The biomechanical differences between barefoot and shod distance running: a systematic review and preliminary meta-analysis

A comparison of foot and ankle biomechanics during running drills and distance running

The aim of this study was to compare the foot-ankle joint mechanics of running drills and running. Seventeen long-distance runners performed five popular running drills (A-skip, B-skip, Bounding, Heel flicks, Straight leg running) and a run at 3.88 m/s. Kinematics, kinetics and power values were calculated for the ankle, midtarsal (MT) and metatarsophalangeal (MP) joints. Electromyographic activity was recorded for the soleus, gastrocnemius medialis, lateralis and abductor hallucis muscle. The A-skip, the B-skip and the Heel flicks induced a smaller ankle (p < 0.001, ŋ2 = 0.41), MT (p < 0.001, ŋ2 = 0.43) and MP (p < 0.001, ŋ2 = 0.47) dorsiflexion peak than running. No difference was found between the running drills and running for ankle, MT and MP moment. The Bounding induces a higher positive ankle power than running (diff: 5.5 ± 7.5 J/kg, p = 0.014, d = 1.05). The A-skip (diff: 2.8 ± 2.9 J/kg, p < 0.001, d = 1.5) and the B-skip (diff: 2.7 ± 2.1 J/kg, p < 0.001, d = 1.4) induce a smaller MT positive power than running. This study offers an analysis of the mechanical behaviour of the foot-ankle complex to help track and field coaches select their running drills in an evidence-based manner.

Enhancing running injury prevention strategies with real-time biofeedback: A systematic review and meta-analysis

The number of runners and the incidence of running-related injuries (RRIs) are on the rise. Real-time biofeedback gait retraining offers a promising approach to RRIs prevention. However, due to the diversity in study designs and reported outcomes, there remains uncertainty regarding the efficacy of different forms of feedback on running gait biomechanics. Three databases: MEDLINE, PUBMED, and SPORTDiscus were searched to identify relevant studies published up to March 2024, yielding 4646 articles for review. The quality of the included studies was assessed using the Downs and Black Quality checklist. Primary outcomes, including Peak Tibial Acceleration (PTA), Vertical Average Loading Rate (VALR), and Vertical Instantaneous Loading Rate (VILR), were analysed through meta-analysis. 24 studies met the inclusion criteria and were analysed in this review.17 used visual biofeedback (VB) while 14 chose auditory biofeedback (AB). The meta-analysis revealed a reduction in loading variables both immediately following the intervention and after extended training, with both visual and auditory feedback. Notably, the decrease in loading variables was more pronounced post-training and VB proved to be more effective than AB. Real-time biofeedback interventions are effective in lowering loading variables associated with RRIs. The impact is more substantial with sustained training, and VB outperforms AB in terms of effectiveness.

Metatarsals and foot phalanges from the Sima de los Huesos Middle Pleistocene site (Atapuerca, Burgos, Spain)

This study provides a complete, updated and illustrated inventory, as well as a comprehensive study, of the metatarsals and foot phalanges (forefoot) recovered from the Middle Pleistocene site of Sima de los Huesos (SH, Atapuerca, Spain) in comparison to other Homo comparative samples, both extant and fossils. This current updated review has established a minimum number of individuals (MNI) of 17, which represent 58.6% of the 29 dental individuals identified within the SH sample. An exclusive or autoapomorphic combination of traits can be recognized within the SH hominin foot sample. A few traits appear primitive or plesiomorphic when compared with earlier Homo individuals and other recent modern humans. There are other metrical and morphological traits that SH hominins and Neandertals have in common that sometimes represent shared derived traits in this evolutionary line, most of which are probably related to robusticity. Furthermore, some exclusive autoapomorphic traits are observed in the SH sample: a very broad first metatarsal, long and broad hallucal proximal foot phalanges and possibly extremely robust lateral distal foot phalanges compared to those of Neandertals and modern humans. In these last traits, the SH metatarsals and pedal phalanges are even more robust than in Neandertals. They are herein named as "hyper-Neandertal" traits, which could suggest a slight gracilization process in this evolutionary line, at least in the hallux toe. Finally, some paleobiological inferences are made in relation to body size (stature and body mass) and some associations are proposed within the SH sample.

Increasing cadence with a metronome and running barefoot changes the sagittal kinematics of the lower limbs and trunk

The purpose was to compare two non-laboratory based running retraining programs on lower limb and trunk kinematics in recreational runners. Seventy recreational runners (30 ± 7.3 years old, 40% female) were randomised to a barefoot running group (BAR), a group wearing a digital metronome with their basal cadence increased by 10% (CAD), and a control group (CON). BAR and CAD groups included intervals from 15 to 40 min over 10 weeks and 3 days/week. 3D sagittal kinematics of the ankle, knee, hip, pelvis, and trunk were measured before and after the retraining program, at comfortable and high speeds. A 3 × 2 mixed ANOVA revealed that BAR and CAD groups increased knee and hip flexion at footstrike, increased peak hip flexion during stance and flight phase, decreased peak hip extension during flight phase, and increased anterior pelvic tilt at both speeds after retraining. In addition, BAR increased ankle plantar flexion at footstrike and increased anterior trunk tilt. Both retraining programs demonstrated significant moderate to large effect size changes in parameters that could reduce the mechanical risks of injury associated with excessive knee stress, which is of interest to coaches, runners and those prescribing rehabilitation and injury prevention programs.

