The Biomechanical Differences Between Barefoot and Shod Distance Running: A Systematic Review and Preliminary Meta-Analysis
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Distance running continues to experience increased participation in the Western world, although it is associated with high injury rates. Barefoot running has been increasingly proposed as a means to prevent overuse injury due to various biomechanical differences, including reduced joint loading rates and altered kinematics and muscle activity patterns compared to shod running.
The aim of this review was to systematically evaluate biomechanical differences between running barefoot and shod, including the quality of available evidence, in order to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities.
A comprehensive search of MEDLINE, Web of Knowledge and EMBASE from inception to January 2013 was performed.
Trials evaluating injury-free recreational or competitive adults who participate in long-distance running (≥5 km), where a comparison of barefoot and shod running lower-limb kinetics, kinematics and/or electromyography were included. Studies examining sprinting and studies of single-subject design were excluded.
Study appraisal and synthesis methods
Following initial searching, two reviewers identified a shortlist of relevant studies based on title and abstract, with the full text of these studies being tested against the inclusion criteria. References of included studies were examined and citation tracking was performed in Web of Knowledge. Two independent reviewers evaluated the methodological quality of each included study using a modified version of the Downs and Black quality index. Results of the quality assessment were used to identify high- and low-quality studies, data pooling was completed where possible and levels of evidence were determined based on the van Tulder criteria.
Eighteen studies were identified, all of low methodological quality. Effect size (ES) calculation was possible for 12 studies. Pooled results indicate moderate evidence that barefoot running is associated with reduced peak ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe. Limited evidence indicates barefoot running is associated with reduced impact GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe. Very limited to limited evidence also indicates power absorption at the knee is decreased while being increased at the ankle whilst barefoot running. Additionally, the effects of barefoot running on loading rate appear dependent on strike pattern adopted, with a forefoot strike pattern found to reduce loading rate, whilst a rearfoot strike pattern increases loading rate when running barefoot compared to shod.
Key methodological weaknesses that must be addressed in future research were identified. Of particular note were absence of investigator blinding, infrequent intervention randomisation, small sample sizes and lack of evaluation following habituation. Two studies could not be retrieved because of publication in a non-English-language journal. Of particular note is that the validity of the body of work is compromised by the lack of evaluation after habituation, or re-training, of previously shod rearfoot-striking runners to barefoot forefoot-striking running styles.
There has been a great deal of publicity for barefoot running, and many claims made about its effects and risks. Despite a large amount of biomechanical data available for meta-analysis, clear guidance for clinical practice is limited because of the low methodological quality of the associated studies. Preliminary biomechanical differences identified suggest barefoot running may be associated with positive biomechanical changes in regards to injury prevention, although this may be dependent on strike pattern adopted. Further research employing more robust methodology, which addresses weaknesses highlighted in this review, is needed to confirm current preliminary evidence. Additionally, prospective research would have higher validity were the biomechanical effects of habituating to barefoot running fully examined alongside an evaluation of prevention of repetitive use injury.
KeywordsGround Reaction Force Overuse Injury Ground Contact Plantar Fasciitis Stride Frequency
This work was unfunded, being the authors’ own-account work at all stages. No authors have any conflicts of interest to declare. All authors contributed to the formulation of the idea, Jonathan Hall and Christian Barton led on the analysis, while Paul Jones also scored the included articles. All authors contributed significantly to the writing of, and also approved, the final manuscript. Professor Irene Davis of Harvard University is thanked for her useful comments on aspects of the Discussion.
- 1.Sporting Goods Manufacturers Association. Sports, Fitness and Recreational Activities Topline Participation Report; 2011.Google Scholar
- 2.Department of Health, Physical Activity, Health Improvement and Protection. Start Active, Stay Active; 2011. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128210.pdf (Accessed 22 Feb 2012).
- 3.National Health Service. Benefits of exercise 2011 [cited 2011 6th December]. http://www.nhs.uk/livewell/fitness/pages/whybeactive.aspx.
- 7.Zadpoor AA, Nikooyan AA. The relationship between lower-extremity stress fractures and the ground reaction force: a systematic review. Clin Biomech (Bristol, Avon). 2011;26(1):23–8.Google Scholar
- 11.Williams DS, McClay IS, Manal KT. Lower extremity mechanics in runners with a converted forefoot strike pattern. J Appl Biomech. 2000;16(2):210–8.Google Scholar
- 12.Laughton CA, Davis IM, Hamill J. Effect of strike pattern and orthotic intervention on tibial shock during running. J Appl Biomech. 2003;19(2):153–68.Google Scholar
- 24.Rothschild C. Running barefoot or in minimalist shoes: evidence or conjecture? J Strength Cond Res. 2012;34(2).Google Scholar
- 25.Rixe JA, Gallo RA, Silvis ML. The barefoot debate: can minimalist shoes reduce running-related injuries? Curr Sports Med Rep. 2012;11(3).Google Scholar
- 28.van Tulder M, Furlan A, Bombardier C, Bouter L; Editorial Board Cochrane C. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2003;28(12):1290–9.Google Scholar
- 34.Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The effect of running shoes on lower extremity joint torques. PM R. 2009;1(12):1058–63.Google Scholar
- 44.Baur H, Hirschmuller A, Muller S, Mayer F. Effects of functional elements of orthotic insoles in sports. Deutsche Zeitschrift Fur Sportmedizin. 2003;54(11):323–8.Google Scholar
- 45.Serrão JC, Amadio AC. Kinetic and electromyographic adaptations in barefoot locomotion. Braz J Biomech. 2001;2(2):43–51.Google Scholar
- 48.Hobara H, Sato T, Sakaguchi M, Nakazawa K. Step frequency and lower extremity loading during running. Int J Sports Med. 2012;33(4):10–3.Google Scholar
- 54.Ness ME, Long J, Marks R, Harris G. Foot and ankle kinematics in patients with posterior tibial tendon dysfunction. Gait Posture. 2008;27(2).Google Scholar