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.

Low back pain and quadriceps compensation. A study.

“Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.“- Hart et al.

Recently I discussed a paper (link below) about how soleus  motoneuron pool excitability increased following lumbar paraspinal fatigue and how it may indicate a postural response to preserve lower extremity function.
Today I bring you an article of a similar sort.  This paper discusses the plausibility that a relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation and the subsequent changes in hip and knee function when running fatigue ensued. 

"Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.”- Hart et al.

Whether this or any study was perfectly performed or has validity does not matter in my discussion here today. What does matter pertaining to my dialogue here today is understanding and respecting the value of the clinical examination (and not depending on a gait analysis to determine your corrective exercise prescription and treatment). When an area fatigues and cannot stabilize itself adequately, compensation must occur to adapt. Protective postural control strategies must be attempted and deployed to stay safely upright during locomotion. The system must adapt or pain or injury may ensue, sometimes this may take months or years and the cause is not clear until clinical examination is performed. Your exam must include mobility and stability assessments, motor pattern evaluation, and certainly skill, coordination, ENDURANCE and strength assessments if you are to get a clear picture of what is driving your clients compensation and pain. 

So, if your client comes in with knee, hip or ankle pain and a history of low back pain, you might want to pull out these articles and bash them and other similar ones into your brain. Remember what I mentioned when i reviewed the soleus article ? I mentioned that the reduced ankle dorsiflexion range may be from a soleus muscle postural compensation reaction to low back pain. In today’s discussion, impairment of the hip ranges of motion or control of the knee (from quadriceps adaptive compensation) may also be related to low back pain, in this case, paraspinal fatigue.  

Sometimes the problem is from the bottom up, sometimes it is from the top down. It is what makes this game so challenging and mind numbing at times. If only it were as simple as, “you need to work on abdominal breathing”, or “you need to strengthen your core”.  If only it were that simple. 

Dr. Shawn Allen, one of the gait guys

J Electromyogr Kinesiol. 2011 Jun;21(3):466-70. doi: 10.1016/j.jelekin.2011.02.002. Epub 2011 Mar 8.
Effects of paraspinal fatigue on lower extremity motoneuron excitability in individuals with a history of low back pain. Bunn EA1, Grindstaff TL, Hart JM, Hertel J, Ingersoll CD.

J Electromyogr Kinesiol. 2009 Dec;19(6):e458-64. doi: 10.1016/j.jelekin.2008.09.003. Epub 2008 Dec 16. Jogging gait kinetics following fatiguing lumbar paraspinal exercise.
Hart JM1, Kerrigan DC, Fritz JM, Saliba EN, Gansneder B, Ingersoll CD

Got Motion Control? Sometimes too much of a good thing is a bad thing!

Welcome to Monday and News You can Use, Folks.

Today we look at short video showing what someone with internal tibial torsion looks like in a medially posted (ie motion control) running shoe. Note how the amount of internal rotation of the lower leg decreases when the shoe is removed and when he runs. Be careful what shoes you recommend, as a shoe like this is likely to cause damage down the road.

You can follow along listening to Dr Ivo’s commentary. This was filmed at a recent seminar he was teaching.

Yes, you are looking INSIDE this toe. That IS a screw and metal plate in that toe. 

What kind of stuff finds its way into your office ? I get all kinds of things it seems, at least once a day something comes in that makes me scratch my head. 

This client just wanted my opinion and thoughts on their toe and their gait once they are ambulating again. They have had multiple surgeries to this poor foot. You can see multiple scars over multiple digits and metatarsals.  This is the 3rd surgery to the big toe, the last 2 have been attempts at correcting failed prior surgeries. This is obviously the last straw surgery, total fusion of the metatarsophalangeal joint.  What is interesting in this case is that this plate was taken out about 4 weeks ago, and the skin was stretched back over and the wound closed up (forgot to take update photo for you). I saw it yesterday, and I was amazed at how healed up the area was. They are months post op now, and they can load the toe heavily now, that is always amazing to me. The body’s healing ability is a miracle. Of course, if you have been with us here long enough you will know that my “concern button” immediately got pushed but the client was proactive and asked the question before my oral diarrhea of concerns started.

