Gender differences associated with rearfoot,midfoot, and forefoot kinematics during running

Females, as compared with males, have a higher proportion of injuries in the foot region. However, the reason for this gender difference regarding foot injuries remains unclear. This study aimed to investigate gender differences associated with rearfoot, midfoot, and forefoot kinematics during running. Twelve healthy males and 12 females ran on a treadmill. The running speed was set to speed which changes from walking to running. Three-dimensional kinematics of rearfoot, midfoot, and forefoot were collected and compared between males and females. Furthermore, spatiotemporal parameters (speed, cadence, and step length) were measured. In the rearfoot angle, females showed a significantly greater peak value of plantarflexion and range of motion in the sagittal plane as compared with males (effect size (ES)?=?1.55 and ES?=?1.12, respectively). In the midfoot angle, females showed a significantly greater peak value of dorsiflexion and range of motion in the sagittal plane as compared with males (ES?=?1.49 and ES?=?1.71, respectively). The forefoot peak angles and ranges of motion were not significantly different between the genders in all three planes. A previous study suggested that a gender-related difference in excessive motions of the lower extremities during running has been suggested as a contributing factor to running injuries. Therefore, the present investigation may provide insight into the reason for the high incidence of foot injuries in females.     

Foot strike patterns of recreational and sub-elite runners in a long-distance road race

Although the biomechanical properties of the various types of running foot strike (rearfoot, midfoot, and forefoot) have been studied extensively in the laboratory, only a few studies have attempted to quantify the frequency of running foot strike variants among runners in competitive road races. We classified the left and right foot strike patterns of 936 distance runners, most of whom would be considered of recreational or sub-elite ability, at the 10 km point of a half-marathon/marathon road race. We classified 88.9% of runners at the 10 km point as rearfoot strikers, 3.4% as midfoot strikers, 1.8% as forefoot strikers, and 5.9% of runners exhibited discrete foot strike asymmetry. Rearfoot striking was more common among our sample of mostly recreational distance runners than has been previously reported for samples of faster runners. We also compared foot strike patterns of 286 individual marathon runners between the 10 km and 32 km race locations and observed increased frequency of rearfoot striking at 32 km. A large percentage of runners switched from midfoot and forefoot foot strikes at 10 km to rearfoot strikes at 32 km. The frequency of discrete foot strike asymmetry declined from the 10 km to the 32 km location. Among marathon runners, we found no significant relationship between foot strike patterns and race times.     

Foot strike patterns of recreational and sub-elite runners in a long-distance road race

Abstract

Although the biomechanical properties of the various types of running foot strike (rearfoot, midfoot, and forefoot) have been studied extensively in the laboratory, only a few studies have attempted to quantify the frequency of running foot strike variants among runners in competitive road races. We classified the left and right foot strike patterns of 936 distance runners, most of whom would be considered of recreational or sub-elite ability, at the 10 km point of a half-marathon/marathon road race. We classified 88.9% of runners at the 10 km point as rearfoot strikers, 3.4% as midfoot strikers, 1.8% as forefoot strikers, and 5.9% of runners exhibited discrete foot strike asymmetry. Rearfoot striking was more common among our sample of mostly recreational distance runners than has been previously reported for samples of faster runners. We also compared foot strike patterns of 286 individual marathon runners between the 10 km and 32 km race locations and observed increased frequency of rearfoot striking at 32 km. A large percentage of runners switched from midfoot and forefoot foot strikes at 10 km to rearfoot strikes at 32 km. The frequency of discrete foot strike asymmetry declined from the 10 km to the 32 km location. Among marathon runners, we found no significant relationship between foot strike patterns and race times.     

Relationship between foot strike pattern,running speed,and footwear condition in recreational distance runners

Compared to competitive runners, recreational runners appear to be more prone to injuries, which have been associated with foot strike patterns. Surprisingly, only few studies had examined the foot strike patterns outside laboratories. Therefore, this study compared the foot strike patterns in recreational runners at outdoor tracks with previously reported data. We also investigated the relationship between foot strike pattern, speed, and footwear in this cohort. Among 434 recreational runners analysed, 89.6% of them landed with rearfoot strike (RFS). Only 6.9 and 3.5% landed with midfoot and forefoot, respectively. A significant shift towards non-RFS was observed in our cohort, when compared with previously reported data. When speed increased by 1 m/s, the odds of having forefoot strike and midfoot strike relative to RFS increased by 2.3 times and 2.6 times, respectively. Runners were 9.2 times more likely to run with a forefoot strike in minimalists compared to regular running shoes, although 70% of runners in minimalists continued to use a RFS. These findings suggest that foot strike pattern may differ across running conditions and runners should consider these factors in order to mitigate potential injury.     

