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Foot And Knee Pain In Running

Revealed: 3 SUPER popular questions on FOOT and KNEE PAIN in those who run or walk a lot.

“What is the proper FOOT STRIKE?”

As the owner of John Lathrop Physical Therapy, I often partner with various running groups and running shoe stores to promote injury prevention among runners and to help get them back on their feet after an injury. The hot topic for several years now has been regarding how someone should strike their foot to the ground (initial strike) during the running gait pattern. I would say that AT LEAST 80% of the time I hear people discussing how forefoot and mid-foot striking are the “correct” ways to run. I’ll then chime in to the conversation and ask why they think this and who informed them of this. Nobody can seem to give me an answer, and usually the person who told them was a colleague, friend, or other runner. No one has seemed to back up their answer with biomechanical evidence.

The normal gait pattern in an individual without physical limitations is to use heel strike and the initial strike phase of the gait cycle. This is factual evidence based upon the studies of mechanical efficiencies of the body during walking. To the extreme, while sprinting, the body is moving too fast to allow for heel strike at initial strike. In fact, the only part of the foot to touch the ground is the forefoot while an individual is in a 100% effort sprint. So if heel strike is normal and efficient during walking, and forefoot strike is normal and efficient while sprinting, then isn’t it logical to suggest that the area of the foot that should first strike the ground is a product of speed of ambulation? Simply put, as an individual begins to ambulate faster, the initial strike moves gradually from the hind-foot toward the forefoot.

“What type of SHOE should I wear?”

Everyone likes to bring up the book called “Born to Run” when this topic comes up. My take on that book is that there were individuals who loved to run and did so without shoes because that’s the way it had always been done. To me, the book wasn’t preaching that barefoot running leads to less injuries than running WITH shoes. I’ve seen many people grow up running WITH shoes and then try to convert to barefoot running because they think it’s going to help build up their (foot) intrinsic strength, however, many of these individuals get injured and return to running WITH shoes. I believe this is simply due to doing something one way for a long time, and then making a drastic change. So to conclude this quick side-topic, Born to Run was a book about a group of people who loved the act of running, and in their culture, then ran barefoot….period.

At the extreme ends, there are people with pes cavus and people with pes planus. People with pes cavus typically have a very rigid foot that provides as a terrific lever during the push-off phase in the gait cycle, however, they do not have enough mobility throughout their mid-foot and hind-foot to initiate proper shock attenuation during initial strike and mid stance. People with pes planus typically have a very mobile foot that allows for good shock attenuation and conformation to uneven terrains, however, the hypermobility in the mid-foot and hind-foot does not allow for enough tension for proper leverage during the push-off phase in the gait cycle. Therefore, people with pes cavus most typically benefit from a shoe that is light weight and assists in shock absorption, while people with pes planus usually most benefit from a shoe that helps control mid-foot pronation and hind-foot eversion.

“What is the most common RUNNING INJURY you see?”

For me, knee injuries are by FAR the most commonly injured area that I see in runners. From taking several CEUs and reading lots of journal articles, it is suggested that most knee injuries in runners occur from a “braking effect.” Simplified, this is when forward momentum is lost at the moment of initial strike during the running gait cycle. The braking effect causing excessive force to the knee joint, ligaments, and tendons. To prevent this effect, a running form analysis is often done and education and/or treatment can be given to the patient to make their running form more effective and safer.

We at John Lathrop Physical Therapy specialize in sports injuries, and have helped hundreds of runners not only come back after injury, but improve their running ability.

Hope this helps you,

Johnny Lathrop

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