So, they wanted to know about their gait and what to watch out for.  Off the top of your head, without thinking, you should be able to rattle off the following:

  • impaired toe off
  • premature heel rise
  • watchful eye on achilles issues
  • impaired hip extension and gluteal function
  • impaired terminal ankle plantar flexion (because they cannot access the synergists FHL and FHB)
  • impaired terminal ankle dorsi flexion (because they cannot access the synergists EHL and EHB)
  • lateral toe off which will promote ankle and foot inversion, which will challenge the peronei
  • frontal plane hip-pelvis drift because of the lateral toe off and lack of glute function
  • possible low back pain/tightness because of the  frontal plane pelvis drift and from altered hip extension motor patterning (and glute impairment)
  • possible knee pain from tracking challenges because they cannot complete medial tripod loading and thus sufficient pronation to internally spin the limb to get the knee to sagittal loading
  • impaired arm swing, more notable contralaterally

There is more, but that is enough for now. You need to know total body mechanics, movement patterns, normal gait cycle events (you have to know normal to know abnormal) and more. You have to know what normal is to understand when you are looking at abnormal.

* So, dial this back to something more simple, a “stubbed toe”, a painful sesamoid, painful pronation or a turf toe or hallux limitus.  They will all have the same list of complications that need to be evaluated, considered and addressed. This list should convey the importance that if your client has low back pain, examining the big toe motion is critical. Also, if you are just looking at the foot and toe in these cases, pack your bags … .  you don’t belong here. If you are just adjusting feet and toes and playing with orthotics while the list above does not constantly file back and forth through your brain, again, pack all your bags, grab your cat and leave town (just kidding, try reading more and get to some seminars).

If you know the complicated things, then the simple things become … … . . simple.

Your local treadmill gait analysis guru should know all of this if they are going to recommend shoes and exercises. Shame on them if there is no physical exam however. The data roadmap from the gait analysis software print out is not going to get you even out of the driveway let alone down the street. The data is going to tell you what you are doing to compensate, not tell you what is wrong. You must know anatomy, biomechanics, neurology, orthopedics and how to apply them to get the recipe right, not just which shoe in a store will unload the medial tripod of the foot or which exercise will lengthen your stride on the left. 

… .  sorry for the rant, too much coffee this morning, obviously.

Shawn Allen, one of the gait guys

and what have we been saying for the last several years?

“The development of bone marrow edema after transitioning from traditional running shoes to minimalist footwear is associated with small intrinsic foot muscle size, according to research from Brigham Young University in Provo, UT.

The findings, epublished in late October by the International Journal of Sports Medicine, suggest that runners with small intrinsic foot muscles may benefit from strengthening exercises prior to attempting the transition to minimalist running.

Investigators randomized 37 habitually shod runners to 10 weeks of running in minimalist footwear or their own shoes, and performed magnetic resonance imaging at baseline and after the intervention to detect bone marrow edema and assess intrinsic foot muscle size.

Eight of the runners in the minimalist group had developed bone marrow edema at 10 weeks, as well as one in the control group. Those who developed bone marrow edema had significantly smaller intrinsic foot muscles than those who did not.

In addition, running in minimalist footwear was associated with a 10.6% increase in abductor hallucis cross-sectional area, a statistically significant change”.


Johnson AW, Myrer JW, Mitchell UH, et al. The effects of a transition to minimalist shoe running on intrinsic foot muscle size. Int J Sports Med 2015 Oct 28. [Epub ahead of print]

Podcast 101: Physics of falling & running.

Podcast 101: Physics of Falling & Running
Plus: calf strengthening problems, odometer neurons help you find your way, Chi running and more !

