought to you and the internet by yours truly a few years ago (here on Youtube link).  It is easy to see that the projected foot landing will be on a virtual line and thus appear to run on a line or even cross the feet over the line indicating that this client is not stacking the foot, knee and hips vertically and thus challenging the gluteus medius and hip stability into the frontal plane (video link here). This client will be wasting energy and efficiency in the frontal plane (side to side movement) and challenging the core, risking knee tracking issues and excessive foot pronation forces beyond the safe and normal.  

Running on the readers right, green shirt #8:  There appears to be a strong stance phase leg collapse, the hip is lateral to the foot and the knee is perhaps on its way to medial from a vertical line from the foot. This can be, and often is, from the issues of cross over described in the middle runner above but it can also be simply found in someone who is striking with the foot/knee/hip joints stacked but does not have sufficient gluteus medius strength to keep the pelvis level on the horizon (thus drift laterally). When this happens the downward collapse of the opposite side pelvis is often, but not always, see as a valgus collapse at the knee since the femur is allowed to drift medially from insufficient strength, skill or endurance pairing of the gluteus medius/maximus pairing and the medial quadriceps. This client is  likely a cross over victim as well and this would give good reason to the aforementioned.  Again, this is all theoretical from a static picture but knowing these patterns like we do, we know these typical patterns of breakdown. This is also suspect because of the foot more positioned under the midline of the body instead of under the knee and hip vertically stacked and the obvious proximity of the knees to one another.  These clients often kick or brush the foot or shoe against the stance phase lower leg as they swing the foot through. 

Who is going to win this race ? One cannot tell. But if they were the same on all levels of endurance, training, VO2 max and equal on every parameter except what was mentioned above, well then our man in Blue, # 232 would be the most efficient and likely the least injured.

Photo from an Outside Magazine article. We Would reference it, and would be happy to do so, but we cannot find the net article anywhere now. Please send it our way if you happen across it !

Shawn and Ivo, The Gait Guys … .  followed in 51 countries and counting.

Lateral Forefoot loading. Why do we see so many runners laterally strike on the forefoot ?

This was from a reader on our Facebook PAGE. It was a great observation and a great topic to continue on our dialogue here on the blog and on our last 2 podcasts. We discussed this on the last podcast but we feel that there needs to be further clarification. (FB link) and (Pod link)

I think Runblogger or someone like that showed video clips of footstrike at an elite (or pro) level race…virtually all the elites (or pros) were first contacting the ground on the outside of their forefoot and rolling to the inside.

The Gait Guys response:

For some people, their anatomy “works” or can tolerate the forefoot contact better than others. Remember, the natural walking gait foot progression is heel, lateral forefoot, medial forefoot. The natural running foot strike is under greater debate as you all know if you have been following the materials here on our blog, facebook, twitter and podcasts. Our last two podcasts (#19 and #20) have gone into this in greater depth.

What you likely are seeing (the more lateral forefoot loading pattern) for these elite pro runners in the video you spoke of is normal clean biomechanics (for them), but for many people, you are not seeing that (by the way, we saw plenty of nice squared off forefoot loading responses as well in other pics and videos); rather you are seeing a coping compensation or just simply poor biomechanics that will lead them to injury. The question is when does it become excessive for a person via poor running form choice, forefoot varus foot type or internal tibial torsion etc ? Perhaps a more important question is whether the person has a flexible mid foot and fore foot that will allow the drop of the first metatarsal (medial tripod) to the ground to complete the foot tripod without having to over pronate through the midfoot or forefoot ? That is the key ! 

And these are valid concerns. Many of people have this, the elites you saw obviously have tolerant anatomy and tolerant biomechanics, for them. For them, they orchestrate all of the parts, perfect or imperfect, into a symphony. This is not as common as many of us would wish. Sure a more (not 100%) squared off forefoot strike is more perfect but not many people have perfect anatomy, in fact we are taught in med school that anatomic variance is the norm. And besides, what is perfect for any given person ?  Perfect and clean biomechanics for a given person could arguably be debated as that which enables them to be most efficient without injury long term. Meaning that which may not look pristine but that which acts as such over the long term.

Classically, a brief, controlled, and non-excessive lateral strike may be  normal, and with a normal and progressive transition to the medial side of the foot however, many people have a rigidity-flexibility issue between the forefoot and rearfoot (ie. rigid or uncompensated forefoot varus for example) and these people often become patients as runners.  This was what we were referring to in podcast #20 which spurred the readers inquiry.  These folks cannot adequately, safely and efficiently drop the medial tripod down (1st metatarsal head) without having to so much of the movement more grossly through the midfoot and excessive pronation.  Many people try to fix this with shoes or orthotics but it is a bit more complicated than that, although on the surface it seems logical and simple.

Obviously those pros that were viewed do not have these issues, hence why they are pros, meaning optimal mechanics, rarely injured for long combined and with gifted cardio fitness. To be a pro you need all of the pieces, just wanting to run fast or simply training hard is often just not enough to become elite. The pros are a small percent of the population. Many others are not in that category and thus remain at risk injury or become statistics. We have had plenty of elite runners in our offices who had the cardio and the will but not the anatomy and biomechanics to stay out of our offices long term (injury free) to compound the necessary training.  Many of these folks were converted to triathletes and have been able to compete at world class levels because we found a way for them to dampen the impact miles on tortured running anatomy. 

Sometimes a person’s will is not enough, sometimes you have to have the complete package. And that means competent anatomy and a tolerance system to aberrant biomechanics.  In our opinion our dialogue here is critical in runners, unfortunately there are some big gaps from the medical and biomechanics side in  many of the dialogues on the internet.  But that is were we find our niche, and it is where we are best positioned to help the masses. 

Join us weekly on our podcasts,  here on our blog, or our other social media sites. Join the Gait Guys brethren !
Shawn and Ivo

The Gait Guys

all material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Please ask before lifting our stuff!