Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Meta-analysis.

STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To determine the biomechanical differences between foot-strike patterns used when running. BACKGROUND Strike patterns during running have received attention in the recent literature due to their potential mechanical differences and associated injury risks. METHODS Electronic databases (MEDLINE, Embase, LILACS, SciELO, and SPORTDiscus) were searched through July 2014. Studies (cross-sectional, case-control, prospective, and retrospective) comparing the biomechanical characteristics of foot-strike patterns during running in distance runners at least 18 years of age were included in this review. Two independent reviewers evaluated the risk of bias. A meta-analysis with a random-effects model was used to combine the data from the included studies. RESULTS Sixteen studies were included in the final analysis. In the meta-analyses of kinematic variables, significant differences between forefoot and rearfoot strikers were found for foot and knee angle at initial contact and knee flexion range of motion. A forefoot-strike pattern resulted in a plantar-flexed ankle position and a more flexed knee position, compared to a dorsiflexed ankle position and a more extended knee position for the rearfoot strikers, at initial contact with the ground. In the comparison of rearfoot and midfoot strikers, midfoot strikers demonstrated greater ankle dorsiflexion range of motion and decreased knee flexion range of motion compared to rearfoot strikers. For kinetic variables, the meta-analysis revealed that rearfoot strikers had higher vertical loading rates compared to forefoot strikers. CONCLUSION There are differences in kinematic and kinetic characteristics between foot-strike patterns when running. Clinicians should be aware of these characteristics to help in the management of running injuries and advice on training.