You might think your shoe is doing more to control motion of your foot than it is actually doing.

You might think your shoe is doing more to control motion of your foot than it is actually doing.

"The measurement of rearfoot kinematics by placing reflective markers on the shoe heel assumes its motion is identical to the foot’s motion."
The results of this study revealed that "calcaneal frontal plane ROM was significantly greater than neutral and support shoe heel ROM. Calcaneus ROM was also significantly greater than shoe heel ROM in the transverse and sagittal planes. No change in tibial transverse plane ROM was observed."

It is easy to underestimate the calcaneal ROM across all planes of motion. Motion is going to occur somewhere, hopefully you can help your client control the excessive ROMs that are occurring and causing their symptoms. But just do not think that a shoe is going to markedly help, it might, but let your interventions and your client's feedback on pain lead you.

Calcaneus range of motion underestimated by markers on running shoe heel.
Ryan S. Alcantara'Correspondence information about the author Ryan S. AlcantaraEmail the author Ryan S. Alcantara
, Matthieu B. Trudeau, Eric S. Rohr
Human Performance Laboratory, Brooks Running Company, 3400 Stone Way N, Suite 500, Seattle, WA 98103 United States

Podcast #140: Running, hallux amputation, building deeper gait concepts.

Topics:

hallux amputation, achilles tendon, achilles tendinopathy, rehab achilles, bursae, marathons, vapourfly, shoes, shoe fit, gait, gait problems, gait correction, gait retraining, running, foot strike, heel strike, midfoot strike, rearfoot strike, heel strike, loading responses, gait rehab, muscle strength, isotonics

Links to find the podcast:

Look for us on iTunes, Google Play, Podbean, PlayerFM and more.

Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com

doctorallen.co

summitchiroandrehab.com

shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_140real_-_10618_9.18_AM.mp3


Permalink URL: http://thegaitguys.libsyn.com/podcast-140-running-hallux-amputation-building-running-concepts


Libsyn Directory URL:http://directory.libsyn.com/episode/index/id/7135745


Topics and links:


The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. Nuri L, et al. J Exp Biol. 2017.

https://www.ncbi.nlm.nih.gov/m/pubmed/28620014/

Good tip to decrease loading and help decrease injury risk in runners: See study by Chan et al.:
http://journals.sagepub.com/doi/abs/10.1177/0363546517736277?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Vapourfly shoe
https://www.nytimes.com/interactive/2018/07/18/upshot/nike-vaporfly-shoe-strava.html

Men’s marathon:
https://twitter.com/chrisbramah/status/1019481750039343104/photo/1


fun facts:

Foot strike patterns of the World Championships Marathon:
Women’s race:
73% rearfoot, 24% midfoot, 3% forefoot
Men’s race:
67% rearfoot, 30% midfoot, 3% forefoot
pic.twitter.com/iWRzjImQBZ
https://www.iaaf.org/about-iaaf/documents/research#biomechanical-research-projects

Foot structure and stiffness is critical
https://www.nature.com/articles/srep29870

Tendons can change
Progressive calf strength training led to increased achilles stiffness @ 4 weeks & increased tendon cross sectional area @ 8 weeks
https://link.springer.com/article/10.1007/s00421-018-3904-1

Bursae can thicken painlessly as a normal adaption to activity... just like skin calluses!
https://www.ncbi.nlm.nih.gov/pubmed/24907190

Between 63-72% of participants were wearing incorrectly sized footwear. review of the literature here from @LTPodiatry team:
https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z

How Neuroscientists Explain the Mind-Clearing Magic of Running -- from the Science of Us
https://www.huffingtonpost.com/science-of-us/how-neuroscientists-expla_b_9787466.html

Knee flexion in gait loading. Heeled shoes do things.

