Sports Medicine

, Volume 43, Issue 12, pp 1335–1353 | Cite as

The Biomechanical Differences Between Barefoot and Shod Distance Running: A Systematic Review and Preliminary Meta-Analysis

  • Jonathan P. L. Hall
  • Christian Barton
  • Paul Remy Jones
  • Dylan MorrisseyEmail author
Systematic Review



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.

Data sources

A comprehensive search of MEDLINE, Web of Knowledge and EMBASE from inception to January 2013 was performed.

Study selection

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.


Ground Reaction Force Overuse Injury Ground Contact Plantar Fasciitis Stride Frequency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

40279_2013_84_MOESM1_ESM.doc (148 kb)
Supplementary material 1 (DOC 147 kb)


  1. 1.
    Sporting Goods Manufacturers Association. Sports, Fitness and Recreational Activities Topline Participation Report; 2011.Google Scholar
  2. 2.
    Department of Health, Physical Activity, Health Improvement and Protection. Start Active, Stay Active; 2011. (Accessed 22 Feb 2012).
  3. 3.
    National Health Service. Benefits of exercise 2011 [cited 2011 6th December].
  4. 4.
    van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Hreljac A. Impact and overuse injuries in runners. Med Sci Sports Exerc. 2004;36(5):845–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32(9):1635–41.CrossRefPubMedGoogle Scholar
  7. 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
  8. 8.
    Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clin J Sport Med. 2009;19(5):372–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Nigg BM, Wakeling JM. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev. 2001;29(1):37–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Chuter VH, Janse de Jonge XA. Proximal and distal contributions to lower extremity injury: a review of the literature. Gait Posture. 2012;36(1):7–15.CrossRefPubMedGoogle Scholar
  11. 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. 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
  13. 13.
    Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44(7):1325–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Diebal AR, Gregory R, Alitz C, Gerber JP. Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med. 2012;40:1060–7.CrossRefPubMedGoogle Scholar
  16. 16.
    von Tscharner V, Goepfert B, Nigg BM. Changes in EMG signals for the muscle tibialis anterior while running barefoot or with shoes resolved by non-linearly scaled wavelets. J Biomech. 2003;36(8):1169–76.CrossRefGoogle Scholar
  17. 17.
    Novacheck TF. The biomechanics of running. Gait Posture. 1998;7(1):77–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Lieberman DE. What we can learn about running from barefoot running: an evolutionary medical perspective. Exerc Sport Sci Rev. 2012;40(2):63–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br J Sports Med. 2009;43(3):159–62.CrossRefPubMedGoogle Scholar
  20. 20.
    Squadrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009;49(1):6–13.PubMedGoogle Scholar
  21. 21.
    Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M. Athletic footwear, leg stiffness, and running kinematics. J Athl Train. 2006;41(4):387–92.PubMedGoogle Scholar
  22. 22.
    Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PLos ONE. 2013;8:1.CrossRefGoogle Scholar
  23. 23.
    Jenkins DW, Cauthon DJ. Barefoot running claims and controversies a review of the literature. J Am Podiatr Med Assoc. 2011;101(3):231–46.PubMedGoogle Scholar
  24. 24.
    Rothschild C. Running barefoot or in minimalist shoes: evidence or conjecture? J Strength Cond Res. 2012;34(2).Google Scholar
  25. 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
  26. 26.
    Fong Yan A, Sinclair PJ, Hiller C, Wegener C, Smith RM. Impact attenuation during weight bearing activities in barefoot vs. shod conditions: a systematic review. Gait Posture. 2013;38:175–86.CrossRefPubMedGoogle Scholar
  27. 27.
    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.CrossRefPubMedGoogle Scholar
  28. 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
  29. 29.
    Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47:207–14.CrossRefPubMedGoogle Scholar
  30. 30.
    Morley JB, Decker LM, Dierks T, Blanke D, French JA, Stergiou N. Effects of varying amounts of pronation on the mediolateral ground reaction forces during barefoot versus shod running. J Appl Biomech. 2010;26(2):205–14.PubMedGoogle Scholar
  31. 31.
