There’s a particular narrative that’s seeped into running culture like blisters in a cotton sock: the idea that you’re doing it wrong. You’re doing it wrong if you’re a heel striker. If you land on your heels, the logic goes, you’re basically braking with every step, pounding your knees into submission, and running with all the biomechanical grace of a truck backing up through a garden. The solution? Switch to a forefoot strike. Land on your midfoot. Run naturally, they tell you, as if the way your body has been moving for years is somehow unnatural.

This narrative got real legs with the 2009 release of Chris McDougall’s Born to Run. Suddenly, forefoot striking became synonymous with evolutionary correctness, with biomechanical enlightenment, with the secret sauce that separates elite runners from the pack-jogging masses. The problem is that the science doesn’t support the hype. Not even close.

What Research Tells Us

Let’s start with the clearest finding: there is little or no difference in running economy between runners who habitually use forefoot versus heel-strike patterns. Research by Perl, Daoud, and Lieberman (2012) measured the metabolic cost of running in subjects who habitually run in minimal shoes or barefoot while running at 3.0 m/s (about a 9:00 minute mile) on a treadmill during forefoot and rearfoot striking, controlling for shoe mass and stride frequency. The oxygen cost of running at a given pace was the same. The energy expenditure the same. The efficiency with which your body propels you forward was the same again (Perl et al.).

But it gets better, or worse, depending on how invested you are in changing your running form. Habitual heel-strike runners actually reduce their running economy when they switch to forefoot running at slow and medium speeds (Perl et al.). The intervention that’s supposed to make you more efficient makes you less efficient. In the short term, at least. Adaptation to the new gait might eventually reverse those losses, but the fact remains: forcing a change on your body often makes it worse before it gets better.

The running economy argument, then, crumbles almost entirely. But runners and coaches don’t just advocate for foot strike changes on economic grounds. They point to injury prevention as the real prize. So let’s see what happens in that regard.

Injury Risk

Here’s where things get genuinely complicated, and where the research actually provides useful insight. But, unfortunately, that insight is messier than we’d like it to be, regardless of your footstrike preferences.

When you land on your forefoot with a plantar-flexed ankle, you reduce the impact via the spring-absorption mechanisms of the calf and arch. This subsequently reduces the axial force transmitted through the lower extremities. When you land on your heel, more of that impact travels up the kinetic chain toward your knees and hips. The biomechanics here are real, and this is what led to the injury-prevention hypothesis.

At first, it appears to hold up. A 2012 retrospective study by Daoud and colleagues examining collegiate cross-country runners found that “runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike” (Daoud et al., 2012). This seemed to support the forefoot-strike-as-injury-prevention narrative. Yet when you look at the broader literature, changing to a mid- or forefoot strike does not reduce the risk of running-related injuries (van Gent et al., 2007; Nielsen et al., 2012). How can this be?

The answer is that you don’t eliminate injury risks. You redistribute them. With a heel strike pattern, the force is moved away from your foot and ankle but increases at your knee, which can increase your risk of developing knee injuries like patellofemoral pain syndrome or IT band syndrome. With a forefoot strike pattern, the load is moved off the knee but added to the foot and ankle, which may predispose you to Achilles tendinopathy, metatarsalgia, and plantar fasciitis (Goss & Gross, 2012).

Think of it like financial portfolio management. You don’t eliminate risk; you redistribute where the vulnerabilities lie. A heel striker might develop runner’s knee. A forefoot striker might develop an Achilles problem. Neither is safer. They’re just different flavors of the same basic problem: the demands of running stress the human body. Where that stress manifests depends on how you move.

Evolution Fallacy

One of the most compelling arguments in McDougall’s Born to Run involves human evolution. Barefoot runners, the logic goes, must strike with their forefeet because that’s what evolution optimized us for. Shod runners heel-strike because modern shoes have massive cushioning under the heel, essentially cheating the problem. But when you look at this closely, it doesn’t hold up either.

Barefoot runners don’t cooperate with this narrative. Lieberman’s original 2010 Nature study found that habitually barefoot endurance runners often land on the forefoot, but they sometimes land with a flat foot (midfoot strike) or, less often, on the heel (Lieberman et al., 2010). The pattern is diverse. More significantly, when researchers have examined other populations of habitually barefoot runners, the picture has grown murkier.