The effect of attentional cues on mechanical efficiency and movement smoothness in running gait: An interdisciplinary investigation

The aim was to examine the effect of focus of attention cues on foot angle for retraining movement purposes. Twenty (females: 8) rearfoot-striking recreational runners (mass: 72.5 ± 11.8 kg; height: 1.73 ± 0.09 m; age: 32.9 ± 11.3 years) were randomly assigned to an internal focus (IF) (n = 10) or external focus (EF) (n = 10) verbal cue group. Participants performed 5 × 6 minute blocks of treadmill running (control run, 3 × cued running, retention run) at a self-selected running velocity (9.4 ± 1.1 km∙h-1) during a single laboratory visit. Touchdown foot angle, mechanical efficiency, internal and external work were calculated and, centre of mass (COM) and foot movement smoothness was quantified. Linear-mixed effect models showed an interaction for foot angle (p < 0.001, ηp2 = 0.35) and mechanical efficiency (p < 0.001, ηp2 = 0.40) when comparing the control to the cued running. Only the IF group reduced foot angle and mechanical efficiency during cued running, but not during the retention run. The IF group produced less external work during the 1st cued run than the control run. COM and foot smoothness were unaffected by cueing. Only an IF produced desired technique changes but at the cost of reduced mechanical efficiency. Movement smoothness was unaffected by cue provision. Changes to foot angle can be achieved within 6 minutes of gait retraining.

Effect of Foot Rehabilitation Exercises for Painful Flat Foot in a 20-Year-Old Female: A Case Study Analysis

Pes planus, commonly referred to as flatfoot, is a congenital foot deformity characterized by the descent of the medial longitudinal arch, resulting in reduced spring action and increased stress on the foot during ambulation. This condition, opposite to pes cavus, typically lacks symptomatic presentation despite its structural abnormality. This case report discusses a 20-year-old female presenting to the musculoskeletal department of physiotherapy with impaired gait attributed to developmental flatfeet and an underdeveloped heel on one foot since birth. Apart from these foot deformities, no other significant abnormalities were noted upon examination. Orthotic management and ongoing monitoring have been initiated to facilitate functional independence. The prognosis for the patient's gait impairment remains optimistic with continued rehabilitation efforts aimed at dispelling misconceptions and barriers surrounding the correction of flatfoot deformities. This report underscores the importance of comprehensive rehabilitation strategies in managing flatfoot conditions to optimize patient outcomes and quality of life.

Maximalist Shoes: Separating Science From Hype

One of the most discussed but misunderstood topics in foot and ankle is shoe wear choices and the purported benefits of each type of shoe versus their actual scientific advantages. All foot and ankle care providers should be familiar with the various shoe wear types available to patients to improve their overall foot health. Recently, mainstream popularity and media coverage of maximalist shoes has created increased interest in the science and potential clinical benefits of maximalist shoes. The purpose of this review is to present the current biomechanical evidence of maximalist shoes and to help inform the foot and ankle community of their potential therapeutic applications.Levels of Evidence: Level V.

Larger Achilles and plantar fascia induce lower duty factor during barefoot running

OBJECTIVES

Tendons play a crucial role allowing the storage and release of mechanical energy during the running cycle. Running kinematics, including duty factor, constitute a basic element of the runner's biomechanics, and can determine their performance. This study aimed to analyze the link between Achilles tendon and plantar fascia morphology and running parameters, considering the influence of wearing shoes versus running barefoot.

DESIGN

Cross-sectional study.

METHODS

44 participants (30 men and 14 women) engaged in two running sessions, one with shoes and one without, both lasting 3 min at a consistent speed of 12 km/h. We captured running kinematic data using a photoelectric cell system throughout the sessions. Before the trials, we measured the thickness and cross-sectional area of both the Achilles tendon and plantar fascia using ultrasound.

RESULTS

The Pearson test revealed a significant correlation (p < 0,05) between Achilles tendon and plantar fascia morphology and contact time (r > -0.325), flight time (r > -0.325) and duty factor (ratio of ground contact to stride time) (r > -0.328) during barefoot running. During the shod condition, no significant correlation was found between connective tissue morphology and kinematic variables.

CONCLUSIONS

In barefoot running, greater size of the Achilles tendon and plantar fascia results in a reduced duty factor, attributed to longer flight times and shorter contact times.

Effect of Footwear Versus Barefoot on Double-Leg Jump-Landing and Jump Height Measures: A Randomized Cross-Over Study

Background

Assessing individuals in their own athletic footwear in clinics is common, but can affect movement, performance, and clinical measures.

Purpose

The aim was to compare overall Landing Error Scoring System (LESS) scores, injury risk categorization, specific LESS errors, and jump heights between habitual athletic footwear and barefoot conditions.

Study design

Randomized cross-over laboratory study.

Methods

Eighty healthy individuals (55% male) completed the LESS following standard procedures (i.e., land from a 30-cm box to a distance of 50% of body height and then jump upwards maximally). Participants performed the LESS three times in two randomized conditions: footwear and barefoot. LESS data were extracted from 2D videos to compare group-level mean LESS scores, group-level and individual-level injury risk categorization (5-error threshold), specific landing errors, and jump heights between conditions.

Results

LESS scores were significantly greater (0.3 errors, p=0.022) and jump heights were significantly lower (0.6 cm, p=0.029) in footwear than barefoot, but differences were trivial (d = 0.18 and -0.07, respectively) and not clinically meaningful. Although the number of high injury-risk participants was not statistically different at a group level (p=1.000); 27 individuals (33.8%) exhibited a clinically meaningful difference between conditions of one error or more in LESS score, categorization was inconsistent for 16.3% of individuals, and four of the 17 landing errors significantly differed between conditions.

Conclusion

At a group level, habitual athletic footwear does not meaningfully influence LESS scores, risk categorization, or jump height. At an individual level, footwear can meaningfully affect LESS scores, risk categorization, and alter landing strategies. Use of consistent protocol and footwear is advised for assessing movement patterns and injury risk from the LESS given the unknown predictive value of this test barefoot.

