Running: Why Your Feet (and Everything Else) Might Be Mad at You
Running has come a long way from being a survival skill. Once upon a time, we ran to chase dinner. These days, we run for fun, stress relief, competition, and adrenaline/runner's high, or to get some easy-access exercise. Whatever gets you lacing up your sneakers, one thing is for sure: if you're running, you're putting your body to work — and sometimes, it complains.
If you've ever found yourself wondering why your knees ache or your shins feel like they're about to snap, you're not alone. Let's break down the most common running injuries, why they happen, and — most importantly — what you can do about them.
Let’s Talk Foot Strikes
When you run, your foot is the first thing to greet the ground — and how it lands can make a big difference. There are three main ways your foot might hit:
- Rearfoot Strike: landing on your heel.
- Midfoot Strike: landing flat-ish, around the middle of your foot.
- Forefoot Strike: landing on the ball of your foot.
From kids playing tag to Olympic sprinters, everyone does this a little differently, and your strike pattern shapes which muscles, tendons, ligaments, and joints do the heavy lifting. The “great debate” is usually between rearfoot and forefoot striking — so let’s take a look at both.
The Forefoot Striker Club
If you’ve ever watched a sprinter take off or seen barefoot runners in action, you’ve probably noticed they land on the balls of their feet. Forefoot striking can feel fast and springy, and some runners switch to it hoping to avoid knee pain. The reason? When you land on your forefoot, your muscles absorb more shock than your bones — but that’s not always a free pass.
Common forefoot injuries:
- Achilles Tendonitis: Your calf muscles do a lot of work here. Overuse or tightness can put major strain on your Achilles tendon (the one connecting your calf to your heel).
- Metatarsalgia: Landing on your forefoot puts pressure on the long bones behind your toes, an area of the foot that doesn't have much cushion. This can cause sharp, nagging pain under the ball of your foot.
- Plantar Fasciitis: That tight, band-like tissue under your foot can get irritated when your calves are overworked or stiff, setting off heel and arch pain. This one often coincides with achilles tendonitis because the achilles tendon attaches to the plantar fascia.
- Shin Splints: Forefoot runners load their shins more than other foot-strike patterns, stressing the shin and muscles in front of the shin in ways that can leave you hobbling after a few runs.
The Rearfoot Striker Majority
Most runners — around 89%! — land on their heels first. While it can increase demand on the quads (thigh) and put more stress on the knees and the heel, it’s a natural fit for long distances, especially in cushioned shoes, because it spreads out the load and lets your glutes and thigh muscles help control the impact. The main risk of rearfoot striking is overstriding, which is when the heel lands too far forward from your center of gravity, potentially leading to the injuries listed below:
Risk list for rearfoot striking:
- Runner’s Knee (Patellofemoral Syndrome): If your foot rolls inward too much when you land (called “over-pronation”), it can rotate your shin and move your kneecap out of alignment, irritating all the tissues around it. Weak hips and feet can make this worse.
- Stress Fractures: Rearfoot striking hits your shin bones and feet with sharp, repetitive forces — especially if you overstride (landing too far in front of your body). That can turn into small fractures of your shins or the bones in the foot over time.
- Shin Splints (again!): Whether you land on your heels or forefoot, your shins can end up paying the price. Overuse of the muscles that lift your foot can lead to inflammation and pain.
So... Which Is Better?
I know what you are thinking, how can you get the same injuries from different ways of running? This depends on the primary structures that are stressed, dosage (distance, frequency, duration), and what the rest of your body is doing to maintain control. So to answer the rearfoot and forefoot debate, there is no right or wrong way. In a 2017 study, analysis of all footstrikes suggested that there were no obvious benefits to changing a current pattern, and may even increase susceptibility to injury by stressing tissues that are not usually affected.1
That’s where a Physical Therapist comes in! At Hey Babe Physical Therapy, we help you figure out the real story behind your pain, not just slap a band-aid on the symptoms. Every runner's body is different — and the “perfect” stride for you is the one that works for your unique strength, flexibility, and movement patterns.
Our Running Assessments Look At:
💪 Strength: Are your muscles doing their job, or are they calling in backup (aka your joints)?
👣 Running Form: Are you landing evenly? Is your hip dropping? Are you pushing off properly?
🧍♀️ Posture & Alignment: How’s your spine, hips, knees, and feet stacking up?
🧠 Balance: Running is just a series of controlled falls — do you have the stability to stay upright?
🧘♂️ Flexibility: Tight hips, hamstrings, or calves can mess with your stride. We want to assess if these muscles are allowing adequate range of motion to make full strides, swing through, and make thorough contact with the ground when you land
After all this information is collected, it will give us a story about the source of your pain. At the end of the day, there’s no one-size-fits-all fix for running injuries, but there is one smart first step: get curious about how you move.
So go ahead — strike up a conversation (pun absolutely intended) with a Physical Therapist at Hey Babe Physical Therapy and Wellness and let’s figure out what’s best for your body.
Works Cited
- Effects of habitual foot strike patterns on patellofemoral joint and Achilles tendon loading in recreational runner
- Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Meta-analysis