Hatala and colleagues examined 38 habitually barefoot Daasanach adults from northern Kenya in 2013 and found that 72 percent landed on their rearfoot when running barefoot at self-selected comfortable speeds (Hatala et al., 2013). This directly contradicted the forefoot-strike-is-natural hypothesis. The key difference? The Daasanach rarely ran, unlike Lieberman’s elite Kalenjin subjects who trained intensely and ran at sub-5:00/mile pace. When Daasanach runners increased speed, they were more likely to shift to midfoot or forefoot strikes, but at slower, endurance running speeds, heel strikes dominated.

The plot thickened further with research from Pontzer and colleagues examining Hadza hunter-gatherers in Tanzania. They found that Hadza men preferentially employed midfoot strikes (86.7%), while Hadza women and juveniles preferentially employed rearfoot strikes (90.9% and 85.7% respectively). No forefoot striking was recorded (Pontzer et al., 2014). They weren’t just different from each other; they were different from the Kalenjin, the Daasanach, and everything the barefoot-running narrative had predicted.

What emerged from comparing these populations was clear: habitually barefoot people do not naturally converge on a single strike pattern. Instead, they employ all three, modulated by running speed, training level, running frequency, surface properties, and individual biomechanics. The Lieberman lab’s own 2015 follow-up study in Kenya found that 72% of habitually barefoot participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently (Lieberman et al., 2015). Running experience shaped the pattern as much as bare feet did.

The evolutionary argument, that our ancestors must have been forefoot strikers, crumbles when confronted with modern barefoot populations. Evolution optimized humans not for a single running pattern, but for flexibility. We can adjust to speed, surface, training load, and experience. That adaptability, it turns out, is our competitive advantage. It always has been.

Elite Athletes Show No Consensus

If foot strike pattern mattered for performance at the highest levels, you’d expect elite runners to congregate around a particular pattern. They don’t. A 2019 study by Hanley and colleagues examining the 2017 IAAF World Championships marathon found that the most common footstrike pattern was rearfoot striking, with proportions never less than 54% of men or 67% of women at any distance throughout the race (Hanley et al., 2019). Crucially, most athletes were rearfoot strikers, including the top four finishing men, suggesting there appears to be no clear advantage to non-rearfoot striking in marathon running.

Read that again. The top four men in the world at marathon were all rearfoot strikers. These are people who’ve had decades to develop the most economical patterns possible. They have coaches, biomechanists, sports scientists at their beck and call. If heel striking were inferior, elite athletes would abandon it. They haven’t.

The study noted that coaches should recognize that “it is normal for elite marathon runners to be either RFS (rear foot strikers) or NRFS (non rear foot strikers); however, forefoot striking was rare” (Hanley et al.). Even among the world’s best, forefoot striking barely registers. Instead, there’s a clear preference for individualized patterns; athletes overwhelmingly maintained their natural footstrike pattern throughout the race, reflecting deeply ingrained biomechanical preferences.

The Shoes Matter. A Bit

One nuance worth exploring: shoe design definitely influences strike pattern. In trained runners, habitually shod runners mostly rearfoot strike, facilitated by the elevated and cushioned heel of the modern running shoe (Stacoff et al., 2000; Larson et al., 2011). And while the majority of shod runners use a rearfoot strike, and minimal shoes or barefoot runners use forefoot and midfoot strikes respectively. This seems to hold to the evolutionary pattern argued above, yes, but remember, the evolutionary pattern is more complex than McDougall makes it out to be and we’re here to discuss whether you should change your footstrike, not who is doing it.

Here’s what’s fascinating: in a two-week prospective study where conventional heel strikers trained in minimalistic footwear, the majority of participants (71%) before the intervention demonstrated a rearfoot strike pattern while running in minimalistic footwear, and this proportion did not decrease after two weeks (Runciman et al., 2013). The runners didn’t convert to forefoot striking just because they put on minimalist shoes. They maintained their preferred pattern. Moreover, those runners who chose a rearfoot pattern in minimalistic shoes experienced a vertical loading rate that was three times greater than those who chose to run with a non-rearfoot strike pattern. This creates a mismatch between shoe design and individual physiology.