Level of Evidence

Level 3.©The Author(s).

Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners

There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.

[The influence of footwear on the human gait]

The development of individual gait and running patterns is influenced by internal (anatomical, anthropometric) and external (activity-related, environmental) factors. The predominantly used rearfoot running style is mainly attributed to the use of cushioned shoes, although from an anthropological perspective running barefoot, and thus running forefoot, is considered to be more natural. Numerous studies have shown a long-term influence of habitual footwear use on foot morphology, running biomechanics and basic motor skills. It has further been shown that an acute change in footwear, e.g. by running barefoot, immediately changes kinematics and vertical load parameters. However, to date, there is no strong evidence for an influence of habitual footwear use or footstrike patterns on the prevalence of injuries or physical complaints.

Validity of IMU measurements on running kinematics in non-rearfoot strike runners across different speeds

This study aims to determine the validity of the lower extremity joint kinematics measured by inertial measurement units (IMUs) in non-rearfoot strike pattern (NRFS) runners across different speeds. Fifteen NRFS runners completed three 2-min running tests on a treadmill in random order at 8, 10 and 12 km/h, whilst data were synchronously collected using the IMU system and an optical motion capture system. Before the offset was corrected, the validity of the knee angle waveform was higher than that of the hip and ankle; after the offset was corrected, the validity increased in all three joints. The correlation between the touchdown angles in the sagittal plane measured by the two systems was relatively high after the offset was corrected. The running speed influenced the offset-corrected measurements, with higher error values at higher speeds. The IMU system was able to provide measurements of running kinematics in the sagittal plane of NRFS runners at different running speeds but was unable to reliably measure motion in the frontal and horizontal planes. Future research should analyse the 3D gait of NRFS runners under a larger range of speed conditions to provide evidentiary support for the use of IMUs in running analysis outside the laboratory.

Simulation of Lower Limb Muscle Activation Using Running Shoes with Different Heel-to-Toe Drops Using Opensim

BACKGROUND

Although numerous studies have been conducted to investigate the acute effects of shoe drops on running kinematics and kinetic variables, their effects on muscle forces remain unknown. Thus, the primary aim of this study was to compare the muscle force, kinematics, and kinetic variables of habitually rearfoot runners with heel-to-toe drops of negative 8 mm shoes (minimalist shoes) and positive 9 mm shoes (normal shoes) during the running stance phase by using musculoskeletal modeling and simulation techniques.

METHODS

Experimental data of lower limb kinematics, ground reaction force, and muscle activation from 16 healthy runners with rearfoot strike patterns were collected and analyzed in OpenSim. Using Matlab, the statistical parameter mapping paired t-test was used to compare the joint angle, moment, and muscle force waveform.

RESULTS

The results revealed differences in the sagittal ankle and hip angles and sagittal knee moments between the different heel-to-toe drops of running shoes. Specifically, it showed that the negative 8 mm running shoes led to significantly smaller values than the positive 9 mm running shoes in terms of the angle of ankle dorsiflexion, ankle eversion, knee flexion, hip flexion, and hip internal and hip external rotation. The peak ankle dorsiflexion moment, ankle plantarflexion moment, ankle eversion moment, knee flexion moment, knee abduction moment, and knee internal rotation also decreased obviously with the minimalist running shoes, while the lateral gastrocnemius, Achilleas tendon, and extensor hallucis longus muscles were obviously greater in the minimalist shoes compared to normal shoes. The vastus medialis, vastus lateralis and extensor digitorum longus muscles force were smaller in the minimalist shoes.

CONCLUSIONS

Runners may shift to a midfoot strike pattern when wearing negative running shoes. High muscle forces in the gastrocnemius lateral, Achilleas tendon, and flexor hallucis longus muscles may also indicate an increased risk of Achilleas tendonitis and ankle flexor injuries.

Effects of load carriage on measures of postural sway in healthy, young adults: A systematic review and meta-analysis

Load carriage (LC) is a contributing factor to musculoskeletal injury in many occupations. Given that falls are a common mechanism of injury for those frequently engaging in LC, understanding the effects of LC on postural stability (PS) is necessary. A systematic review and meta-analysis was conducted to examine effects of LC on PS. Sixteen and 9 studies were included in the qualitative and quantitative synthesis, respectively. In most studies, it was found that LC leads to a decrease in PS with significant effects on center of pressure (COP) sway area (standardized mean difference = 0.45; p < 0.005) and COP anterior-posterior excursion (standardized mean difference = 0.52; p < 0.05). Furthermore, load magnitude and load placement are factors which can significantly affect COP measures of PS. It is recommended to minimize load magnitude and equally distribute load when possible to minimize LC effects on PS. Future research should examine additional factors contributing to differences in individual PS responses to LC such as changes in muscle activation and prior LC experience.

Effects of minimalist shoes on pelvic floor activity in nulliparous women during running at different velocities: a randomized cross-over clinical trial

In the last decade, minimalist shoes have gained popularity as an alternative to traditional shoes. The aim of the present study was to determine the short-term effects of minimalist shoes in femur range of motion (ROM) and cadence. The secondary objectives were the assessment of the electromyographic activity of the pelvic floor muscles (PFM) in nulliparous women. A randomized, prospective cross-over clinical trial design was used for the study. A total of 51 participants were randomly allocated into a two-sequence crossover design (AB/BA crossover design). Femur ROM, cadence and PFM activity were recorded. The femur ROM at 6 km/h was greater with the minimalist shoes by 1.62 degrees than with the traditional ones (p = 0.001). There was a main effect of the type of shoe (p = 0.015) systematically observing a higher running cadence with the minimalist shoe compared to the traditional one. Electromyographic activity of the PFM revealed significant differences for 11 km/h for the total average (p = 0.027) and the minimum peaks at 9 km/h (p = 0.011) and 11 km/h (p = 0.048) for the minimalist shoe with respect to the traditional shoes. Minimalist shoes produce immediate effects on the biomechanical variables of running. An increase was observed in the femur ROM at 6 km/h and in the cadence at 11 km/h with the use of minimalist shoes. The use of minimalist shoes increased the electromyographic activation of the PFM in the minimum peaks at speeds of 9 and 11 km/h and in the total average at speeds of 11 km/h compared to the traditional shoe.

