Forefoot Runners Research Articles

Effects of different contact angles during forefoot running on the stresses of the foot bones: a finite element simulation study.

Introduction: The purpose of this study was to compare the changes in foot at different sole-ground contact angles during forefoot running. This study tried to help forefoot runners better control and improve their technical movements by comparing different sole-ground contact angles. Methods: A male participant of Chinese ethnicity was enlisted for the present study, with a recorded age of 25years, a height of 183cm, and a body weight of 80kg. This study focused on forefoot strike patterns through FE analysis. Results: It can be seen that the peak von Mises stress of M1-5 (Metatarsal) of a (Contact angle: 9.54) is greater than that of b (Contact angle: 7.58) and c (Contact angle: 5.62) in the three cases. On the contrary, the peak von Mises stress of MC (Medial Cuneiform), IC (Intermediate Cuneiform), LC (Lateral Cuneiform), C (Cuboid), N (Navicular), T (Tarsal) in three different cases is opposite, and the peak von Mises stress of c is greater than that of a and b. The peak von Mises stress of b is between a and c. Conclusion: This study found that a reduced sole-ground contact angle may reduce metatarsal stress fractures. Further, a small sole-ground contact angle may not increase ankle joint injury risk during forefoot running. Hence, given the specialized nature of the running shoes designed for forefoot runners, it is plausible that this study may offer novel insights to guide their athletic pursuits.

The impact of local muscle fatigue and foot strike techniques on kinematic features and plantar pressure distribution while walking

Although numerous studies have been performed, there are no clear findings providing a meaningful statement about how foot strike changes as a result of muscular fatigue. In studies on running fatigue, it is not possible to differentiate which kinematic or kinetic changes are a direct result of local muscle fatigue and varied speeds. This study aimed to investigate the effect of foot strike technique and localized muscle fatigue of the plantar and dorsal flexors on plantar pressure distribution and selected kinematic features of treadmill running. Twenty-six voluntary forefoot and rearfoot runners of similar age and body mass participated in the study. Each group completed two tests with a time interval of 3-7 days. The kinematic data was measured with the help of a three-dimensional measuring and analysis system while the volunteers ran on the treadmill. The fatigue protocol included an isometric maximal force test and an isokinetic endurance test. In order to check the differences, a variance analysis with repeated measurements was used. The strength values of the two groups of runners showed significant average differences in the plantar flexors in the endurance test and in the fatigue index for both the left and right legs. The results of the strength values are surprising because the plantar flexors of this group of runners should be well-trained due to the forefoot strike during regular running. In response to fatigue, the pressure maxima decreased under the exposed foot regions, i.e. under the forefoot at forefoot strike and under the heel at rearfoot strike. The two groups of runners differed in foot angle at foot-on with higher values measured in the forefoot runners. The larger foot angle of the forefoot runners improved shock absorption and can thus reduce the risk of injury.

The effect of footwear on mechanical behaviour of the human ankle plantar-flexors in forefoot runners.

PurposeTo compare the ankle plantar-flexor muscle-tendon mechanical behaviour during barefoot and shod forefoot running.MethodsThirteen highly trained forefoot runners performed five overground steady-state running trials (4.5 ± 0.5 m.s-1) while barefoot and shod. Three-dimensional kinematic and ground reaction force data were collected and used as inputs for musculoskeletal modelling. Muscle-tendon behaviour of the ankle plantar-flexors (soleus; medial gastrocnemius; and lateral gastrocnemius) were estimated across the stance phase and compared between barefoot and shod running using a two-way multivariate analysis of variance.ResultsDuring barefoot running peak muscle-tendon unit (MTU) power generation was 16.5% (p = 0.01) higher compared to shod running. Total positive MTU work was 18.5% (p = 0.002) higher during barefoot running compared to shod running. The total sum of tendon elastic strain energy was 8% (p = 0.036) greater during barefoot compared to shod running, however the relative contribution of tendon and muscle fibres to muscle-tendon unit positive work was not different between conditions.ConclusionBarefoot forefoot running demands greater muscle and tendon work than shod forefoot running, but the relative contribution of tendon strain energy to overall muscle-tendon unit work was not greater.

