Key Takeaway
Moderate evidence supports biomechanical differences in barefoot running including reduced ground reaction forces and knee extension moments, but insufficient high-quality evidence to draw definitive conclusions about injury risks or benefits.
Summary
This systematic review examined whether running barefoot or in minimalist shoes reduces injuries and improves running economy compared to traditional shod running. The authors searched MEDLINE, SPORTDiscus, and CINAHL databases through September 2013 and analyzed 23 articles using the Downs and Black quality assessment checklist.
The review found moderate evidence for several biomechanical differences when running barefoot versus in shoes: lower maximum vertical ground reaction forces, reduced extension moment and power absorption at the knee, less dorsiflexion at contact, shorter ground contact time, and increased knee flexion at ground contact. These biomechanical shifts suggest a pattern of reduced impact loading and altered joint mechanics.
However, study quality scores ranged from only 13-19 out of 27 points, reflecting evidence quality ranging from very limited to moderate. The authors concluded that no definitive conclusions can be drawn about specific risks or benefits of barefoot, shod, or minimalist running due to the lack of high-quality evidence. They called for more rigorous, prospective research to clarify long-term injury and performance outcomes.
Methods
- Systematic review of 23 peer-reviewed articles
- Databases searched: MEDLINE, SPORTDiscus, CINAHL through September 2013
- Two independent reviewers evaluated study quality
- Used Downs and Black quality assessment checklist (27-point scale)
- Outcome measures included pain, injury rates, running economy, joint forces, velocity, EMG, and muscle performance
Key Results
- Moderate evidence for lower maximum vertical ground reaction forces when barefoot
- Reduced knee extension moment and power absorption barefoot
- Less dorsiflexion at initial contact when barefoot
- Shorter ground contact time in barefoot running
- Increased knee flexion at ground contact when barefoot
- Study quality scores ranged from 13-19 out of 27 (low to moderate quality)
- Insufficient evidence for definitive injury risk or benefit conclusions
Limitations
- Low to moderate study quality across all included articles
- Lack of prospective, long-term injury outcome studies
- Most studies examined acute biomechanical differences, not chronic adaptation
- Heterogeneous study designs limited direct comparisons
- No definitive conclusions possible due to evidence gaps