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Forefoot running improves pain of chronic exertional compartment syndrome

NEW YORK (Reuters Health) – Forefoot strike running can improve the pain and disability associated with chronic exertional compartment syndrome (CECS), according to findings published recently.

“As long as the patient is willing to modify their running form, forefoot running training should be the first management technique utilized for CECS,” said the study’s lead author, Major Angela R. Diebal, in an email to Reuters Health.

At Keller Army Community Hospital at West Point, New York, Dr. Diebal and colleagues tested a forefoot running technique intervention in 10 consecutive patients (8 male, 2 female) with CECS symptoms for at least 10 months.

All patients demonstrated a hindfoot striking gait pattern during the initial running examination, and they all reported leg pain that started within the first five minutes of running and progressively worsened while running.

According to a report online March 16 in The American Journal of Sports Medicine, instruction and training to adopt a forefoot strike running technique led to significant reductions in intracompartmental pressures.

These improvements translated into significant increases in running difference (from 1.4 to 4.8 km), significant differences in pain while running (from 71.3 to 2.7 mm on visual analog scale), and significant increases in rates of perceived exertion.

As late as one year after the intervention, eight of the 10 patients were running at least 5 km two to three times per week. The other two patients reported no running limitations before recent anterior cruciate ligament tear (one patient) and ankle sprain (one patient).

All 10 patients were able to return to sports participation without limitation, and none required fasciotomy.

Step length and contact time decreased while step rate increased significantly after the intervention.

“Forefoot running training can be performed by any certified professional,” Dr. Diebal said. “One helpful website is; on this website you can search for certified running coaches in your state.”

She added, “Remind patients that changing their running form is difficult (for some more so than others) but with perseverance it can be done and done in a short amount of time.”

Dr. Diebal also recommended a nine-minute instructional video developed by herself and another Army PT, Jennifer Rieger. The video (viewable on YouTube at gives an overall idea of the running form as well as the training drills performed.


Am J Sports Med 2012.