The effect of uneven terrain conditions during shod vs. barefoot running

Background: The majority of research on barefoot running focuses on acute changes in altering footwear without regard to the runner's experience with barefoot or minimalist footwear running. Objective: The objective of this study was to compare the effect of footwear (standard cushioned running shoes, barefoot) and running surface (flat surface, uneven terrain) on gait in experienced runners using minimalist shoes. Methods: Terrain running was simulated by three custom-made mats with randomly placed firmly attached stones. Seven experienced trail runners participated in this study. All participants were forefoot strikers. Participants underwent three-dimensional kinematic and kinetic analysis consisting of five running trials in each combination of footwear and surface. A trial was successful when the participant maintained a velocity of 3.2 ± 0.16 m/s without targeting a force platform. Results: Uneven terrain conditions along with barefoot conditions led to significantly decreased peak moment of ankle plantarflexion (terrain: p = .041, footwear: p = .026) and decreased second peak of vertical ground reaction force in comparison with other conditions (terrain: p = .026, footwear: p = .004). Uneven terrain conditions also significantly decreased ankle dorsiflexion at initial contact with the ground for both footwear conditions (p = .021). Conclusions: We conjecture that net ankle moments could be decreased by barefoot running in terrain conditions in skilled forefoot runners. Experienced runners using minimalist shoes may incorporate trail running into their barefoot running regime without risk of higher Achilles tendon loading compared to even running.

Foot joint coupling variability differences between habitual rearfoot and forefoot runners prior to and following an exhaustive run

As joint coupling variability has been associated with running-related lower extremity injury, the purpose of this study was to identify how variability within the foot may be different between forefoot (FFS) and rearfoot strike (RFS) runners. Identifying typical variability in uninjured runners may contribute to understanding of ideal coordination associated with running foot strike patterns.Fifteen FFS and 15 RFS runners performed a maximal-effort 5 km treadmill run. A 7-segment foot model identified 6 functional articulations (rearfoot, medial and lateral midfoot and forefoot, and 1st metatarsophalangeal) for analysis. Beginning and end of the run motion capture data were analyzed. Vector coding was used to calculate 6 joint couples. Standard deviations of the coupling angles were used to identify variability within subphases of stance (loading, mid-stance, terminal, and pre-swing). Mixed between-within subjects ANOVAs compared differences between the foot strikes, pre and post run.Increased variability was identified within medial foot coupling for FFS and within lateral foot coupling for RFS during loading and mid-stance. The exhaustive run increased variability during mid-stance for both groups.Interpretation. Joint coupling variability profiles for FFS and RFS runners suggest different foot regions have varying coordination needs which should be considered when comparing the strike patterns.

Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern

ABSTRACTWe examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running.Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness

Altered multi-muscle coordination patterns in habitual forefoot runners during a prolonged, exhaustive run

Introduction: In response to fatigue during an exhaustive treadmill run, forefoot runner’s muscles must adapt to maintain their pace. From a neuromuscular control perspective, certain muscles may not be able to sustain the force to meet the run’s demands; thus, there may be alternative muscle coordination in the lower extremity that allows for continued running for an extended period of time. The aim of this study was to quantify the change in muscle coordination during a prolonged run in forefoot runners.Methods: Thirteen forefoot runners performed exhaustive treadmill runs (mean duration: 15.4 ± 2.2 min). The muscle coordination of seven lower extremity muscles was quantified using a high-resolution time–frequency analysis together with a pattern recognition algorithm.Results: The mean EMG intensity for the lateral and medial gastrocnemius muscles decreased with the run (p = 0.02; 0.06). The weight factors of the second principal pattern decrease by 128.01% by the end of run (p = 0.05, Cohen’s d = 0.42) representing a relatively greater biceps femoris activation in midstance but smaller midstance rectus femoris, vastus medialis, triceps surae, and tibialis anterior activation.Discussion: These results suggest that forefoot runners cannot sustain plantar flexor activation throughout an exhaustive run and change their muscle coordination strategy as a compensation. Understanding the underlying compensation mechanisms humans use to cope with fatigue will help to inform training modalities to enhance these late stage muscle activation strategies for athletes with the goal of improving performance and reducing injury.

