Share this article on:

Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study


Medicine & Science in Sports & Exercise: July 2012 - Volume 44 - Issue 7 - p 1325–1334
doi: 10.1249/MSS.0b013e3182465115

Purpose This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike.

Methods We measured the strike characteristics of middle- and long-distance runners from a collegiate cross-country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate, and severe injuries per mile run.

Results Of the 52 runners studied, 36 (69%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (P < 0.01) with repetitive injury rates.

Conclusions Competitive cross-country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared with a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.

Supplemental digital content is available in the text.

1Department of Human Evolutionary Biology, Harvard University, Cambridge, MA; 2Department of Athletics, Harvard University, Boston, MA; 3University Health Services, Harvard University, Cambridge, MA; and 4Baylor Health Care System, Institute of Health Care Research and Improvement, Dallas, TX

Address for correspondence: Daniel E. Lieberman, Ph.D., Department of Human Evolutionary Biology, Harvard University, 11 Divinity, Cambridge, MA 02138; E-mail:

Submitted for publication June 2011.

Accepted for publication December 2011.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

©2012The American College of Sports Medicine