More research on Forefoot Running: Forefoot Varus and the toe extensor muscles.

Lately we have all seen much in the news about the forefoot strike loading in runners and many of the proposals and rebuttals regarding injury rates.  Our dialogue less than 2 weeks ago on some of Lieberman’s recent comments (our blog article “Dear Dr. Lieberman”, click here) seem to be ringing true again. Here are just two more insightful and important studies when it comes to looking at some of the proposed ideas and causes of forefoot varus. Naturally, a thinking mind would wonder if some of these weaknesses in anterior and posterior tibialis muscles as well as extensor toe musculature, as proposed in just these 2 articles, are causal to the forefoot injuries that seem inevitable as Lieberman seems to suggest (again, see our blog post). Naturally, weaknesses and poor motor patterns of some or all of these muscles is going to create and insufficient and possibly inefficient and pathologic forefoot loads because of the forefoot varus foot type these muscular imbalances can functionally produce.  We have been pounding sand on this issue for years but still no one listens.  The medial research, as evidenced here is supportive of our theories and everyday clinical findings.

To summarize, ONCE AGAIN, not everyone is suited or possibly ready for forefoot load/contact/strike running.  And if you have injury or problems in doing so, don’t blame your minimalist shoe……. it is either a foot type that needs functional repair or a foot type that is fixed an must opt for midfoot strike.

There is SO MUCH MORE to this game than just strap on some minimalist shoes and start forefoot loading your way on your next run.  Buyer beware !

Shawn and Ivo…….. the gait guys……..two guys who are “Gandhi’d” regularly. 

“First they ignore you, then they laugh at you, then they fight you, then you win.”

- Mahatma Gandhi


Foot (Edinb). 2009 Jun;19(2):69-74. Epub 2008 Dec 31.

Foot varus in stroke patients: muscular activity of extensor digitorum longus during the swing phase of gait.

Reynard F, Dériaz O, Bergeau J.

Clinique romande de réadaptation, SUVA Care, Av. Gd-Champsec 90, Sion, Switzerland.


CONCLUSIONS: The activity of extensor digitorum longus muscle during the swing phase of gait is important to balance the foot in the frontal plane. The activation of that muscle should be included in rehabilitation programs.


J Bone Joint Surg Am. 2006 Aug;88(8):1764-8.

The contributions of anterior and posterior tibialis dysfunction to varus foot deformity in patients with cerebral palsy.

Michlitsch MG, Rethlefsen SA, Kay RM.

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.


RESULTS: The muscular contributor to varus deformity was the anterior tibialis in thirty feet, the posterior tibialis in twenty-nine feet, both the anterior tibialis and the posterior tibialis in twenty-seven feet, and another contributor in two feet. Seventy feet had varus deformity during both stance phase and swing phase. Of these seventy feet, twenty-five exhibited dysfunction of the anterior tibialis, twenty exhibited dysfunction of the posterior tibialis, and twenty-three exhibited dysfunction of both muscles. Therefore, the timing of varus was not predictive of the contributing muscle or muscles.

CONCLUSIONS: The current study demonstrated a higher prevalence of anterior tibialis dysfunction, both alone and in combination with posterior tibialis dysfunction, as a contributor to pes varus in patients with pes varus and cerebral palsy than had been reported previously. Dynamic electromyography provides clinically useful information for the assessment of such patients.