Systematic review of 13 studies on foot strike technique and running-related injury: low evidence for any relationship; 3 of 6 categorical studies found more retrospective injury in rearfoot strikers and 1 found more risk with mid/forefoot strike, but these were very low quality; only 1 of 7 continuous-measure studies found a relationship
Search of MEDLINE, PubMed, SPORTDiscus, Scopus and Web of Science for English-language studies (January 1960 to November 2020) on foot strike technique and running-related injury; evidence graded with GRADE.
Participants
n=13 studies: 6 reported foot strike categorically (pattern), 7 used continuous measures (foot contact angle, ankle flexion angle, strike index).
Protocol
Systematic search, extraction and collation; GRADE synthesis of evidence quality.
Key Results
Low evidence for a relationship between foot strike technique (categorical or continuous) and running-related injury.
Categorical: 3 of 6 studies found a significantly greater retrospective injury rate in rearfoot than non-rearfoot strikers; 1 other found greater risk with midfoot and forefoot strike.
Continuous measures: only 1 of 7 studies reported a significant relationship.
The categorical studies were very low quality: retrospective designs, low participant numbers, poor assessment of strike pattern. Authors call for large prospective studies.
Practical Application
Foot strike pattern is not an established injury risk factor; do not change a healthy runner's strike to prevent injury on this evidence.
Retrospective "rearfoot strikers report more injuries" findings cannot separate cause from consequence. Inference: an injury can itself change how a runner lands.
Not from this paper: prospective data since this review, REF-1117 (no foot strike association in a cadet cohort).
Limitations
Only 13 studies, mostly retrospective and small; English-language only.
Mixed exposure definitions (categorical vs continuous) prevent pooling; no pooled estimate in the abstract.
Populations and injury definitions are not described in the abstract.
How this entry was checked and changed
Why this level
systematic review, but the evidence in it is low to very low quality (GRADE), largely retrospective