Is there a minimum complexity required for the biomechanical modelling of running?

Mathematical models have the potential to provide insight into human running. Existing models can be categorised as either simple or complex, and there appears to be a lack of natural progression in model development. By sequentially adding complexity, there is the potential to determine how different mechanical components contribute to the biomechanics of running. In this study, a series of four models, of increasing complexity were developed in OpenSim: a simple spring-mass model, a two-segment model with a torsional spring at the knee and two three-segment models, one with a sprung knee and ankle and another with a sprung knee and actuated ankle. For each model, a forward simulation was developed and model predictions compared with experimental data from 10 forefoot runners. The results showed the spring-mass model overestimated the vertical displacement of the centre of mass (percentage difference: 43.6(22.4)-67.7(21.7)%) and underestimated the vertical ground reaction force (percentage difference: 13.7(8.9)-34.4(10.9)%) compared to the experimental data. Adding a spring at the knee increased the match with the vertical centre of mass displacement (percentage difference: 4.4(25.2)-18.4(40.2)%), however, geometry restrictions meant it was only possible to model approximately 60% of stance. The passive three-segment model showed a good match with centre of mass movements across most of stance (percentage difference in the vertical centre of mass displacement: 4.3(24.5)-21.3(19.2)%), however, actuation at the ankle was required to obtain a closer match with experimental kinetics and joint trajectories (e.g. vertical ground reaction force RMSD decreased by approximately 0.4BW). This is the first study to investigate models of increasing complexity of distance running. The results show that agreement between experimental data and model simulations improves as complexity increases and this provides useful insight into the mechanics of human running.

P 002 – Ankle muscle strength and its relationship to the lower trunk movement during running

The forefoot running footfall pattern has been suggested to reduce the risk of developing running related overuse injuries due to a reduction of impact related variables compared with the rearfoot running footfall pattern. However, only time-domain impact variables have been compared between footfall patterns. The frequency content of the impact shock and the degree to which it is attenuated may be of greater importance for injury risk and prevention than time-domain variables. Therefore, the purpose of this study was to determine the differences in head and tibial acceleration signal power and shock attenuation between rearfoot and forefoot running.Nineteen habitual rearfoot runners and 19 habitual forefoot runners ran on a treadmill at 3.5 m/s using their preferred footfall patterns while tibial and head acceleration data were collected. The magnitude of the first and second head acceleration peaks, and peak positive tibial acceleration were calculated. The power spectral density of each signal was calculated to transform the head and tibial accelerations in the frequency domain. Shock attenuation was calculated by a transfer function of the head signal relative to the tibia.Peak positive tibial acceleration and signal power in the lower and higher ranges were significantly greater during rearfoot than forefoot running (p < 0.05). The first and second head acceleration peaks and head signal power were not statistically different between patterns (p > 0.05). Rearfoot running resulted in significantly greater shock attenuation for the lower and higher frequency ranges as a result of greater tibial acceleration (p < 0.05).The difference in impact shock frequency content between footfall patterns suggests that the primary mechanisms for attenuation may differ. The relationship between shock attenuation mechanisms and injury is not clear but given the differences in impact frequency content, neither footfall pattern may be more beneficial for injury, rather the type of injury sustained may vary with footfall pattern preference.

Trabecular bone in the calcaneus of runners.