Watch this video, you have likely seen it already but did you notice it ? You will have to fast forward to 1:40 to see the video that applies to this screenshot here today.
How much knee flexion should occur during the initial loading response ? In this walking gait video, if you look closely enough, her high heeled shoes are forcing her to load in a what is technically a midfoot stride (because of the high heel) when in fact she is truly loading initially in a forefoot load, ie. plantarflexion. This abrupt load is forcing her to dampen the load with a quadriceps eccentric (if you watch closely enough, the knee flexes every time during loading, more than it should). Normally, in flat-er shoes, this knee eccentric is basically hidden (it is almost an isometric), it should never be this obvious unless one's quads are truly too weak. To be fair, the shoes are propping her into anterior pelvis tilt, as these high heeled shoes always do, which promotes lower abdominal challenges and premature quad loading, and delayed glute loading (don't believe us? stand up, dump into an anterior pelvic tilt and increased lordosis and try to engage your glutes. Nadda ! So the loading shifts into the quads).
Welcome to another ramification of high heeled shoes, again.
Admittedly, this lady does a great job. Her belt line stays pretty neutral and doesn't dip on each loading response and she is in good control. Ivo and Shawn on the other hand are terrible in their pumps :)

Sprinters, and those who forefoot load during running, are you surprised with anterior knee pain when it comes on, or achilles pain or calf tightness when the calf fatigues and can no longer hold you in adequate plantarflexion ? How about low back pain or tightness after runs ? No, you should not be surprised is the correct answer (unless you have enough durability in the quad and calf, and lower abdominals to sustain the length of your workouts, over and over and over.

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

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

Midfoot Striking Monsters.  That’s right, a gorgeous HD video for you today. Reminds us of a Joseph Campbell storyline.  A beautiful video and an Angus Young-ish young boy with perfect midfoot strike, along with his monster buddies.

Something a little lighter today for the gait brethren here on The Gait guys.  Proof that it doesn’t always have to be cerebral here on the Gait Guys. Today just sit back, go full screen HD on this one, and turn it up loud !

This kid should give form running clinics. Its simply a beautiful running form.

Shawn and Ivo.

___________________

credits:

RUN BOY RUN EP ON I-TUNES : itunes.apple.com/fr/album/run-boy-run-remixes-ep/id522665628

WOODKID - RUN BOY RUN - Video directed by Yoann Lemoine

Produced By ICONOCLAST with the help of Picseyes
Produced by Roman Pichon 
Art director / Chef Decorateur : Pierre Pell 
Post Production by OneMore Prod
VFX SUPERVISOR : Gregory Lanfranchy
FLAME ARTIST : Herve Thouement
FLARE ARTISTS : Laura Saintecatherine & Romain Leclerc
3D : Olivier Junquet & Priscilla Clay
MATTE PAINTING : Arnaud Philippe Giraux
POST PRODUCER : Raminta Poskute
Label & Video commissioner Pierre Le Ny

P & C 2012 GREEN UNITED MUSIC ICONOCLAST / GREEN UNITED MUSIC / SEIZE ZÉRO TROIS
label-gum.com/

Retail/Coach/Trainer Focus: When a stability shoe does not stop gait or running pronation.

This video is unlisted. You will need this link to view it if it does not show up in the player above this blog post:    http://youtu.be/Lt6RbEtALUY

This is a higher end stability shoe. We know what shoe it is and you can see the significant amount of dual density mid sole foam in the shoe, represented by the darker grey foam in the medial mid sole.  The point here is not to pick on the shoe or the brand. The point here is to:

1. not prescribe a shoe entirely on the appearance of the foot architecture

2. not to prescribe a shoe merely because a person is a pronator

3. not to assume that a stability shoe will prevent pronation

4. not to assume that technique does not play a part in shoe prescription

5. not to assume that all pronation occurs at the mid foot (which is the traditional thinking by the majority of the population, including shoe store sales people)

There you go, plenty of negatives. But there are positives here. Knowing the answers and responses to the above 5 detractors will make you a better athlete, better coach, better shoe sales person, a safer runner, a more educated doctor or therapist and a  wiser person when it comes to human locomotion. 

