Side stitches, runner’s knee, sprained ligaments, irritated tendons, knee or hip pain — almost every runner experiences complaints at some point in their running career.
No surprise: with roughly 1,000 foot strikes per kilometer, the repetitive load is high. Sports medicine estimates place the injury rate among runners at about 30 percent. In total, 28 running‑related injuries are described.
Notably, the five most common problems occur below the knee. Studies show that pain along the medial or lateral borders of the shin is most frequent (medial tibial stress syndrome), followed by Achilles tendinopathy, plantar fasciitis, pain at the kneecap/anterior knee (patellar tendinopathy), and ankle sprains.
Despite 40 years of research and innovation in the running‑shoe industry, injury rates among runners are higher than ever.
The human foot is a masterpiece of engineering that doesn’t need external “support.” You can picture it as a twisted, spring‑like plate anchored to the ground at the front by the toes. At initial contact, the plate “opens” and lengthens to absorb impact. The plantar fascia pulls the toes into the ground (the reverse windlass mechanism), anchoring the foot and creating a stable base.
As body weight moves forward, the heel lifts and the toe joints act as pivots (windlass mechanism). Now the toes tension the plantar fascia, the arch rises, and the foot twists and shortens. The spring becomes tighter and stiffer—ready for the critical push‑off.
The forefoot optimizes propulsion, the midfoot provides mobility, and the heel attenuates impact.
Learn more in our YouTube video
This is exactly where the shoe industry intervenes—and prevents the foot from working as a mobile shock absorber and a stable lever for propulsion. Aiming to reduce injuries, it introduces innovations that create new problems. Harvard professor Daniel E. Lieberman and colleagues have shown how toe spring disables the toe flexor muscles and increases injury risk.
You can see it every day:
because roll‑through over the big toe is blocked, runners avoid the necessary torque, turn the foot outward, and pronate more. The trend toward carbon plates in the midsole is equally paradoxical. The foot is effectively “cast” in a single direction; the calf muscles and Achilles tendon lose their jobs and grow weaker. Multiple studies and expert reports from leading biomechanists also show that big‑toe position influences rearfoot pronation during stance.
The more deformed and “shoe‑shaped” the big toe is (hallux valgus), the more pronounced the pronation. And the industry helps create this hallux valgus by sticking with asymmetrical lasts that squeeze the toes in the forefoot.
Instead of forcing pronation control at the rearfoot, the data suggest a different approach:
running shoes need more room up front. Greater space in the forefoot immediately increases stability and helps prevent long‑term injuries below the knee. The good news: even with knee or Achilles pain, the body can recover. If you choose anatomically correct, foot‑shaped shoes for daily life and running, you can restore the foot’s structure and function—and enjoy your sport sustainably, free from pain and injury.
- Medial tibial stress syndrome (shin splints): incidence 13.6–20%, prevalence 9.5%
- Achilles tendinopathy: incidence 9.1–10.9%, prevalence 6.2–9.5%
- Plantar fasciitis: incidence 4.5–10.0%, prevalence 5.2–17.5%
- Patellar tendinopathy: incidence 5.5–22.7%, prevalence 12.5%
- Ankle sprain: incidence 10.9–15%, prevalence 9.5%
Source: Lopes et al., 2012.
Lee Saxby is one of the world’s most renowned running‑technique coaches. His knowledge and experience in biomechanics and foot function have helped injured runners at every level—from recreational to elite.
Together with Sebastian Bär, he is bringing the principles of natural foot function to a wider audience and putting the most underestimated part of the body in focus: our feet.
