As I was sifting through the research on metatarsal stress fractures in running -- the metatarsals
are the long thin bones that line the top of the foot as shown here - I noticed that
there was a lot of published data on stress fractures of the first and second metatarsal
head was actually very common in heel strike runners, but not so much in forefoot strike
runners.
So, I wanted to find out the main risk factors responsible for a heel strike runner potentially
have a more pronounced, out-sized risk of a metatarsal stress fracture of the first
and second metatarsal head as compared with a forefoot striker and the clues I gathered
clearly indicated that an increased likelihood of a metatarsal stress fracture of the first
and second metatarsal head during running is strongly influenced by how plantar, or
foot, pressure travels over the foot when the foot is in contact with the ground and
that It's incredibly important to remember that plantar pressure travel patterns completely
differ between a heel strike landing pattern and a forefoot strike landing pattern in running.
So let me discuss, in further detail, what all this means, but the bottom line here is
that the plantar pressure distribution pattern unique to heel strike running may be blamed
for the high prevalence of metatarsal stress fracture on either the 1st or 2nd metatarsal
head and may be the core reason 1st and 2nd metatarsal head stress fracture may be more
common in heel strike runners, than in forefoot strike runners.
I’m going to talk about the differences in plantar pressure distribution patterns
between a forefoot strike landing pattern and a heel strike landing during running and
what the differences in plantar pressure distribution patterns mean in terms of influencing bony
injuries, like a 1st or 2nd metatarsal stress fracture of the foot.
Research, and I’ve linked the research papers down below in the description box, has identified
clear distinguishing differences between plantar pressure distribution patterns in heel strike
running vs in forefoot strike running and it turns out that the way the plantar pressure
travels and disperses over the foot in heel strike running, because of the heavy impact
loads that comes with heel striking during running, may be responsible for abnormal doses
of stress and loading under the 1st and 2nd toes, an area not fully physically equipped
with the sufficient strength to effectively absorb the heavy volume of plantar pressure
that's unleashed or spurred on by the heavy impact loads produced as soon as and after
the heel plows into the ground and that this abnormal surge in plantar plantar pressure
under the big toe may cause the 1st and 2nd metatarsal heads to be very vulnerable to
bone fatigue and fracture, especially when running over long distance or at faster running
intensities with a heavy heel strike landing pattern.
In heel strike running, the plantar pressure distribution travel pattern begins at the
heel because the heel is precisely where initial ground-contact is made on the foot with the
ground in a heel strike landing pattern during running, but it's at this point during the
initial contact phase on the heel in heel strike running that generates an impact spike
that produces high stress on the heel and this high stress travels over the foot as
soon as the foot rolls over the heel, over the arch and on to the toes, whereby the intensity
of the heel strike-impact peak is the main driving force behind the increases in plantar
pressure that travels from the heel and ends up piercing through the 1st and 2nd metatarsal
heads (just under the 1st and 2nd toe), causing plantar pressure to abnormally disperse in
high volumes in this area of the forefoot but why’s this a problem?
Why would it be harmful to the foot to have high volumes of plantar pressure traveling
in through the 1st and 2nd metatarsal heads during heel strike running as compared with
forefoot strike running?
The evidence seems to indicate that the 1st and 2nd metatarsal heads physically under-provide
the capacity to sufficiently absorb or deflect the uniquely high volumes of plantar pressure
associated with heel strike running.
In other words, the area under the 1st and 2nd toes just aren't fully structurally stable
enough to effectively accommodate the exceedingly high volumes of plantar pressures arising
from the intensive impact-peak force that’s uniquely generated in heel strike running
and is carried along when the foot rolls over heel-to-toe, carrying these high pressures
in through the foot, up through the 1st and 2nd metatarsal heads.
So, I really want to underscore and be more specific that greater landing force intensities
in heel strike running leads to greater plantar pressure pulses whereby plantar stress is
further compounded and made worse by the magnitude of the peak vertical ground reaction force
that’s accompanied by landing heel first during running whereby this force occurs at
magnitude of 3 times the body’s weight which further accelerates high volumes of plantar
pressure, really putting the 1st and 2nd metatarsal heads under strong pressure.