A shoe prescription does not always make things better. You have heard it here and we will say it again. What you see is not necessarily what you get.  This case is a classic example of how everything done for the right reasons when so very wrong for this young runner.

What do you see ?

Pronation can occur at:

  1. the rear foot (we refer to this as excessive rear foot eversion or calcaneal eversion driven sometimes by rearfoot valgus). This can be structural (congenital) in the bone (calcaneus or talus) or functional from weaknesses in one or several rear foot eversion controlling muscles.
  2. the mid foot as is traditionally assumed (this is often referred to as “arch collapse” ).
  3. the fore foot. (possibly many causes, such as a Rothbart Foot variant, short first metatarsal, a bunion , forefoot varus, hallux valgus, weakness of the hallux controlling muscles etc)

So, in this case you might assume that the stability shoe that is designed to prevent rear and midfoot pronation is:

  1. not doing its job sufficiently OR
  2. the pronation is occuring at the forefoot OR
  3. there is a myriad of of issues (yes, this is the answer)

However, the keen eye can clearly see that this is a case of heavy forefoot pronation but there are also mechanical flaws in technique (driven by weaknesses, hence just working on her running form will not solve her issues, it will merely force her to adopt a new set of strategies around those weaknesses !). The problems must be resolved before a new technique is forced.  This is perhaps the number one mistake runners make that drives new injuries.  They tend to blame the injury on new shoes, old shoes, increased miles, the fartlek they did the other day, the weather, their mom, there spouse, their kids…….runners come up with some great theories. Heck, all of our athletes do ! It keeps things amusing for us and we get to joke around with our athletes and throw out funny responses like, “I disagree, it was more likely the coming precession of the equinox that caused this injury !”. 

Although his individual does not have a fore foot varus deformity (because we have examined  her) it needs to be ruled out because it is  big driver of what you see in many folks.  In FF varus the forefoot is inverted with respect to the rear foot. This can be rigid (cannot descend the 1st ray and medial side of the tripod) or plastic (has the range of motion, but it hasn’t been developed).

We, as clinicians, like to assume that MOST FEET have a range of motion that folks are not using, which may be due to muscle weakness, ligamentous tightness, pathomechanics, joint fixation, etc. Our 1st job is to examine test the feet and make sure they are competent. Then and only then, after a trial of therapy and exercise, would you consider any type of more permanent “shoe prescription”.

If the individual has a rigid deformity, then you MAY consider a shoe that “brings the ground up” to the foot. Often time we find, with diligent effort on your and the individuals part, that a shoe with motion control features is not needed.

Sometimes the individual is not willing to do their homework and put in the work necessary to make things happen. This would also be a case where an orthotic or shoe can assist in giving the person mechanics that they do not have.

We have not seen many (or any) shoes that correct specifically for a fore foot varus (ie a shoe with fore foot motion control ONLY). The Altra Provision/Provisioness has a full length varus post which may help, but may over correct the mid foot as well. Be careful of what you prescribe.

Yes, we have been studying, blogging, videoing and talking about this stuff for a long time. Yes, much of it is often subtle and takes a trained eye to see. It is also the stuff that goes the “extra mile” and separates good results from great ones.

We are The Gait Guys. Watch for some seminars on some of our analysis and treatment techniques this fall and winter, and some pretty cool video, soon to be released.

Midfoot strike 5 year old running barefoot in grass.

So, heel strike you say ?  Have  a closer look.  This is a near perfect midfoot strike. What you cannot see is his torso progression. As long as the torso has enough forward lean heel strike cannot occur. Heel contact can occur, but not heel strike or impact.