Are muscle activation patterns altered during shod and barefoot running with a forefoot footfall pattern?

This study aimed to investigate the activation of lower limb muscles during barefoot and shod running with forefoot or rearfoot footfall patterns. Nine habitually shod runners were asked to run straight for 20 m at self-selected speed. Ground reaction forces and thigh and shank muscle surface electromyographic (EMG) were recorded. EMG outcomes (EMG intensity [iEMG], latency between muscle activation and ground reaction force, latency between muscle pairs and co-activation index between muscle pairs) were compared across condition (shod and barefoot), running cycle epochs (pre-strike, strike, propulsion) and footfall (rearfoot and forefoot) by ANOVA. Condition affected iEMG at pre-strike epoch. Forefoot and rearfoot strike patterns induced different EMG activation time patterns affecting co-activation index for pairs of thigh and shank muscles. All these timing changes suggest that wearing shoes or not is less important for muscle activation than the way runners strike the foot on the ground. In conclusion, the guidance for changing external forces applied on lower limbs should be pointed to the question of rearfoot or forefoot footfall patterns.     

Relationship between Achilles tendon properties and foot strike patterns in long-distance runners

The purpose of this study was to investigate the relationship between Achilles tendon properties and foot strike patterns in long-distance runners. Forty-one highly trained male long-distance runners participated in this study. Elongation of the Achilles tendon and aponeurosis of the medial gastrocnemius muscle were measured using ultrasonography, while the participants performed ramp isometric plantar flexion up to the voluntary maximum. The relationship between the estimated muscle force and tendon elongation during the ascending phase was fit to a linear regression, the slope of which was defined as stiffness. In addition, the cross-sectional area of the Achilles tendon was measured using ultrasonography. Foot strike patterns (forefoot, midfoot and rearfoot) during running were determined at submaximal velocity (18 km · h^?1) on a treadmill. The number of each foot strike runner was 12 for the forefoot (29.3%), 12 for the midfoot (29.3%) and 17 for the rearfoot (41.5%). No significant differences were observed in the variables measured for the Achilles tendon among the three groups. These results suggested that the foot strike pattern during running did not affect the morphological or mechanical properties of the Achilles tendon in long-distance runners.     

Strike type variation among Tarahumara Indians in minimal sandals versus conventional running shoes

PurposeThis study examined variation in foot strike types, lower extremity kinematics, and arch height and stiffness among Tarahumara Indians from the Sierra Tarahumara, Mexico.MethodsHigh speed video was used to study the kinematics of 23 individuals, 13 who habitually wear traditional minimal running sandals (huaraches), and 10 who habitually wear modern, conventional running shoes with elevated, cushioned heels and arch support. Measurements of foot shape and arch stiffness were taken on these individuals plus an additional sample of 12 individuals.ResultsMinimally shod Tarahumara exhibit much variation with 40% primarily using midfoot strikes, 30% primarily using forefoot strikes, and 30% primarily using rearfoot strikes. In contrast, 75% of the conventionally shod Tarahumara primarily used rearfoot strikes, and 25% primarily used midfoot strikes. Individuals who used forefoot or midfoot strikes landed with significantly more plantarflexed ankles, flexed knees, and flexed hips than runners who used rearfoot strikes. Foot measurements indicate that conventionally shod Tarahumara also have significantly less stiff arches than those wearing minimal shoes.ConclusionThese data reinforce earlier studies that there is variation among foot strike patterns among minimally shod runners, but also support the hypothesis that foot stiffness and important aspects of running form, including foot strike, differ between runners who grow up using minimal versus modern, conventional footwear.     