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Other Gait Guys stuff

A. Podcast links:

direct download URL:

permalink URL:

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D. other web based Gait Guys lectures:
Monthly lectures at : type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
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Show Notes:

‘Odometer neurons’ encode distance traveled and elapsed time

Snap on shoe

Physics of falling/running

Foot strike and (pre)positioning ?

Non-local fatigue

Chi running, less injuries?  

CAlf strength screen? screen

We always like to try and reproduce the problem. We like to say “If we can reproduce the pain, we can probably fix the cause”, which seems to hold true in many cases. This article makes us think about seeing the patient at a point in their training that they feel the discomfort or are having the problem (after 30 minutes, after 20 miles, etc). There may be some value to scheduling their exam later, rather than sooner. A nice fatigue article from one of our favs “LER”.

More on the Minimalist Debate

“Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems.

More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%).

While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.”

“In physics, angular momentum is the rotational analog of linear momentum. Like linear momentum it involves elements of mass and displacement. Unlike linear momentum it also involves elements of position and shape.  It is an important quantity in physics because it is a conserved quantity – the angular momentum of a system remains constant unless acted on by an external torque.” – wikipedia

The Gait Guys Podcast #101 launches later this week. Here is a tickler. On the podcast we delve a little into this article based on Angular Momentum. We are not physics guys, but we try to give this idea some critical thought. Chime in if you know more than us, we would love to hear your research backed thoughts.

“To most runners and coaches, running is a series of jumps, says Svein Otto Kanstad, a physicist and former competitive runner based in Volda, Norway. Gravity isn’t considered helpful, because its force is perpendicular to the direction a runner is moving. But this mindset neglects the concept of angular momentum, Kanstad says. Rather than thinking of running as a series of jumps – leaping off one foot and landing again on the other – runners should view their sport as a series of falls, aided by gravity, he says.” -Boyle

Read the Rebecca Boyle and Kanstad articles then watch the World Record race video by Michael Johnson. Study his leg turn over on the straight away as compared to his closest 2 competitors. Something is different. His steps are shorter, and it is difficult to determine, but is he doing what Kanstad is suggesting ?


As Rebecca Boyle suggests,  “a runner’s hips rotate to bring each leg forward, he or she gains angular momentum. But most runners don’t make the best use of this. At the moment their leading leg hits the ground, the second leg is usually stretched out behind. In Kanstad’s revised gait, the second leg will already have rotated forward again before the leading leg hits the ground. By doing this, the runner’s centre of mass is tilted far forward allowing for more forward momentum, but the recovery leg is there to stop a fall.”

As Kanstad suggests in his research: “A theory is developed to determine the magnitude and nature of these effects of gravity, showing that more than 10% of the energy needed for running can be obtained from the field of gravity. Likewise, at a particular optimum velocity, walking may become entirely driven by gravity-induced angular momentum without any muscular effort.”

*Addendums (copied discussions from our Social media pages, we have smart people follow our work, so we wanted to include some dialogues here. We do not necessarily agree with everything said here, but in turn we also do not know everything. So, it is worthy of sharing in the hopes it takes us all further down the road to enlightenment).

reader: For some interesting applications and background on whole body angular momentum check out Anne Silverman’s work (Col School of Mines). There’s some interesting implications for how gait is regulated. Hope all is well.

Gait Guys:  Dear X, we very much appreciate your contributions and thoughts here. You seem to be a strong advocate of Romanov’s work. Can you furnish us with some of his research, we like to see the numbers and studies. His stuff has been around for awhile, certainly there has to be a few good papers you can lead us too to cut down our search to the good ones.

another reader:  After reading this (original article) I didn’t know whether to laugh or cry! It’s still amazing to me the confusion and mayhem surrounding running gait mechanics. With Nicholas Romanov already establishing the idea of gravitational torque as the propulsive force in running, how can Kanstad’s “new ” belief be taken seriously: vis-a-vis the Pose Method being conceptualized during the 1970’s. It truly makes me wonder whether scientists, researchers or coaches are actually trying to understand the truth or just emblazon their own reputations. From Bobby McGee to Daniel Lieberman, the misinterpretation of how we move in a gravitational environment is profound. The idea that we can generate anti-gravitational force via muscular effort to generate movement has an almost ludicrous logic to it. The idea of “just run barefoot” or “take smaller strides” or “land of the midfoot” trivializes the unique hierarchical interplay at the core of all human movement.