Barefoot Running on Grass as a Potential Treatment for Plantar Fasciitis: A Prospective Case Series

BACKGROUND

Foot characteristics and running biomechanics in shod populations are associated with the aetiology of plantar fasciitis, the most common musculoskeletal disease of the foot. Previous Case reports have demonstrated improvements in the symptoms of plantar fasciitis after a period of barefoot running on grass.

METHODS

Recreational runners with symptomatic plantar fasciitis were prospectively enrolled into a 6-week grass based barefoot running programme. Duration of symptoms, previous management and current pain scores (NRS, VAS) were recorded at entry. Daily pain scores were recorded during the 6-week period and 12 weeks from entry to the programme.

RESULTS

In total, 20 of 28 patients (71.4%) enrolled were included in the analysis. Relative to the entry point, pain at 6-weeks was lower (2.5 ± 1.4 vs. 3.9 ± 1.4, p < 0.001) and pain at the 12-week point was lower (1.5 (1.8), p = 0.002). 19 out of 20 patients had improved at week-6 (mean ± SD % change in pain score, -38.8 ± 21.5%) and at week-12 (median (IQR) % change in pain score, -58.3 (34.8) %).

CONCLUSION

Barefoot running on grass improved pain associated with plantar fasciitis at the 6-week and 12-week follow up points. This type of barefoot running has the ability to improve symptoms whilst allowing patients to continue running, the intervention may also address some impairments of the foot associated with plantar fasciitis.

The influence of surface and speed on biomechanical external loads obtained from wearable devices in rearfoot strike runners

External load variables such as peak tibial acceleration (PTA), peak vertical ground reaction forces (GRF) and its instantaneous vertical loading rate (IVLR) may contribute to running injuries although evidence is conflicting given the influence of training load and tissue health on injuries. These variables are influenced by footwear, speed, surface and foot strike pattern during running. The purpose of this study was to assess the influence of four surfaces and two running speeds on external load variables in rearfoot strike (RFS) runners. Twelve RFS runners (confirmed with sagittal foot contact angle) completed a 2-min running bout on a treadmill and 50-m running bouts over the three surfaces (pavement, rubber track and grass) in standardised shoes at their preferred speed and 20% faster. PTA and vertical GRFs were collected using inertial measurement units and in-shoe force insoles. No interaction or surface effects were observed (p > 0.017). The faster speed produced greater axial PTA (+19.2%; p < 0.001), resultant PTA (+20.7%; p < 0.001), peak vertical GRF (+6.6%; p = 0.002) and IVLR (+16.5%; p < 0.001). These findings suggest that surface type does not influence PTA, peak vertical GRF and IVLR but that running faster increases the magnitude of these external loads regardless of surface type in RFS runners.

A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy

BACKGROUND

The biomechanics of barefoot and shod running are different for typically developing children but unknown for children with cerebral palsy (CP). Such differences may have implications for injury and performance.

AIMS

The primary aims of this study were to compare the lower limb biomechanics of barefoot and shod running in children with CP, and to determine whether any differences were the same in GMFCS levels I and II.

METHODS

This cross-sectional study examined 38 children with CP (n = 24 (GMFCS) level I; n = 14 GMFCS II), running overground at 3 speeds (jog, run, sprint) in barefoot and shod conditions. Marker trajectories and force plate data were recorded, and lower limb kinematics, kinetics and spatiotemporal variables were derived. Differences between barefoot and shod running were analysed using linear mixed models.

RESULTS

For both GMFCS levels, barefoot running resulted in higher loading rates, but smaller impact peaks at all speeds. Barefoot running was associated with greater hip and knee power; less ankle dorsiflexion and hip flexion at initial contact, and less ankle and knee range of motion during stance, compared to shod running, at all speeds. Barefoot stride length was shortened, and cadence increased compared to shod during jogging and running but not sprinting. For GMFCS level I only, barefoot running involved a higher incidence of forefoot strike, greater ankle power generation and less hip range of motion during stance.

SIGNIFICANCE

Running barefoot may facilitate running performance by increasing power generation at the ankle in children with CP, GMFCS level I. Higher barefoot loading rates may have implications for performance and injury.

Comparative Acceptability of Weightbearing Physical Activity in Sporting Footwear Versus Barefoot in Habitually Shod Individuals

BACKGROUND

Perceived acceptability of barefoot use has largely been ignored in the literature despite its importance to long-term implementation and behavior change. This study aimed to compare the acceptability of undertaking weightbearing physical activities in regular running shoes versus barefoot in habitually shod individuals.

METHODS

Healthy young men and women were recruited from the Gold Coast. Participants completed six activities (ie, lunges, walking, jogging, sidestep, vertical jump, and hop) in shod and barefoot conditions then answered questions pertaining to level and source of discomfort, ease of performance, and acceptability. Indices of bone quality were measured from their dominant calcaneus by quantitative ultrasound.