We have talked about this on many occasions here on The Gait Guys Blog. No one else is talking about this fine line difference between heel strike and heel contact.  Everyone still seems hell bent on talking about forefoot strike. Forefoot strike in distance running is not normal, midfoot strike like you see here in this young child is natural and normal. This 5 year old was likely just asked to run barefoot, he was not likely coached. This is because midfoot strike is natural and normal.  As we said, as long as the torso is directly above or in front of the foot contact position there is no way that heel STRIKE can occur, rather heel CONTACT can only occur (unless you have hamstrings like cirque du soleil acrobats and do not mind going into a posterior tilted pelvis at contact). 

We tell our runners to:

  • lift the chest and lean
  • raise the toes and dorsiflex the ankle  (engage the anterior lower leg compartment) so that the arch is maximally prepared
  • a heel KISS of the ground is fine, just no impact
  • you do not need to forefoot strike to run naturally
  • * and, here is one more reason why we like a midfoot strike over a forefoot strike…. because a midfoot strike means that the body continues forward whereas a forefoot strike that then allows into a heel kiss/touchdown means that there is a posterior progression and eccentric lengthening of the posterior chain (hamstrings and calf muscles). This posterior directed motions is not exactly wise when forward progression is the goal of running !

This little fella is doing it right. Largely because he has not been in shoes long enough to corrupt the natural tissues and mechanisms (both the body parts and the natural neuromotor patterns).

* Addendum: after a really productive FAcebook dialogue with some readers we felt we needed to be more clear on some of our unspoken assumptions here.  If the heel hits first, it will be a STRIKE and not a KISS and the load will be high. The only way the heel can kiss the ground like we mention above is if the heel is absolutely contacting at the same time as the forefoot, one could say that there is a more dominant load on the mid-forefoot but the heel can still strike at this same time.  Striking clearly on the forefoot and then touching down the heel is satisfactory but there is still a retrograde movement which we believe is not as economical yet certainly better than heel impact/strike.  To get the perfect midfoot strike with barely a subtle heel CONTACT (not impact or strike) requires greater skill and more mastery as a runner.  And if you are wearing a shoe that is not minimalist or zero drop developing this skill will be a challenge and you will be misleading yourself.    This ammendment added 1 hour post blog post launch.

Shawn and Ivo…….. the Devil is in the Details. 

Is Barefoot more economical ?

Researchers at England’s Northumbria University analyzed the gait and oxygen uptake of 18 recreational and elite runners performing a series running tasks both barefoot and shod.

Dr. Michael Wilkinson, lead researcher and avid barefoot runner determined the following in their study:

- a significant saving in energy from taking off running shoes

- mechanical differences in the foot strike patterns (shod runners did more heel strike, unshod were more midfoot striking)

- there were immediate foot strike changes in previously shod  runners who suddenly changed to unshod foot strike

- there is less oxygen use during barefoot running compared to running shod at the same speed. Hence improved running economy.

Characteristically, skilled unshod runners have a distinctive running gait utilizing:

- mid-foot landing

- shorter stride lengths

- faster stride rates

- reduced ground contact time

- lower impact force and loading rates which dampens injury inducing forces

- reduced oxygen utilization. The 6% improvement in economy was the same as that previously reported after a nine-week training program for shoe-wearing runners, who also enjoyed a 3% improvement in running performance.

Click on the link above for the Science article.

Biomechanist challenges idea that forefoot strike pattern reduces runners’ injury rate

Cites lack of conclusive evidence

By Jordana Bieze Foster

http://www.lowerextremityreview.com/issues/may/biomechanist-challenges-idea-that-forefoot-strike-pattern-reduces-runners-injury-rate

“UMass researchers have demonstrated that, although forefoot strikers do not experience a vertical ground reaction force “impact peak,” they do experience impacts during running, albeit at lower frequencies than rearfoot strikers. This research, presented last summer at the American College of Sports Medicine meeting in Denver, suggests that because those lower frequencies are attenuated by muscle tissues, while higher frequencies are attenuated by bone, forefoot strikers may actually face a higher risk of muscle injury than rearfoot strikers.