    Divert C, Mornieux G, Baur H, Mayer F, Belli A. Mechanical comparison of barefoot and shod running. Int J Sports Med. 2005;26(7):593–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Stacoff A, Kalin X, Stussi E. The effects of shoes on the torsion and rearfoot motion in running. Med Sci Sports Exerc. 1991;23(4):482–90.CrossRefPubMedGoogle Scholar
  33. 33.
    Komi PV, Gollhofer A, Schmidtbleicher D, Frick U. Interaction between man and shoe in running—considerations for a more comprehensive measurement approach. Int J Sports Med. 1987;8(3):196–202.CrossRefPubMedGoogle Scholar
  34. 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
  35. 35.
    Braunstein B, Arampatzis A, Eysel P, Brueggemann G-P. Footwear affects the gearing at the ankle and knee joints during running. J Biomech. 2010;43(11):2120–5.CrossRefPubMedGoogle Scholar
  36. 36.
    McNair PJ, Marshall RN. Kinematic and kinetic-parameters associated with running in different shoes. Br J Sports Med. 1994;28(4):256–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Kurz MJ, Stergiou N. The spanning set indicates that variability during the stance period of running is affected by footwear. Gait Posture. 2003;17(2):132–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Kurz MJ, Stergiou N. Does footwear affect ankle coordination strategies? J Am Podiatr Med Assoc. 2004;94(1):53–8.PubMedGoogle Scholar
  39. 39.
    Bonacci J, Saunders PU, Hicks A, Rantalainen T, Vicenzino BG, Spratford W. Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med. 2013;47:387–92.CrossRefPubMedGoogle Scholar
  40. 40.
    De Wit B, De Clercq D, Aerts P. Biomechanical analysis of the stance phase during barefoot and shod running. J Biomech. 2000;33(3):269–78.CrossRefPubMedGoogle Scholar
  41. 41.
    Divert C, Baur H, Mornieux G, Mayer F, Belli A. Stiffness adaptations in shod running. J Appl Biomech. 2005;21(4):311–21.PubMedGoogle Scholar
  42. 42.
    Williams DS 3rd, Green DH, Wurzinger B. Changes in lower extremity movement and power absorption during forefoot striking and barefoot running. Int J Sports Phys Ther. 2012;7(5):525–32.PubMedGoogle Scholar
  43. 43.
    Burkett LN, Kohrt WM, Buchbinder R. Effects of shoes and foot orthotics on VO2 and selected frontal plane knee kinematics. Med Sci Sports Exerc. 1985;17(1):158–63.CrossRefPubMedGoogle Scholar
  44. 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. 45.
    Serrão JC, Amadio AC. Kinetic and electromyographic adaptations in barefoot locomotion. Braz J Biomech. 2001;2(2):43–51.Google Scholar
  46. 46.
    Bates BT, Osternig LR, Mason B, James LS. Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sports Med. 1979;7(6):338–42.CrossRefPubMedGoogle Scholar
  47. 47.
    Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296–302.CrossRefPubMedGoogle Scholar
  48. 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
  49. 49.
    Cheung RTH, Davis IS. Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Ther. 2011;41(12):914–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Stergiou N, Bates BT, James SL. Asynchrony between subtalar and knee joint function during running. Med Sci Sports Exerc. 1999;31(11):1645–55.CrossRefPubMedGoogle Scholar
  51. 51.
    Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when running step rate is increased. Gait Posture. 2012;36(2):231–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Tessutti V, Trombini-Souza F, Ribeiro AP, Nunes AL, Neves Sacco IdC. In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners. J Sci Med Sport. 2010;13(1):151–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Derrick TR. The effects of knee contact angle on impact forces and accelerations. Med Sci Sports Exerc. 2004;36(5):832–7.CrossRefPubMedGoogle Scholar
  54. 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
  55. 55.
    Tome J, Nawoczenski DA, Flemister A, Houck J. Comparison of foot kinematics between subjects with posterior tibialis tendon dysfunction and healthy controls. J Orthop Sports Phys Ther. 2006;36(9):635–44.CrossRefPubMedGoogle Scholar
  56. 56.
    Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011;34(7):e320–3.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Jonathan P. L. Hall
    • 1
  • Christian Barton
    • 1
  • Paul Remy Jones
    • 1
  • Dylan Morrissey
    • 1
    Email author
  1. 1.Centre for Sports and Exercise Medicine, William Harvey Research InstituteBart’s and the London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK

Personalised recommendations