As a Movement Specialist, former student of Dr. Romanov’s and someone with a passion for the history of biomechanics, the fundamental flaw is obvious: science observed human gait and tried to conjecture based on the idea of the human body being a machine, rather than the body as another biological system on this planet. The ideas of everyone from Aristotle to daVinci, Galileo to the Weber brothers concluded that the the body must move in harmony with nature. Perhaps it was the rush of modern civilization via the Industrial Age which signified a change in the scientific method. Whatever the specific catalyst, the onslaught of data collection as evidence was born.

Even today, with all of the technology available, the idea of the foot being a fulcrum for the body to rotate over, is lost. What’s even further not understood is that the body, as a lever arm, must be aligned properly – if not, the fall forward is interrupted and all of the mistakes taught in classical stride mechanics (push-off, drive, etc.) become common error. It’s ironic that Kanstad mentions Michael Johnson (who I agree ran with proper “pose"technique), but who even today, would describe his own form differently. Which is why Usain Bolt, the who does pretty much everything correctly, is still a scientific conundrum.

 I can provide Pose-related research (though I suggest looking at the information in his Pose Triathlon book). But as you know, there are many contrary arguments and much conflicting information out there that is seemingly supported by data research as well. What I tried to elucidate is that it’s difficult to consistently quantify proper running technique. Research studies would have to be designed differently, the athletes trained for longer periods of time, acclimated to both normal ground and treadmill surfaces, freed from any musculoskeletal and psychological inhibitions to running better. With any athlete I work with, there is usually a period of (at least) a year’s time of training which must be performed: longer periods for endurance or injured athletes. Studies can try to isolate certain physical elements or characteristics of form: these clearly miss the perceptive and sensory aspects most critical to better form. Essentially what it always come down to is basic: where are you when your foot hits the ground, how long do you spend on the ground and what do you look like at terminal stance? If these concepts could be studied, then I’m all for it. Unfortunately, studies continue to observe and rely on the factorial by-products or results of error-filled running technique. In the end, who is deciding if the subjects are actually doing things well enough to warrant studying them?

another reader: As a PT I agree with Kanstad. While Michael Johnson appears to be fully upright, his chest and stomach are leaning forward. I’m willing to bet his COM is anterior to his trunk while he’s running. There’s probably some give and take though, just like anything else. Leaning too far forward will make you unsteady and you’ll end up slowing down to prevent a fall. Leaning too far backwards or even being vertically upright would, as Kanstad suggests, would prevent any angular momentum via gravity from assisting a runner, and would even work against them and push them backwards.

another reader: Sir Isaac Newton is turning over in his grave…and he is likely doing that by using zombie muscles to push down to overcome both the downward force of gravity and his inertia and then using multiple muscle to rotate about his transverse plane.

Reference sources:

Rebecca Boyle,

Gravity-driven horizontal locomotion: theory and experimentSvein Otto Kanstad, Aulikki KononoffPublished 16 September 2015.DOI: 10.1098/rspa.2015.0287

Notice the differences in running (top) vs sprinting (bottom) activation patterns?

This picture (along with the MIchaud muscular firing pattern ones) are becoming some of my favorite ones to talk about. I just stare at them and look for differences and similarities. 

Check out that the abs do not seem to fire in running (in this study at least), but do in sprinting. Note also that most muscles fire longer (and we wil assume harder) during sprinting. Also check out the peroneals, which fire just as the foot touches down in sprinting, probably to make up for the instrinsics not firing, and assist in creating a rigid lever for push off. 

from: Mann et al 1986