Comparison of plantar loads among runners with different strike patterns

ABSTRACT

This study aimed to explore the plantar loading variables between habitual rearfoot strike (RFS) and non-rearfoot strike (NRFS) during running. 78 healthy males participated in this study (41 RFS, 37 NRFS). In-shoe pressure sensors were used to measure plantar loading while the participants were running on a 15 m indoor runway with their preferred foot strike pattern (FSP) at 12.0 ± 5% km/h. Results indicate that force and pressure parameters were much higher in the rearfoot and midfoot regions during RFS running and relatively greater in forefoot region during NRFS running. However, compared with NRFS running, the contact area, maximum force and force-time-integrals during RFS running on total foot were 21.44% (P < 0.001, ES = 2.29), 13.99% (P = 0.006, ES = 0.64) and 21.27% (P < 0.001, ES = 0.85) higher, respectively. Total foot peak pressure and pressure-time-integral between two FSPs were similar. Higher loads in the rearfoot region may transmit to the knee joint and result in patellofemoral joint injuries. NRFS runners’ higher loads in forefoot seem to be ralated to metatarsal stress fractures and compensatory damage to the Achilles tendon. Therefore, runners should choose proper FSPs according to their unique physical conditions.     

Age and sex influences on running mechanics and coordination variability

The purpose of this study was to examine the impact of age on running mechanics separately for male and female runners and to quantify sex differences in running mechanics and coordination variability for older runners. Kinematics and kinetics were captured for 20 younger (10 male) and 20 older (10 male) adults running overground at 3.5 m · s^?1. A modified vector coding technique was used to calculate segment coordination variability. Lower extremity joint angles, moments and segment coordination variability were compared between age and sex groups. Significant sex–age interaction effects were found for heel-strike hip flexion and ankle in/eversion angles and peak ankle dorsiflexion angle. In older adults, mid-stance knee flexion angle, ankle inversion and abduction moments and hip abduction and external rotation moments differed by sex. Older compared with younger females had reduced coordination variability in the thigh–shank transverse plane couple but greater coordination variability for the shank rotation–foot eversion couple in early stance. These results suggest there may be a non-equivalent aging process in the movement mechanics for males and females. The age and sex differences in running mechanics and coordination variability highlight the need for sex-based analyses for future studies examining injury risk with age.     

Comparison of foot strike patterns of barefoot and minimally shod runners in a recreational road race

BackgroundPrevious studies of foot strike patterns of distance runners in road races have typically found that the overwhelming majority of shod runners initially contact the ground on the rearfoot. However, none of these studies has attempted to quantify foot strike patterns of barefoot or minimally shod runners. This study classifies foot strike patterns of barefoot and minimally shod runners in a recreational road race.MethodsHigh-speed video footage was obtained of 169 barefoot and 42 minimally shod distance runners at the 2011 New York City Barefoot Run. Foot strike patterns were classified for each runner, and frequencies of forefoot, midfoot, and rearfoot striking were compared between the barefoot and minimally shod groups.ResultsA total of 59.2% of barefoot runners were forefoot strikers, 20.1% were midfoot strikers, and 20.7% were rearfoot strikers. For minimally shod runners, 33.3% were forefoot strikers, 19.1% were midfoot strikers, and 47.6% were rearfoot strikers. Foot strike distributions for barefoot and minimally shod runners were significantly different both from one another and from previously reported foot strike distributions of shod road racers.ConclusionFoot strike patterns differ between barefoot and minimally shod runners, with forefoot striking being more common, and rearfoot striking less common in the barefoot group.     

Primary mechanical factors contributing to foot eversion moment during the stance phase of running

Rearfoot external eversion moments due to ground reaction forces (GRF) during running have been suggested to contribute to overuse running injuries. This study aimed to identify primary factors inducing these rearfoot external eversion moments. Fourteen healthy men ran barefoot across a force plate embedded in the middle of 30-m runway with 3.30 ± 0.17 m · s^–1. Total rearfoot external eversion/inversion moments (Mtot) were broken down into the component Mxy due to medio-lateral GRF (Fxy) and the component Mz due to vertical GRF (Fz). Ankle joint centre height and medio-lateral distance from the centre of pressure to the ankle joint centre (a_cop) were calculated as the moment arm of these moments. Mxy dominated Mtot just after heel contact, with the magnitude strongly dependent on Fxy, which was most likely caused by the medio-lateral foot velocity before heel contact. Mz then became the main generator of Mtot throughout the first half of the stance phase, during which a_cop was the critical factor influencing the magnitude. Medio-lateral foot velocity before heel contact and medio-lateral distance from the centre of pressure to the ankle joint centre throughout the first half of the stance phase were identified as primary factors inducing the rearfoot external eversion moment.     