Claims that loading rate is significantly lower in forefoot strikers than rearfoot strikers also may not be entirely accurate, Hamill said. He cited research from Iowa State University, scheduled to be presented in August at the annual meeting of the American Society of Biomechanics, suggesting that when natural forefoot strikers switch to a rearfoot strike pattern, their loading rate actually decreases.

Research, most notably the oft-cited Harvard study published in Nature in 2010, have found higher magnitudes of ground reaction force in rearfoot strikers than in forefoot strikers. However, Hamill noted, the heel is a much less delicate structure than the forefoot and therefore may be better suited to absorb higher forces.”

The Risks for Forefoot Strike running. YOU NEED TO READ THIS ! YES, YOU !

OK, we are going to go on a rant here…… it is time.

We have been talking about problems of forefoot strike for some time now. We like a midfoot strike, and we have research-based, well founded logic to our opinion.  A Forefoot strike reduces the amount of pronation possible for shock absorption because  when the foot is plantarflexed it is in a supinated state which is reserved for a rigid propulsive mechanism.  At impact some degree of pronation is necessary otherwise force attenuation must occur elsewhere in the kinetic chain otherwise it creates bone, joint or soft tissue pathology/injury somewhere in the chain.  However, one of the major issues we have been pounding our fists on the table about, for years, are forefoot orientation anomalies.  A significant portion of the population have forefoot types of varus or valgus, some flexible and some more rigid, some compensated and some uncompenated (yes, this is difficult stuff……but if you are going to make orthotics or if you are going to be a runner or sell or make shoes or coach or even speak about running form styles…… you had better know this stuff or we will call you out on it). 

No one is talking about this stuff except The Gait Guys. 

Is this because no one knows about it ? Maybe.

It is because those in the running fields do not understand it well ? Likely. 

It is because it creates fear and anxiety about selling shoes ? Probably.

Is it because it complicates shoe fabrication? Likely. 

Does that make it right to just ignore it all together ? No ! 

With a forefoot strike into one of these “pathologic” forefoot types the anatomical variance is accentuated.  In this scenario, a varus foot type that lands and subsequently has not choice but to drive hyperpronation strain not only suffers from the increased pronatory collapse but they are unable to acquire a subsequent rigid toe off which in itself can drive further pathology.  And a valgus forefoot strike is even more rigid than a neutral forefoot strike impact and they are also at risk for inversion strain on the lateral foot.  A midfoot strike can reduce some of these consequences by setting the foot up for a preparatory transition. We know this, we see this everyday, it is what we do. These runners need to be categorized and educated as to why their injury is present or chronically persists, and why we insist a program to reteach a midfoot strike. 

As always, if the doctor knows what anatomy presents itself with the client, and adequately educates the athlete……..then a good relationship and outcome will ensue. Additionally, a change in shoe is not  uncommon when their strike mechanics change.


Here is what spurred our soapbox rant today…….. thanks Lower Extremity Review for bringing the June ASCM to light early !!!
_________________________________________________________________________________

from LER, Link is above:

“The frequency content of vertical ground reaction forces generated during running differ among forefoot strikers and rearfoot strikers, and this may have implications for injury risk, according to findings from the University of Massachusetts presented in June at the ACSM meeting.

Researchers assessed frequency amplitude and power in 10 natural rearfoot strikers and 10 natural forefoot strikers as they ran across a force platform.

At frequencies above 9 Hz, rearfoot strikers’ amplitude exceeded that of forefoot strikers. Similarly, above 22 Hz, power was significantly greater in rearfoot strikers. This is consistent with previous reports that only rearfoot strikers have an impact peak, which occurs between 10 Hz and 20 Hz.

But between 4 Hz and 7 Hz, amplitudes were higher in forefoot strikers. And for frequencies less than 6 Hz and between 9 Hz and 11 Hz, power was greater in forefoot strikers.

Because the body attenuates shock differently at different frequencies, the findings could suggest that even forefoot strikers (including most barefoot runners) may be at risk for certain injuries despite lacking an impact peak.”