RESULTS

Seventeen healthy male (n = 8) and female (n = 9) university students participated in the study (age, 26.59 ± 7.26 years; body mass index, 23.08 ± 3.58 kg/m2). Men were taller, heavier, and had higher broadband ultrasound attenuation than women (P < .05). For "no" discomfort, "very easy" ease of performance, and a "good amount" or "very good amount" of acceptability, the shod condition demonstrated response rates of 87.25%, 55.88%, and 72.55%, respectively. The barefoot condition demonstrated rates of those responses of 62.75%, 39.22%, and 48.03%, respectively, and reported more ball-of-foot, forefoot, heel, and plantar skin locations as sources of discomfort during activity than in the shod condition. The group vertical jump height was higher barefoot than shod (44.88 ± 8.44 cm and 43.25 ± 8.76 cm, respectively; P < .05), but no difference was seen for the hop. Men jumped and hopped higher than women under both footwear conditions (P < .05).

CONCLUSIONS

Participants initiating barefoot weightbearing exercise may experience slightly greater discomfort and less ease of performance in the initial transition from the shod condition, but may perform better in vertical jump. Whether those differences in experience persist over the long term will require longitudinal studies.

Alterations in peripheral joint muscle force control in adults with musculoskeletal disease, injury, surgery, or arthroplasty: A systematic review and meta-analysis

PURPOSE

To systematically review and analyse whether musculoskeletal conditions affect peripheral joint muscle force control (i.e. magnitude and/or complexity of force fluctuations).

METHODS

A literature search was conducted using MEDLINE, CINAHL and SPORTDiscus databases (from inception-8th April 2021) for studies involving: 1) participants with musculoskeletal disease, injury, surgery, or arthroplasty in the peripheral joints of the upper/lower limb; 2) comparison with an unaffected control group or unaffected contralateral limb; and 3) measures of the magnitude and/or complexity of force fluctuations during targeted isometric contractions. The methodological quality of studies was evaluated using a modified Downs and Black Quality Index. Studies were combined using the standardized mean difference (SMD) in a random-effects model.

RESULTS

14 studies (investigating 694 participants) were included in the meta-analysis. There was a significant effect of musculoskeletal conditions on peripheral joint muscle force coefficient of variation (CV; SMD = 0.19 [95 % CI 0.06, 0.32]), whereby individuals with musculoskeletal conditions exhibited greater CV than controls. Subgroup analyses revealed that CV was only greater: 1) when comparison was made between symptomatic and asymptomatic individuals (rather than between affected and contralateral limbs; SMD = 0.22 [95 % CI 0.07, 0.38]); 2) for conditions of the knee (SMD = 0.29 [95 % CI 0.14, 0.44]); and 3) for ACL injury post-surgery (SMD = 0.56 [95 % CI 0.36, 0.75]).

CONCLUSION

Musculoskeletal conditions result in an increase in peripheral joint muscle force CV, with this effect dependent on study design, peripheral joint, and surgical status. The greater force CV is indicative of decreased force steadiness and could have implications for long-term tissue health/day-to-day function.

Influence of the Shod Condition on Running Power Output: An Analysis in Recreationally Active Endurance Runners

Several studies have already analysed power output in running or the relation between VO2max and power production as factors related to running economy; however, there are no studies assessing the difference in power output between shod and barefoot running. This study aims to identify the effect of footwear on the power output endurance runner. Forty-one endurance runners (16 female) were evaluated at shod and barefoot running over a one-session running protocol at their preferred comfortable velocity (11.71 ± 1.07 km·h−1). The mean power output (MPO) and normalized MPO (MPOnorm), form power, vertical oscillation, leg stiffness, running effectiveness and spatiotemporal parameters were obtained using the Stryd™ foot pod system. Additionally, footstrike patterns were measured using high-speed video at 240 Hz. No differences were noted in MPO (p = 0.582) and MPOnorm (p = 0.568), whereas significant differences were found in form power, in both absolute (p = 0.001) and relative values (p < 0.001), running effectiveness (p = 0.006), stiffness (p = 0.002) and vertical oscillation (p < 0.001). By running barefoot, lower values for contact time (p < 0.001) and step length (p = 0.003) were obtained with greater step frequency (p < 0.001), compared to shod running. The prevalence of footstrike pattern significantly differs between conditions, with 19.5% of runners showing a rearfoot strike, whereas no runners showed a rearfoot strike during barefoot running. Running barefoot showed greater running effectiveness in comparison with shod running, and was consistent with lower values in form power and lower vertical oscillation. From a practical perspective, the long-term effect of barefoot running drills might lead to increased running efficiency and leg stiffness in endurance runners, affecting running economy.

Effects of Minimalist Footwear and Foot Strike Pattern on Plantar Pressure during a Prolonged Running

The use of minimalist shoes (MS) in running involves changes in running mechanics compared to conventional shoes (CS), but there is still little research analysing the effects of this footwear on plantar pressure, which could help to understand some risk injury factors. Moreover, there are no studies examining the effects of a prolonged running and foot strike patterns on baropodometric variables in MS. Therefore, the aim of this study was to analyse the changes produced using MS on plantar pressure during a prolonged running, as well as its interaction with the time and foot strike pattern. Twenty-one experienced minimalist runners (age 38 ± 10 years, MS running experience 2 ± 1 years) ran with MS and CS for 30 min at 80% of their maximal aerobic speed, and mean pressure, peak pressure, contact time, centre of pressure velocity, relative force and contact area were analysed using a pressure platform. Foot strike pattern and time were also considered as factors. The multivariable linear regression mixed models showed that the use of MS induced, at the end of a prolonged running, higher peak pressure (p = 0.008), lower contact time (p = 0.004) and lower contact area (p < 0.001) than using CS. Also, runners with forefoot strike pattern using MS, compared to midfoot and rearfoot patterns, showed higher mean and peak pressure (p < 0.001) and lower contact time and area (p < 0.05). These results should be considered when planning training for runners using MS, as higher peak pressure values when using this type of footwear could be a risk factor for the development of some foot injuries.