Stresses in the plantar region for long- and short-range throws in women basketball players

Abstract

This study aimed to assess plantar pressure pattern modifications caused by short- and long-distance shots in women basketball players. To this end, 24 experienced national- and regional-level basketball players performed 3 trials of 4 technical gestures (free throw, jump stop shot, three-point shot and lay-up) barefoot on a pressure platform placed in fixed positions on the court. Raw data were processed to calculate location and magnitude of pressure peaks in three sub-regions (forefoot, midfoot and rearfoot), and the increase ratio was calculated relative to plantar pressure measured during a static bipedal and unipedal upright stance. The results showed significant increases (p<0.001) in plantar pressure peaks in forefoot (but not midfoot and rearfoot) for all the gestures that involved the use of both legs. Particularly large increases were detected for the three-point shot. All three sub-regions underwent significant changes of the pressure peak in the case of lay-up (forefoot and rearfoot: p<0.001, midfoot: p=0.002). The high levels of contact stress detected for routinely performed technical gestures suggest that a detailed knowledge of changes in the physiological patterns of plantar stresses that take place during play is crucial in reducing the risk of foot injuries and establishing proper training and rehabilitation protocols.     

Impact shock frequency components and attenuation in rearfoot and forefoot running

BackgroundThe forefoot running footfall pattern has been suggested to reduce the risk of developing running related overuse injuries due to a reduction of impact related variables compared with the rearfoot running footfall pattern. However, only time-domain impact variables have been compared between footfall patterns. The frequency content of the impact shock and the degree to which it is attenuated may be of greater importance for injury risk and prevention than time-domain variables. Therefore, the purpose of this study was to determine the differences in head and tibial acceleration signal power and shock attenuation between rearfoot and forefoot running.MethodsNineteen habitual rearfoot runners and 19 habitual forefoot runners ran on a treadmill at 3.5 m/s using their preferred footfall patterns while tibial and head acceleration data were collected. The magnitude of the first and second head acceleration peaks, and peak positive tibial acceleration were calculated. The power spectral density of each signal was calculated to transform the head and tibial accelerations in the frequency domain. Shock attenuation was calculated by a transfer function of the head signal relative to the tibia.ResultsPeak positive tibial acceleration and signal power in the lower and higher ranges were significantly greater during rearfoot than forefoot running (p < 0.05). The first and second head acceleration peaks and head signal power were not statistically different between patterns (p > 0.05). Rearfoot running resulted in significantly greater shock attenuation for the lower and higher frequency ranges as a result of greater tibial acceleration (p < 0.05).ConclusionThe difference in impact shock frequency content between footfall patterns suggests that the primary mechanisms for attenuation may differ. The relationship between shock attenuation mechanisms and injury is not clear but given the differences in impact frequency content, neither footfall pattern may be more beneficial for injury, rather the type of injury sustained may vary with footfall pattern preference.     

Foot strike pattern in preschool children during running: sex and shod–unshod differences

Purpose: This study aims to determine the foot strike patterns (FSPs) and neutral support (no inversion [INV]/eversion [EVE] and no foot rotation) in preschool children, as well as to determine the influence of shod/unshod conditions and sex. Methods: A total of 1356 children aged 3–6 years (673 boys and 683 girls) participated in this study. A sagittal and frontal-plane video (240?Hz) was recorded using a high-speed camcorder to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/ eversion (INV/EVE) and foot rotation on initial contact. Results: There were no between-sex significant differences in both shod and unshod conditions in RFS. In the unshod condition, there was a significant reduction (p?Conclusion: In preschool children, no between-sex differences were found in relation to prevalence of RFS and neutral support (no INV/EVE). Shod running alters FSP of running barefoot, producing a significant increase of RFS prevalence.     

Forefoot running requires shorter gastrocnemius fascicle length than rearfoot running

ABSTRACT

This study aimed to investigate the influence of foot strike patterns on the behaviour of the triceps surae muscle-tendon unit, including the Achilles tendon whose length nearly corresponds to force of the triceps surae, and the medial gastrocnemius muscle (MG) during running. Seven male volunteers ran with forefoot and rearfoot strikes at 10, 14 and 18 km h^?1 on a treadmill. The MG fascicle length was measured using ultrasonography. The in vivo length of the curved Achilles tendon was quantified by combining ultrasonography with optical motion capture of reflective markers on the right lower limb and an ultrasound probe. The forefoot strike resulted in a significantly shorter MG fascicle length at the initial contact, at Achilles tendon peak elongation, and at toe-off, than the rearfoot strike. The Achilles tendon length at initial contact was greater during the forefoot strike than during the rearfoot strike at 18 km h^?1, while its peak elongation was not significantly different during forefoot and rearfoot running. These results indicate that the MG, with a shorter length during forefoot running, manages to address demands for a similar peak force of the triceps surae than during rearfoot running.     