Trabecular bone of the human calcaneus is subjected to extreme repetitive forces during endurance running and should adapt in response to this strain. To assess possible bone functional adaptation in the posterior region of the calcaneus, we recruited forefoot-striking runners (n = 6), rearfoot-striking runners (n = 6), and non-runners (n = 6), all males aged 20–41 for this institutionally approved study. Foot strike pattern was confirmed for each runner using a motion capture system. We obtained high resolution peripheral computed tomography scans of the posterior calcaneus for both runners and non-runners. No statistically significant differences were found between runners and nonrunners or forefoot strikers and rearfoot strikers. Mean trabecular thickness and mineral density were greatest in forefoot runners with strong effect sizes (<0.80). Trabecular thickness was positively correlated with weekly running distance (r2 = 0.417, p<0.05) and years running (r2 = 0.339, p<0.05) and negatively correlated with age at onset of running (r2 = 0.515, p<0.01) Trabecular thickness, mineral density and bone volume ratio of nonrunners were highly correlated with body mass (r2 = 0.824, p<0.05) and nonrunners were significantly heavier than runners (p<0.05). Adjusting for body mass revealed significantly thicker trabeculae in the posterior calcaneus of forefoot strikers, likely an artifact of greater running volume and earlier onset of running in this subgroup; thus, individuals with the greatest summative loading stimulus had, after body mass adjustment, the thickest trabeculae. Further study with larger sample sizes is necessary to elucidate the role of footstrike on calcaneal trabecular structure. To our knowledge, intraspecific body mass correlations with measures of trabecular robusticity have not been reported elsewhere. We hypothesize that early adoption of running and years of sustained moderate volume running stimulate bone modeling in trabeculae of the posterior calcaneus.

Which Method Detects Foot Strike in Rearfoot and Forefoot Runners Accurately when Using an Inertial Measurement Unit?

Accelerometers and gyroscopes are used to detect foot strike (FS), i.e., the moment when the foot first touches the ground. However, it is unclear whether different conditions (footwear hardness or foot strike pattern) influence the accuracy and precision of different FS detection methods when using such micro-electromechanical sensors (MEMS). This study compared the accuracy of four published MEMS-based FS detection methods with each other and the gold standard (force plate) to establish the most accurate method with regard to different foot strike patterns and footwear conditions. Twenty-three recreational runners (12 rearfoot and 11 forefoot strikers) ran on a 15-m indoor track at their individual running speed in three footwear conditions (low to high hardness). MEMS and a force plate were sampled at a rate of 3750 Hz. Individual accuracy and precision of FS detection methods were found which were dependent on running styles and footwear conditions. Most of the methods were characterized by a delay which generally increased from rearfoot to forefoot strike pattern and from high to low midsole hardness. It can be concluded that only one of the four methods can accurately determine FS in a variety of conditions.

Effect of eccentric training on sagittal plane lower limb kinematics and kinetics in non-habitual forefoot runners

Effect of eccentric training on sagittal plane lower limb kinematics and kinetics in non-habitual forefoot runners

A Comparison of 3D Methods for Identifying the Stance Phase in Treadmill Running for Both Rearfoot and Forefoot Runners

We compared six 3D methods, OptoGait, and Myotest Run for the determination of contact time for runners with different foot strike patterns. Twenty male participants were divided into two groups: the heel group, who attack the ground with the heel (n = 12), and the toe group, who attack the ground with the middle/front of the foot (n = 8). They performed trials at speeds of 8 km/h then 16 km/h. To detect foot strike, the use of peak velocity of 3D markers located on the heel, the fifth metatarsal, and the great toe provided the best results for both groups. To detect the toe off, the minimum vertical position of a 3D marker placed in line with the great toe gave the most satisfactory results for both groups. In this way, the values of contact time measured with the 3D methods are consistent. Values measured with OptoGait appear consistent too, while those of the Myotest Run underestimate the contact time for both speeds. 3D analysis provides interesting opportunities for calculation of contact time for both rearfoot and forefoot runners, using specific peak velocities to determine foot strike and marker displacement to determine toe off.

Foot Joint Coupling Variability in Rearfoot and Forefoot Runners After an Exhaustive Run

