Risk Factors for Injuries in Runners: A Systematic Review of Foot Strike Technique and Its Classification at Impact

Abstract

Background: It has been suggested that foot strike technique (FST) at initial contact is related to running-related injuries (RRIs). Purpose: To explore the relationship between FST and RRIs. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic electronic search was performed using MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science databases. Included were studies published in the English language that explored the relationship between FST and RRIs between January 1960 and November 2020. Results were extracted and collated. The Grading of Recommendations, Assessment, Development and Evaluation approach was applied to synthesize the quality of evidence. Results: We reviewed 13 studies exploring the relationship between FST and RRIs. Of these, 6 studies reported FST categorically (foot strike pattern [FSP]), and 7 reported continuous measures (foot contact angle, ankle flexion angle, and strike index). Three of the 6 studies looking at categorical FSP found rearfoot strikers have a significantly greater retrospective injury rate than do non– rearfoot strikers, with 1 other study noting a greater risk associated with midfoot and forefoot strike. Regarding the continuous measures of FST, only 1 of the 7 studies reported a significant relationship with RRIs. Conclusion: There was low evidence to suggest a relationship between FST (or its subcategories of categorical FSP and continuous measures) and RRIs. While two-thirds of the categorical studies found a relationship between FSP and RRIs, these studies were very low quality, with limitations such as retrospective study design, low participant numbers, and poor FSP assessment methods. More large-scale prospective studies are required.

Current perception and practice of athletics coaches about the modification of footstrike pattern in endurance runners: A survey

“…Footstrike pattern is often cited as a biomechanical component impacting the risk of injury. 7 Lieberman 8 distinguished three different types of landing during running, based on initial contact: rearfoot strike (RFS), midfoot strike (MFS) and forefoot strike (FFS). A large proportion of long-distance runners land with a RFS (65% to 94%) and a minority land with a MFS (5% to 25%) or a FFS (1%).…”

Running Footwear and Impact Peak Differences in Recreational Runners

“…However, running-related injuries are not directly correlated with foot strike patterns. Burke et al [ 47 ] recently highlighted that there is little evidence to suggest a relationship between these two conditions. Accordingly, we observed the impact peak predominantly in a sample of rearfoot runners; however, we do not speculate about the relationship between the strike pattern and the injury onset.…”

A qualitative examination of the factors affecting the adoption of injury focused wearable technologies in recreational runners

“…Systematic reviews and meta-analyses have been unable to identify strong justifications for the role of specific biomechanical risk factors in the onset of RRI’s [ 63 , 64 ]. While foot strike technique has been suggested to be causative of RRI’s based on the increased load that some techniques produce (especially rear-foot strike [ 65 , 66 ]), a systematic review concluded that there is very low evidence to suggest a relationship with RRI’s in general [ 67 ]. In relation to increased cadence, while a systematic review found that increasing cadence reduces the magnitude of key biomechanical factors (such as joint kinematics and kinetics, and whole body loading) associated with RRI’s [ 68 ], a recent systematic review and meta-analysis concluded that average cadence does not differ between injured and uninjured runners [ 69 ].…”