The research shows that while minimalist shoes have moderate beneficial effects on running economy, there is no detrimental effect of shoe mass on metabolic cost if the combined mass of both shoes is less than 440 grams; however, if the combined mass of shoes exceeds 440 grams, there is a positive correlation with metabolic cost (Perl et al., 2012). But economy and foot strike are separate conversations.

Your shoes constrain your options, sure, but they don’t determine your destiny. If you’re a heel striking runner forced into minimalist shoes, forcing the change can actually increase injury risk by creating high loading rates without adequate cushioning. Working on making it a more gentle heel strike by increasing your running cadence and bringing your landing foot closer to under your body can be more effective and less risky than changing patterns entirely.

Even More Nuance

If the takeaway so far is “your foot strike doesn’t matter,” that’s both right and incomplete. Your foot strike doesn’t determine your destiny on the road, but it does influence how forces propagate through your body. The place where those forces concentrate matters. But not for destiny, it’s for individual vulnerability.

Based on the current literature, causal links to overuse injuries, recommendations to change running technique, and other simplifications solely based on the footstrike pattern are not accurate (Nielsen et al., 2012). “Based on foot strike alone” is the operative phrase. Your strike pattern is one variable in a system with dozens.

The actual determinants of injury are what researchers call multifactorial. Training errors are what break runners. Not foot strike. Not shoe weight. Training errors (van Gent et al., 2007; Nielsen et al.). These include rapid increases in weekly running distance by more than 30% between consecutive weeks. This shows up again and again in injury research. A systematic review examining the link between training characteristics and running-related injuries found that training volume and previous injury history were the two most consistent risk factors across epidemiologic studies (Nielsen et al.). Another prospective study of 76 runners with a one-year follow-up found that male injured runners ran greater weekly distances and did more aerobic training in the three weeks prior to injury, while female injured runners ran longer on the treadmill and did more speed training in the weeks preceding injury (Tenforde et al., 2021). In other words, it’s complicated, but more tends to equal injury.

The research is clear: increasing mileage too quickly, running too hard most days, not taking recovery seriously, and not addressing strength deficits create injuries far more reliably than any particular way of landing your foot. A study of 874 novice runners tracked over a year found that runners who increased weekly distance by more than 30% were at greater risk for “distance-based injuries,” suggesting that the rate of progression matters more than the absolute pattern of movement (Nielsen et al.).

Even more tellingly, evidence about the association between weekly running distance, duration, frequency, intensity, or specific changes in training parameters and the onset of running-related injuries remains conflicting, indicating just how complex the picture really is (van Gent et al.). The multifactorial nature of these injuries means that foot strike is at best a minor player in a larger drama involving training load, previous injury, strength, flexibility, surface changes, and recovery patterns. A 2023 prospective study examining 258 recreational runners tracked for a year found previous history of injury, training for a marathon, frequent changing of shoes, and running technique all played roles but none of them alone determined who got hurt (Tenforde et al.).

Nothing is Best

Here’s what the research tells us, stripped of ideology. Most runners heel-strike. Some midfoot strike. Fewer forefoot strike. All three patterns are used successfully by runners across all ability levels. Changing your strike pattern doesn’t improve running economy (Perl et al., 2012). Changing your strike pattern may shift where injuries occur, but it won’t eliminate them (Daoud et al., 2012). Elite athletes don’t all use the same pattern (Hanley et al., 2019).

Want to run more efficiently? Work on cadence. Get strong. Be patient with your training progression. Practice running form in a holistic way. Posture, leg drive, arm swing, everything together. If you’re injured and a sports medicine professional suggests altering your strike pattern, listen to them. They know your specific case. But if you’re healthy and running a natural pattern that you developed over thousands of miles, there’s no reason to change it.

The narrative of inherent superiority of one way being right is seductive. It promises simple answers to complicated problems. But running, like most physical endeavors, resists simplification. Your body found a pattern that works. The fact that it’s not someone else’s pattern isn’t a flaw to be corrected. It’s a feature of being human.

