Transition to forefoot strike reduces load rates more effectively than altered cadence

Abstract

Background: Excessive vertical impacts at landing are associated with common running injuries. Two primary gait-retraining interventions aimed at reducing impact forces are transition to forefoot strike and increasing cadence. The objective of this study was to compare the short- and long-term effects of 2 gait-retraining interventions aimed at reducing landing impacts.

Methods: A total of 39 healthy recreational runners using a rearfoot strike and a cadence of ≤170 steps/min were randomized into cadence (CAD) or forefoot strike (FFS) groups. All participants performed 4 weeks of strengthening followed by 8 sessions of gait-retraining using auditory feedback. Vertical average load rates (VALR) and vertical instantaneous load rates (VILR) were calculated from the vertical ground reaction force curve. Both cadence and foot strike angle were measured using 3D motion analysis and an instrumented treadmill at baseline and at 1 week, 1 month, and 6 months post retraining.

Results: ANOVA revealed that the FFS group had significant reductions in VALR (49.7%) and VILR (41.7%), and changes were maintained long term. Foot strike angle in the FFS group changed from 14.2° dorsiflexion at baseline to 3.4° plantarflexion, with changes maintained long term. The CAD group exhibited significant reduction only in VALR (16%) and only at 6 months. Both groups had significant and similar increases in cadence at all follow-ups (CAD, +7.2% to 173 steps/min; and FFS, +6.1% to 172 steps/min).

Conclusion: Forefoot strike gait-retraining resulted in significantly greater reductions in VALR and similar increases in cadence compared to cadence gait-retraining in the short and long term. Cadence gait-retraining resulted in small reductions in VALR at only the 6-month follow-up.

Keywords: Foot strike; Gait-retraining; Physical therapy; Running; Step rate.