While most runners use a rearfoot strike (RFS), recent research suggests that midfoot or forefoot strike (FFS) running is more natural and reduces injuries. Joint coupling is believed to be an important factor in running related injuries. Further, according to the dynamical systems theory, increased joint coupling variability while running may prevent repetitive loading of tissues which may lead to overuse injury. PURPOSE: This study compared joint coupling variability of the foot in habitual RFS and FFS runners prior to and following an exhaustive run. METHODS: Fifteen FFS and 15 RFS runners performed a maximal 5 km treadmill run. Foot motion was assessed using a 7-segment foot model which identified 6 functional articulations (rearfoot, medial midfoot, lateral midfoot, medial forefoot, lateral forefoot, and 1st metatarsophalangeal). Motion capture data was collected for 10 s at the beginning and end of the run and 5 steps were processed for subsequent analysis. Vector coding methods were used to calculate 10 different joint couples. Standard deviations of the coupling angles were used to identify variability within the first 2 subphases of stance (0-20% and 21-50% stance). Mixed between-within subjects ANOVAs were used to compare differences between the foot strikes and pre and post run. RESULTS:Subphase 1: FFS group had increased variability over RFS group in 2 medial midfoot-forefoot couples (1.22° and 2.84° difference) while RFS group had increased coupling variability in 1 lateral midfoot-forefoot couple (0.94° difference). Subphase 2: RFS group had increased variability in 3 rearfoot-midfoot couplings over FFS group (3.43°, 3.66°, and 1.30° difference). Subphase 2 post run, both groups increased variability in rearfoot (0.68° difference pre to post run) and 3 rearfoot-midfoot couplings (0.77°, 0.65°, and 0.84° difference). An interaction occurred between group and pre-post run in the midfoot-forefoot where only RFS runners decreased variability over time (0.99°). CONCLUSION: FFS runners had greater variability in subphase 1, while RFS had greater variability in subphase 2 indicating that a FFS may provide better injury protection during the initial heel strike period. Increased variability post-run in subphase 2 suggests that overstressing tissues may be more critical to prevent during subphase 2.

Do footfall patterns in forefoot runners change over an exhaustive run?

ABSTRACTThe purpose of this study was to investigate possible footfall pattern changes in habitual forefoot runners over a prolonged, exhaustive run. A prolonged run was performed to exhaustion in 14 habitual forefoot runners. Vertical ground reaction forces (VGRFs) and kinematics were collected at the beginning and end of the run. Ankle plantar flexor torque and triceps surae electromyographic activity were measured during pre- and post-run isometric contractions. By run’s end, there was an increase in VGRF loading rate and impact peak magnitude, greater dorsiflexion at foot contact and greater knee flexion angle throughout stance. Ankle plantar flexor torque decreased significantly from pre- to post-run tests. This was accompanied by a decrease in the integrated electromyographic activity (iEMG) output for the lateral and medial gastrocnemius. There were significant changes in landing mechanics for forefoot runners that indicate a transition towards more midfoot footfall patterns. A contributing factor may be ankle plantar flexor muscle fatigue that, at touchdown, is exposed to exaggerated eccentric loading. These findings suggest that a forefoot running pattern may become difficult to maintain in longer endurance events, and thus runners should pay attention to this in training to improve performance and mitigate potential injury.

A comparison of haemolytic responses in fore-foot and rear-foot distance runners

ABSTRACTThis study examined the haemolytic effects of an interval-based running task in fore-foot and rear-foot striking runners. Nineteen male distance runners (10 fore-foot, 9 rear-foot) completed 8 × 3 min repeats at 90% vVO2peak on a motorised treadmill. Pre- and post-exercise venous blood samples were analysed for serum haptoglobin to quantify the haemolytic response to running. Vertical ground reaction forces were also captured via a force plate beneath the treadmill belt. Haptoglobin levels were significantly decreased following exercise (P = 0.001) in both groups (but not between groups), suggesting that the running task created a haemolytic stress. The ground reaction force data showed strong effect sizes for a greater peak force (d = 1.20) and impulse (d = 1.37) in fore-foot runners, and a greater rate of force development (d = 2.74) in rear-foot runners. The lack of difference in haptoglobin response between groups may be explained by the trend for fore-foot runners to experience greater peak force and impulse during the stance phase of their running gait, potentially negating any impact of the greater rate of force development occurring from the rear-foot runners’ heel strike. Neither type of runner (fore-foot or rear-foot) appears more susceptible to technique-related foot-strike haemolysis.