In other words, heel strike runners appear to land more intensively, more aggressively,
generating higher doses of impact forces which can lead to bigger increases in plantar pressure
loads on areas of the foot that are anatomically incapable, and proved to be a little too delicate
to sufficiently manage impact loads of this magnitude, and the net effect is that the
plantar stress may overly exceed a tolerable threshold under the mechanical conditions
of heel strike running and thus may be one of the greatest factors of why stress fractures
of the 1st and 2nd metatarsal heads are more prevalent in heel strike runners, but this
is not the case for forefoot strike runners and here’s why.
In forefoot strike running, there isn’t large rises in plantar pressure at the 1st
and 2nd metatarsal heads, like there is heel strike running, and it’s for this reason
that forefoot running may be a clinically effective way around the problem of abnormal
distribution plantar loading under the 1st and 2nd toes and thus, forefoot striking may
work best for preventing stress fractures in that particular area of the foot during
running and this is because the flow of plantar pressure distribution travels in a completely
different route in forefoot strike running than in heel strike running and it flows in
such a way that the net effect is decreased concentrations of plantar pressures under
the first and second toe.
Let's take a closer look at the safer, less threatening flow of plantar pressure distribution
in forefoot strike running.
In a proper forefoot strike landing pattern during running, initial contact of the foot
with the ground is made under the 5th-toe where plantar pressure gets distributed starting
from the 5th metatarsal head, or under the baby toe, and as the rest of the forefoot
comes in contact with the ground, the plantar pressure spreads with better spatial distribution
from the 5th metatarsal head to the 4th-3rd-2nd-1st metatarsal heads in that order.
The vast majority of plantar loads is initially spread out of a larger surface area, that
is over the 5th, 4th and 3rd metatarsal heads, again providing a little more surface area
for plantar pressure to evenly distribute and the bulk of the plantar loads has faded
away once the big toe has made full contact with the ground.
So, this is how the 1st and 2nd metatarsal heads are less likely to buckle, less likely
to over-heat with pressure and fatigue because of the stark reductions in plantar pressures
on that area.
Fundamentally, it’s the specific landing configuration of the foot in a proper forefoot
strike landing pattern that naturally provides an overall larger surface area for greater
spatial distribution, creating a more stable, effective template for a better balance of
plantar pressure distribution over the foot, so there isn't a burst of heavy plantar pressure
forces on just one section of the forefoot; there isn't heavy plantar pressures being
pinned down and heavily localized to an isolated area of the foot like in heel strike running,
which can make a big difference in preventing metatarsal stress fracture.
More notably, the rapidity, or the time of which plantar pressure travels over the forefoot
in a forefoot strike landing pattern during running, the net release of plantar pressure
is very brief and short in duration; the pressure is there and gone more quickly, which reflects
reduced ground-contact time of the foot on the ground which is very necessary for limiting
the time for harmful impact forces to accumulate.
In other words, the less time the feet spend on the ground, helps stop increases in heavy
plantar loading and other force variables, which is obviously good for injury prevention.
Reduced ground contact-time of the foot on the ground is a central property of forefoot
strike running that makes this style of running less forceful on the body as it naturally
influences a lighter, softer, more brief exchange between the foot and the ground to an extent
where you are more well-positioned to avoid impact-related injuries.
Last but not least, another principal reason that forefoot striking during running may
produce plantar pressures that fall within a safer range is because in a forefoot strike
landing, there’s a complete elimination of the impact-peak transient force that's
present in heel strike running; forefoot striking naturally perfect prevents this impact spike
and is sure to be effective in preventing high plantar loads from flooding the foot
because the lighter the foot interacts with the ground, like in forefoot running, will
help scale back impact on the foot, which may be good for preventing the foot from being
bogged down with heavy plantar loads.
So, i just thought it would be important to emphasize the published data showing that
the essential features of a forefoot strike landing pattern may lead to better impact
protections over the foot during running as compared with heel strike running and that
forefoot striking may be something that can really help you in your efforts to potentially
avoid bony injuries of the foot.
I hope you’ve enjoyed this video.
To stay updated on all the latest research on more of the health and performance benefits
of forefoot running and the potential dangers of heel strike running, feel free to hit the
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Thank you so much listening and watching have fun out there on the roads and trails.
Bye for now!