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.”