Purpose-To: 1) determine prevalence of heel-strike in a mid-size city marathon, 2) determine if there is an association between foot-strike classification and race performance, and 3) determine if there is an association between foot-strike classification and gender.Methods-Foot-strike classification (fore-foot strike, mid-foot strike, heel strike, or split-strike), gender, and rank (position in race) were recorded at the 8.1 kilometer (km) mark for 2,112 runners at the 2011 Milwaukee Lakefront Marathon.Results-1,991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n=1,865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (p < 0.0001), with more elite performers being less likely to heel-strike. No significant difference between foot-strike classification and gender was found using a Fisher's exact test. Additionally, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test.Conclusions-The high prevalence of heel-striking observed in this study reflects the footstrike pattern of the majority of mid-to long-distance runners and more importantly, may predict their injury profile based on the biomechanics of a heel strike running pattern. This knowledge can aid the clinician in the appropriate diagnosis, management, and training modifications of the injured runner.

Foot strike pattern has not been examined during ultramarathons where fatigue or avoidance of impact might have greater effect on foot strike and other gait parameters than in shorter events. In this study, video analysis from 3 level sites at a 161-km ultramarathon was used to: (a) examine changes in foot strike pattern, stride rate, and stride length; (b) determine if foot strike pattern is related to performance; and (c) ascertain if post-race blood creatine phosphokinase (CK) concentrations differ by foot strike pattern. Rear-foot strike (RFS) prevalence was 79.9, 89.0, and 83.9% at 16.5, 90.3, and 161.1 km, respectively. There was a significant distance effect observed between the 90.3 and 161.1-km site for stride rate (p < 0.05) and across all distances for stride length (p < 0.0001), but stride rate and length were stable among the top 20 finishers. There was no effect (p = 0.3) of foot strike pattern on performance. However, top 20 finishers had greater use (p = 0.02) of a non-RFS pattern at 161.1 km than the remaining finishers. There was a trend toward greater post-race blood CK values among non-RFS runners compared with RFS runners, reaching significance at the 90.3 km site (p < 0.05). Thus, the increased RFS prevalence by race midpoint was likely because of greater muscular demands of non-RFS patterns as supported by the higher post-race blood CK concentrations among non-RFS runners. Faster runners maintained higher stride rates and lengths throughout the race and made greater use of a non-RFS pattern at the end of the race compared with the slower finishers.

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Recent "in-race" studies have observed the foot strike patterns of runners in traditional road marathon races. However, similar studies have not been conducted for trail runners, which have been estimated to account for 11% of all runners. The purpose of this study was to (a) determine the rear-foot strike (RFS) prevalence in a 50-km trail race and compare with traditional road marathon races; (b) determine if there is a relationship between foot strike and sex in a 50-km trail race; and (c) determine if there is a relationship between foot strike, shoe type, and performance in a 50-km trail race. One hundred sixty-five runners were videotaped at the 8.1-km mark of the 2012 Ice Age Trail 50-km race. Foot strike analysis revealed RFS prevalence of 85.1%, less than previously reported in traditional road marathon races. There was no relationship found between sex and foot strike (p = 0.60). A significant effect of shoe type on foot strike (RFS was less common among runners in minimalist shoes, p < 0.01) and performance (faster runners were more likely to be wearing minimalist shoes, p < 0.01) was observed; however, no association between foot strike and performance was observed (p = 0.83). This study suggests that most trail runners, albeit less than road runners, prefer an RFS pattern, which is accompanied by biomechanical consequences unique from a non-RFS pattern and, therefore, likely carries a unique injury profile. In addition, the findings in this study suggest that minimalist shoes may represent a reasonable training modification to improve performance.

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