Changes in running mechanics using conventional shoelace versus elastic shoe cover

The purpose of this study was to determine whether there are differences in the perceived comfort, plantar pressure, and rearfoot motion between laced running shoes and elastic-covered running shoes. Fifteen male amateur runners participated in the study. Each participant was assigned laced running shoes and elastic-covered running shoes for use during the study. The perceived comfort, plantar loading, and rearfoot motion control of each type of shoes during running were recorded. When the laced running shoes and elastic-covered running shoes were compared, the elastic-covered running shoes were given a lower perceived comfort rating in terms of shoe length, width, heel cup fitting, and forefoot cushioning. The elastic-covered running shoes also recorded higher peak plantar pressure in the lateral side of the forefoot, as well as larger maximum rearfoot pronation. Overall, shoelaces can help runners obtain better foot-shoe fit. They increase the perceived comfort, and decrease the maximum pronation and plantar pressure. Moreover, shoelaces may help prevent injury in running by allowing better control of the aforementioned factors.     

Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern

ABSTRACT

We examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running.

Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness     

Initiating running barefoot: Effects on muscle activation and impact accelerations in habitually rearfoot shod runners

Runners tend to shift from a rearfoot to a forefoot strike pattern when running barefoot. However, it is unclear how the first attempts at running barefoot affect habitually rearfoot shod runners. Due to the inconsistency of their recently adopted barefoot technique, a number of new barefoot-related running injuries are emerging among novice barefoot runners. The aim of this study was therefore to analyse the influence of three running conditions (natural barefoot [BF], barefoot with a forced rearfoot strike [BRS], and shod [SH]) on muscle activity and impact accelerations in habitually rearfoot shod runners. Twenty-two participants ran at 60% of their maximal aerobic speed while foot strike, tibial and head impact accelerations, and tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscle activity were registered. Only 68% of the runners adopted a non-rearfoot strike pattern during BF. Running BF led to a reduction of TA activity as well as to an increase of GL and GM activity compared to BRS and SH. Furthermore, BRS increased tibial peak acceleration, tibial magnitude and tibial acceleration rate compared to SH and BF. In conclusion, 32% of our runners showed a rearfoot strike pattern at the first attempts at running barefoot, which corresponds to a running style (BRS) that led to increased muscle activation and impact accelerations and thereby to a potentially higher risk of injury compared to running shod.     

Lower limb joint angles and ground reaction forces in forefoot strike and rearfoot strike runners during overground downhill and uphill running

This study investigated the normal and parallel ground reaction forces during downhill and uphill running in habitual forefoot strike and habitual rearfoot strike (RFS) runners. Fifteen habitual forefoot strike and 15 habitual RFS recreational male runners ran at 3 m/s ± 5% during level, uphill and downhill overground running on a ramp mounted at 6° and 9°. Results showed that forefoot strike runners had no visible impact peak in all running conditions, while the impact peaks only decreased during the uphill conditions in RFS runners. Active peaks decreased during the downhill conditions in forefoot strike runners while active loading rates increased during downhill conditions in RFS runners. Compared to the level condition, parallel braking peaks were larger during downhill conditions and parallel propulsive peaks were larger during uphill conditions. Combined with previous biomechanics studies, our findings suggest that forefoot strike running may be an effective strategy to reduce impacts, especially during downhill running. These findings may have further implications towards injury management and prevention.     

Effects of running experience on coordination and its variability in runners

The purpose of this study was to examine the differences in coordination variability in running gait between trained runners and non-runners using continuous relative phase (CRP) analysis. Lower extremity kinematic data were collected for 22 participants during the stance phase. The participants were assigned to either a runner or non-runner group based on running volume training. Segment coordination and coordination variability were calculated for selected hip–knee and knee–ankle couplings. Independent t-tests and magnitude-based inferences were used to compare the 2 groups. There were limited differences in the CRP and its variability among runners and non-runner groups. The runners group achieved moderately lower coordination compared with non-runners group in the phase angle for hip abduction/adduction and knee flexion/extension. The runners tended to show moderately lower coordination variability in the phase angle for knee flexion/extension and subtalar inversion/eversion in comparison to non-runners group. These results suggested that levels of experience as estimated from weekly training volume had little influence on coordination and its variability.