Does Site Matter? Impact of Inertial Measurement Unit Placement on the Validity and Reliability of Stride Variables During Running: A Systematic Review and Meta-analysis

BACKGROUND

Inertial measurement units (IMUs) are used for running gait analysis in a variety of sports. These sensors have been attached at various locations to capture stride data. However, it is unclear if different placement sites affect the derived outcome measures.

OBJECTIVE

The aim of this systematic review and meta-analysis was to investigate the impact of placement on the validity and reliability of IMU-derived measures of running gait.

METHODS

Online databases SPORTDiscus with Full Text, CINAHL Complete, MEDLINE (EBSCOhost), EMBASE (Ovid) and Scopus were searched from the earliest record to 6 August 2020. Articles were included if they (1) used an IMU during running (2) reported spatiotemporal variables, peak ground reaction force (GRF) or vertical stiffness and (3) assessed validity or reliability. Meta-analyses were performed for a pooled validity estimate when (1) studies reported means and standard deviation for variables derived from the IMU and criterion (2) used the same IMU placement and (3) determined validity at a comparable running velocity (≤ 1 m·s^-1 difference).

RESULTS

Thirty-nine articles were included, where placement varied between the foot, tibia, hip, sacrum, lumbar spine (LS), torso and thoracic spine (TS). Initial contact, toe-off, contact time (CT), flight time (FT), step time, stride time, swing time, step frequency (SF), step length (SL), stride length, peak vertical and resultant GRF and vertical stiffness were analysed. Four variables (CT, FT, SF and SL) were meta-analysed, where CT was compared between the foot, tibia and LS placements and SF was compared between foot and LS. Foot placement data were meta-analysed for FT and SL. All data are the mean difference (MD [95%CI]). No significant difference was observed for any site compared to the criterion for CT (foot: - 11.47 ms [- 45.68, 22.74], p = 0.43; tibia: 22.34 ms [- 18.59, 63.27], p = 0.18; LS: - 48.74 ms [- 120.33, 22.85], p = 0.12), FT (foot: 11.93 ms [- 8.88, 32.74], p = 0.13), SF (foot: 0.45 step·min^-1 [- 1.75, 2.66], p = 0.47; LS: - 3.45 step·min^-1 [- 16.28, 9.39], p = 0.37) and SL (foot: 0.21 cm [- 1.76, 2.18], p = 0.69). Reliable derivations of CT (coefficient of variation [CV] < 9.9%), FT (CV < 11.6%) and SF (CV < 4.4%) were shown using foot- and LS-worn IMUs, while the CV was < 7.8% for foot-determined stride time, SL and stride length. Vertical GRF was reliable from the LS (CV = 4.2%) and TS (CV = 3.3%) using a spring-mass model, while vertical stiffness was moderately (r = 0.66) and nearly perfectly (r = 0.98) correlated with criterion measures from the TS.

CONCLUSION

Placement of IMUs on the foot, tibia and LS is suitable to derive valid and reliable stride data, suggesting measurement site may not be a critical factor. However, evidence regarding the ability to accurately detect stride events from the TS is unclear and this warrants further investigation.

Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study

Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group (p = 0.037) with no changes during the intervention period (p = 0.997). Within a single session, running stability decreased over the course of the 15-min run (p = 0.012) without differences between both groups (p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.

Most Military Runners Report Recent Changes in Running Parameters Before Lower Limb Injury Onset

INTRODUCTION

While running is a popular activity because of the health and fitness benefits it provides, the yearly incidence of running-related injuries (RRI) is high across all populations of runners, including military members. The etiology of RRI is multifactorial, and despite the numerous studies on risk factors for RRI, there is no clear consensus in the literature on the relative contribution of several intrinsic or extrinsic risk factors to the development of RRI. Furthermore, little is known on RRI profile and running parameters among Canadian military members. The objectives of this study were to (1) describe the clinical presentation of lower limb RRI and running profile among military members and (2) explore any association between recent changes in running parameters (volume or intensity) and specific RRI diagnoses.

MATERIALS AND METHODS

This cross-sectional study was conducted in 107 military members from the Canadian Armed Forces (Valcartier Military Base) who presented with a restriction or interruption of running because of lower limb running-related pain. The following variables were collected during a physiotherapy evaluation: injury location and diagnosis, running kinematics (foot strike pattern and step rate), degree of minimalism of running shoes, running parameters in the last 3 months before consultation (volume, duration, frequency, and intensity), and recent changes in training before pain onset. Descriptive statistical analyses were conducted to describe the clinical presentation and running profile, while chi-square tests and multiple correspondence analysis were used to explore the association between recent changes in running parameters and diagnosis. This study was approved by the institutional ethics committee, and participants signed a detailed consent form.

RESULTS

Among the 107 participants included in the study (mean age: 30.7 ± 8.9 years; 13 females), the most common diagnoses were patellofemoral pain (26.2%), medial tibial stress syndrome (11.2%), plantar fasciopathy (9.3%), and sciatica (9.3%). The average Minimalist Index of running shoes was 27.6 ± 18.5%. Step rate was 161.7 ± 10.3 steps per minute, and 73.3% of the participants used a rearfoot strike pattern. The majority of military runners reported previous RRI, gradual onset of symptoms, and recent changes in their training parameters (75.7%) before injury onset. No association was found between recent changes in running volume ((χ2(4) = 2.849; P = .606)) or intensity ((χ2(4) = 1.381; P = .855)) and diagnosis.