About Luke Hollomon

Luke Hollomon is a physical therapist and founder of RVA Endurance PT. He specializes in treating endurance athletes and has a background in physiology and education, in addition to running coaching. You can get in touch with him at Luke@RVAEndurancePT.com

References

• Daoud, A. I., Geissler, G. J., Wang, F., Saretsky, J., Daoud, Y. A., & Lieberman, D. E. (2012). Foot strike and injury rates in endurance runners: a retrospective study. Medicine and Science in Sports and Exercise, 44(7), 1325–1334. https://doi.org/10.1249/MSS.0b013e3182465115
• Goss, D. L., & Gross, M. T. (2012). Lower extremity biomechanics and self-reported foot-strike patterns among runners in traditional and minimalist shoes. Journal of Athletic Training, 47(5), 528–538. https://doi.org/10.4085/1062-6050-47.5.08
• Hanley, B., Bissas, A., & Gruber, A. H. (2019). Most marathon runners at the 2017 IAAF World Championships were rearfoot strikers, and most did not change footstrike pattern. Journal of Biomechanics, 92, 54–60. https://doi.org/10.1016/j.jbiomech.2019.05.025
• Hasegawa, H., Yamauchi, T., & Kraemer, W. J. (2007). Foot strike patterns of runners at the 15-km point during an elite-level half marathon. Journal of Strength and Conditioning Research, 21(3), 888–893. https://doi.org/10.1519/R-22096.1
• Hatala, K. G., Dingwall, H. L., Wunderlich, R. E., & Richmond, B. G. (2013). Variation in foot strike patterns during running among habitually barefoot populations. PLoS ONE, 8(1), e52548. https://doi.org/10.1371/journal.pone.0052548
• Larson, P., Higgins, E., Kaminski, J., Decker, T., Preble, J., Lyons, D., et al. (2011). Foot strike patterns of recreational and sub-elite runners in a long-distance road race. Journal of Sports Sciences, 29(14), 1665–1673. https://doi.org/10.1080/02640414.2011.610347
• Lieberman, D. E., Castillo, E. R., Otarola-Castillo, E., Sang, M. K., Sigei, T. K., Ojiambo, R., Okutoyi, P., & Pitsiladis, Y. (2015). Variation in foot strike patterns among habitually barefoot and shod runners in Kenya. PLoS ONE, 10(7), e0131354. https://doi.org/10.1371/journal.pone.0131354
• Lieberman, D. E., Venkadesan, M., Werbel, W. A., Daoud, A. I., D’Andrea, S., Davis, I. S., Mang’eni, R. O., & Pitsiladis, Y. (2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, 463(7280), 531–535. https://doi.org/10.1038/nature08723
• Nielsen, R. O., Buist, I., Sørensen, H., Lind, M., & Rasmussen, S. (2012). Training errors and running related injuries: a systematic review. International Journal of Sports Physical Therapy, 7(1), 58–75.
• Perl, D. P., Daoud, A. I., & Lieberman, D. E. (2012). Effects of footwear and strike type on running economy. Medicine and Science in Sports and Exercise, 44(7), 1335–1343. https://doi.org/10.1249/MSS.0b013e318247989e
• Pontzer, H., Suchman, K., Raichlen, D. A., Wood, B. M., Mabulla, A. Z. P., & Marlowe, F. W. (2014). Foot strike patterns and hind limb joint angles during running in Hadza hunter-gatherers. Journal of Sport and Health Science, 3(2), 95–101.
• Runciman, H. M., Tucker, R., & Ferber, R. (2013). Short-term changes in running mechanics and foot strike pattern after introduction to minimalistic footwear. Journal of Sports Medicine, 2013, 392410. https://doi.org/10.1155/2013/392410
• Stacoff, A., Nigg, B. M., Reinschmidt, C., van den Bogert, A. J., & Lundberg, A. (2000). Total foot pronation and lower extremity muscle activity: A comparison between different running shoes. Gait & Posture, 11(3), 195–202.
• Tenforde, A. S., Yin, A., Hunt, K. J., Sritharan, P., Huangfu, R., Brkilder, B., et al. (2021). Outpatient physical therapy and injury outcomes for recreational runners. Journal of Athletic Training, 56(2), 94–101.
• van Gent, R. N., Siem, D., van Middelkoop, M., van Os, A. G., Bierma-Zeinstra, S. M., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in recreational runners: a systematic review. British Journal of Sports Medicine, 41(8), 469–480. https://doi.org/10.1136/bjsm.2006.033548