Ankle plantarflexion strength in rearfoot and forefoot runners: A novel clusteranalytic approach

The purpose of the present study was to test for differences in ankle plantarflexion strengths of habitually rearfoot and forefoot runners. In order to approach this issue, we revisit the problem of classifying different footfall patterns in human runners. A dataset of 119 subjects running shod and barefoot (speed 3.5m/s) was analyzed. The footfall patterns were clustered by a novel statistical approach, which is motivated by advances in the statistical literature on functional data analysis. We explain the novel statistical approach in detail and compare it to the classically used strike index of Cavanagh and Lafortune (1980).The two groups found by the new cluster approach are well interpretable as a forefoot and a rearfoot footfall groups. The subsequent comparison study of the clustered subjects reveals that runners with a forefoot footfall pattern are capable of producing significantly higher joint moments in a maximum voluntary contraction (MVC) of their ankle plantarflexor muscles tendon units; difference in means: 0.28Nm/kg. This effect remains significant after controlling for an additional gender effect and for differences in training levels.Our analysis confirms the hypothesis that forefoot runners have a higher mean MVC plantarflexion strength than rearfoot runners. Furthermore, we demonstrate that our proposed stochastic cluster analysis provides a robust and useful framework for clustering foot strikes.

Impact shock frequency components and attenuation in rearfoot and forefoot running

BackgroundThe forefoot running footfall pattern has been suggested to reduce the risk of developing running related overuse injuries due to a reduction of impact related variables compared with the rearfoot running footfall pattern. However, only time-domain impact variables have been compared between footfall patterns. The frequency content of the impact shock and the degree to which it is attenuated may be of greater importance for injury risk and prevention than time-domain variables. Therefore, the purpose of this study was to determine the differences in head and tibial acceleration signal power and shock attenuation between rearfoot and forefoot running. MethodsNineteen habitual rearfoot runners and 19 habitual forefoot runners ran on a treadmill at 3.5 m/s using their preferred footfall patterns while tibial and head acceleration data were collected. The magnitude of the first and second head acceleration peaks, and peak positive tibial acceleration were calculated. The power spectral density of each signal was calculated to transform the head and tibial accelerations in the frequency domain. Shock attenuation was calculated by a transfer function of the head signal relative to the tibia. ResultsPeak positive tibial acceleration and signal power in the lower and higher ranges were significantly greater during rearfoot than forefoot running (p < 0.05). The first and second head acceleration peaks and head signal power were not statistically different between patterns (p > 0.05). Rearfoot running resulted in significantly greater shock attenuation for the lower and higher frequency ranges as a result of greater tibial acceleration (p < 0.05). ConclusionThe difference in impact shock frequency content between footfall patterns suggests that the primary mechanisms for attenuation may differ. The relationship between shock attenuation mechanisms and injury is not clear but given the differences in impact frequency content, neither footfall pattern may be more beneficial for injury, rather the type of injury sustained may vary with footfall pattern preference.

Vermehrte Inzidenz von Plantarfasziosen bei Vorfußläufern

Summary More and runners change their running style to forefoot running in order to become faster, run more actively or to prevent typical running injuries. Hence, the aim of the present study was to investigate whether forefoot and rearfoot runners show different injury patterns regarding location and frequency distribution. For this purpose 612 runners who's running pattern was analyzed biomechanically and who were treated at our facility due to various typical running injuries were evaluated retrospectively. 146 out of the 612 patients were forefoot runners, 466 patients were midfoot and forefoot runners. The forefoot runner percentage of the total sample was therefore 23.9% which corresponds approximately to the percentage within a healthy running population. The percentages of forefoot runners within the most of the typical injury groups were also in the same order of magnitude and showed no significant differences (Achilles tendon: 21%, Toe flexors and M. tibialis posterior: 25.7%, pelvis/spine: 25.6%, thigh: 27.8%). Remarkable is, that in contrast to other studies the Achilles tendon injury group showed no increased quota for the forefoot runners. In the group of knee injuries, however, the forefoot runners were represented ony by 19.1%, which indicates that the probability to injure the knee using the forefoot running style is reduced. Within the group of plantar fasciosis the forefoot runners were represented by 34.2%, which is than 30% higher compared to the total sample. Hence, it can be concluded that forefoot runners have a higher risk to injure their plantar fascia than rearfoot runners.