Foot Strike change reduces risk of tibial stress fracture, but what injuries will it increase the risk of?

Acute Changes in Foot Strike Pattern and Cadence Affect Running Parameters Associated with Tibial Stress Fractures. Yong at al,  Journal of Biomechanics, Available online 18 May 2018, In Press

The reason for my wrinkles and disquietude is that this paper is yet another in a long line that makes one fairly large (and probably unfounded) claim, whilst failing to acknowledge some potentially very large risks.


Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures.

I will comment on the ins and outs of this specific paper in a moment, but first, let's take a look at what we actually know...

Simon Bartold
Director of Bartold Clinical