REF-1112 · Almeida et al., 2015 · Journal of Orthopaedic & Sports Physical Therapy, · Paper · PubMed
Meta-analysis of 16 studies in adult distance runners: forefoot strikers land with a plantar-flexed ankle and a more flexed knee, and rearfoot strikers have higher vertical loading rates; the abstract reports kinematics and loading rate only
Running economy was not an outcome, and no knee-versus-Achilles load comparison is reported
MEDLINE, Embase, LILACS, SciELO and SPORTDiscus were searched through July 2014 for studies comparing the biomechanics of foot-strike patterns in distance runners aged at least 18. Two reviewers rated risk of bias; data were pooled with a random-effects model.
Participants
16 studies; total n= not given in the abstract (distance runners aged 18 and over).
Protocol
Objective: biomechanical differences between strike patterns. Outcomes pooled: kinematic variables (angles at initial contact, ranges of motion) and kinetic variables (vertical loading rate).
Key Results
Forefoot vs rearfoot: significant differences in foot and knee angle at initial contact and in knee flexion range of motion — forefoot strikers land with a plantar-flexed ankle and a more flexed knee, rearfoot strikers with a dorsiflexed ankle and a more extended knee.
Midfoot vs rearfoot: midfoot strikers had greater ankle dorsiflexion range of motion and less knee flexion range of motion.
Kinetics: rearfoot strikers had higher vertical loading rates than forefoot strikers.
Not reported in the abstract: running economy or oxygen cost, injury rates, and joint moments or Achilles/patellofemoral loads.
Practical Application
Cite this review for contact kinematics and vertical loading rate only. A blog claim that it shows "no economy difference" is not supported: the abstract reports no economy outcome (full text not checked). A claim that it shows knee-vs-Achilles load redistribution is not supported by the abstract, which reports no joint loads.
Inference: a higher vertical loading rate is a mechanical difference, not proof of higher injury risk; the abstract makes no injury claim.
Limitations
Total participants and pooled effect sizes not given in the abstract.
Observational studies of habitual patterns; differences are associations.
Search ends July 2014; mechanics only.
How this entry was checked and changed
Why this level
SR/MA with dual risk-of-bias review, but pooled studies are observational and the outcomes are mechanical, not injury or performance