CONCLUSION

This is the first study to specifically investigate RRI and running profile among Canadian military members. The most common injuries were located at the knee, and the most frequent diagnosis was patellofemoral pain. The majority of military runners reported previous RRI as well as recent changes in their running parameters before injury onset, but unique types of recent changes were not associated with specific diagnoses. This study illustrates the need to further investigate the impact of training loads on the development of RRI.

BIOMECHANICS OF SHOD AND BAREFOOT RUNNING: A LITERATURE REVIEW

ABSTRACT This study aims to analyze and summarize the biomechanical (kinematics, kinetics and neuromuscular) differences between shod and barefoot running, through a literature review. Searches were conducted for complete articles published between 2013 and November 2018 in the Web of Science, PubMed, Scopus and SPORTdiscus databases. The search terms used were Biomechanics, Kinetics, Kinematics, Electromyography, “Surface Electromyography”; and Unshod, Barefoot, Barefeet and Running. The search resulted in 687 articles; after excluding duplicates and selecting by title, abstract and full text, 40 articles were included in the review. The results show that there are important differences in the biomechanics of running when shod or barefoot. In general, studies indicate that in barefoot running: a) individuals present forefoot or midfoot foot strike patterns, while in shod running the typical pattern is the rearfoot strike; (b) greater cadence and shorter stride length are observed; and (c) there is greater knee flexion, lower peak vertical ground reaction force and greater activation of the medial gastrocnemius. In addition, barefoot runners contact the ground with greater plantar flexion, possibly as a strategy to reduce impact when stepping without footwear. These differences, as well as runners’ individual characteristics, should be considered in the prescription of the barefoot running, in order to minimize injuries resulting from the practice. Level of Evidence II; Review.

Barefoot Running: Between Fashion and Real Way to Prevent Joint Osteo Lesions?

Background and objectives

Running has gone from a vital necessity for the man to a playful sport. Different rheumatic and orthopedic pathologies have appeared, in front of which the shoe industry has reacted by creating reinforced shoes that are supposed to overcome the induced lesions. Several years later, the trend toward reinforcement has gone toward minimalism, which is the absence of reinforcement, that is, a more natural race.

Method

We observed variations of kinetics and kinematics in young, unprofessional, healthy runners during a shoe race and a shoeless race, which is the form of maximum minimalism. We then correlated minimalism variations with the variables of the race and the joint angles.

Results

We observed significant difference (P < 0.01) in the cycle rate, the cycle length, the step rate, and the angle of attack between running with and without shoes. A small variation of the minimalism index is associated with an increase in knee angle (r²> 0.5). Conversely, a large variation in the minimalism index is related to a decrease in the knee angle (r²> 0.5). The minimalism index has no impact on the angulation of the ankle and hip (r²< 0.3).

Conclusion

Slow transition will bring gains in terms of decreasing the length of the stride, which limits the load on the shin. Greater flexibility can be achieved by decreasing the flexion angle of the knee, which decreases the demand for quadriceps muscles and the risk of knee injury with a greater risk of injury at the tibial level.

Influence of running shoes on muscle activity

Studies on the paradigm of the preferred movement path are scarce, and as a result, many aspects of the paradigm remain elusive. It remains unknown, for instance, how muscle activity adapts when differences in joint kinematics, due to altered running conditions, are of low / high magnitudes. Therefore, the purpose of this work was to investigate changes in muscle activity of the lower extremities in runners with minimal (≤ 3°) or substantial (> 3°) mean absolute differences in the ankle and knee joint angle trajectories when subjected to different running footwear. Mean absolute differences in the integral of the muscle activity were quantified for the tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM), soleus (SO), vastus lateralis (VL), and biceps femoris (BF) muscles during over ground running. In runners with minimal changes in 3D joint angle trajectories (≤ 3°), muscle activity was found to change drastically when comparing barefoot to shod running (TA: 35%; PL: 11%; GM: 17%; SO: 10%; VL: 27%; BF: 16%), and minimally when comparing shod to shod running (TA: 10%; PL: 9%; GM: 13%; SO: 8%; VL: 8%; BF: 12%). For runners who showed substantial changes in joint angle trajectories (> 3°), muscle activity changed drastically in barefoot to shod comparisons (TA: 39%; PL: 14%; GM: 16%; SO: 16%; VL: 25%; BF: 24%). It was concluded that a movement path can be maintained with small adaptations in muscle activation when running conditions are similar, while large adaptations in muscle activation are needed when running conditions are substantially different.

The influence of footwear on walking biomechanics in individuals with chronic ankle instability

BACKGROUND/PURPOSE

The effects of footwear on the walking kinematics, kinetics and electromyography (EMG) of individuals with chronic ankle instability (CAI) at different speeds are still unknown. The objective of this cross-sectional study was to evaluate the kinematic, kinetic and electromyography differences between shod and barefoot walking at comfortable (CW) and fast (FW) speeds in individuals with CAI.

METHODS

Twenty-one individuals with CAI walked on a 5-meter walkway shod and barefoot at CW and FW speeds. A force plate was used to record the ground reaction forces, a 3-D motion analysis system to record the lower limb kinematics and a surface EMG system to collect the gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles activity. The dependent variables were ankle and knee angles and moments and normalized muscle activity. The shod and barefoot data during CW and FW were compared using a one-dimensional non-parametric mapping analysis.

RESULTS

The main results of this study were that individuals with CAI exhibited more ankle dorsiflexion angle, knee extension and tibialis anterior muscle activation during the beginning of the stance phase during shod compared to barefoot walking. Also, the biomechanical effects of shoes are similar during walking at FW and CW.

CONCLUSION

The biomechanical deficits associated with CAI were partly attenuated during the shod compared to the barefoot condition and these effects were similar at CW and FW. These findings are compatible with the concept that locomotor interventions using suitable shoes may enhance gait abilities in individuals with CAI.

Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis

CONTENT

Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks.

OBJECTIVE

To determine the effects of foot strike techniques on running biomechanics.

DATA SOURCES

The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018.

STUDY SELECTION

The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model.

RESULTS

FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS.

CONCLUSION

Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.

Plantar support adaptations in healthy subjects after eight weeks of barefoot running training

Background

Although the studies of barefoot running have intensified, it is still missing longitudinal work analyzing the effects of barefoot running on the phases of plantar support. The objective of this research was to analyze the modifications undergone by the Total Foot Contact (TFC) phase and its Flat Foot Phase (FFP) in subjects beginning the practice of barefoot running, in its acute and chronic effects.

Methods

A total of 28 subjects were divided into the Barefoot Group (BFGr) (n = 16) and the Shod Group (SHGr) (n = 12), evaluated before (Baseline) and after running for 20 min at 3.05 m·s⁻¹ (Post 20 min Running), and at the end of a running training protocol with an 8-week long progressive volume (Post-8-week Training). The dynamic plantar support was measured with a baropodoscope. The duration of TFC (ms), the moment at which the FFP occurred, the maximum surface of TFC (MSTFC) (cm²), the FFP surface (SFFP) (cm²), the peak pressure of TFC (PP°TFC) (kg·cm⁻²), and the peak pressure of FFP (PP°FFP) (kg·cm⁻²) were recorded. The 3 × 2 ANOVA analysis was made to determine the effects and interactions that the condition produced (Shod/Barefoot), and the time factor (Baseline/Post 20 min Running/Post-8-week Training).

Results

The condition factor caused more significant effects than the time factor in all the variables. Duration of TFC in BFGr showed significant differences between the Baseline and Post-8-week Training (p = 0.000) and between Post-20-min Running and Post-8-week Training (p = 0.000), with an increasing trend. In the moment at which the FFP occurred a significant increase (p = 0.029) increase was found in Post-20 min Running (48.5%) compared to the Baseline (42.9%). In MSTFC, BFGr showed in Post-8-week Training values significantly higher than the Baseline (p = 0.000) and than Post-20-min Running (p = 0.000). SHGr presented a significant difference between the Baseline and Post-8-week Training (p = 0.040). SFFP in BFGr modified its values with an increasing trend (p = 0.000). PP°TFC in BFGr showed a significant decrease (p = 0.003) in Post-8-week Training (1.9 kg·cm⁻²) compared to the Baseline (2.4 kg·cm⁻²). In PP°FFP significant decreases were recorded in BFGr and between Post-8-week Training and Baseline (p = 0.000), and Post-8-week Training and Post 20 min Running (p = 0.035).

Conclusions

The adaptation took place after the 8-week training. The adaptations to running barefoot were characterized by causing an increase of the foot’s plantar support in TFC and in FFP, as well as a decrease of the plantar pressure peak in both phases. Also, there is an increased duration of the TFC and FFP, which may be related to an acquired strategy to attenuate the impacts of the ground’s reaction forces.

Running-related muscle activation patterns and tibial acceleration across puberty

This study examined whether differences exist in tibial acceleration transients and electromyography (EMG) variables during running across female pubertal development. Sixty-four girls classified as pre- (n = 19), early/mid- (n = 22) and late/post-pubertal development (n = 23) ran in a laboratory whilst EMG data were recorded from quadriceps, hamstring and calf muscle groups, and acceleration transients from a triaxial accelerometer. The late/post-pubertal girls exhibited delayed vastus lateralis onset (mean difference (MD) = 0.02, 95% CI = 0.008, 0.34 ms)) compared to pre-pubertal girls, lower vastus lateralis pre-activation (MD = 7.02, 95% CI = 12.63, 1.42%) compared to early/mid-pubertal girls, and longer time to peak (TTP) anterior/posterior (A/P) tibial acceleration compared to pre-pubertal girls (MD = 0.02, 95% CI = 0.006, 0.03 s). By contrast, late/post-pubertal girls demonstrated earlier semitendinosus onset compared to both early/mid- (MD = 0.02, 95% CI = 0.03, 0.005 ms) and pre-pubertal girls (MD = 0.02, 95% CI = 0.04, 0.007 ms). No other between-group differences were found for peak A/P, vertical and TTP vertical tibial acceleration (p > 0.05). Subsequently, regression analysis revealed that EMG variables accounted for approximately 34% (R² = 0.34) of the variance in TTP A/P tibial acceleration. These findings highlight that neuromuscular recruitment patterns and kinetics differ across female pubertal development while running and should be further explored in the context of adolescent female musculoskeletal injuries.

Morphology-Related Foot Function Analysis: Implications for Jumping and Running

Barefoot and shod running has received increased attention in recent years, however, the influence of morphology-related foot function has not been explored. This study aimed to investigate morphology-related jumping and running biomechanical functions in habitually barefoot and shod males. A total of 90 barefoot males (Indians) and 130 shod males (Chinese), with significant forefoot and toe morphology differences, participated in a vertical jump and running test to enable the collection of kinematic and kinetic data. The difference of pressure distribution in the hallux and forefoot was shown while jumping and running. The unrestricted forefoot and toes of the barefoot group presented flexible movement and leverage functions to expand the forefoot loading area during performance of the two tasks. Findings related to morphology functions, especially in the forefoot and toe may provide useful information for footwear design.

Adaptation of Running Biomechanics to Repeated Barefoot Running: A Randomized Controlled Study

BACKGROUND

Previous studies have shown that changing acutely from shod to barefoot running induces several changes to running biomechanics, such as altered ankle kinematics, reduced ground-reaction forces, and reduced loading rates. However, uncertainty exists whether these effects still exist after a short period of barefoot running habituation.

PURPOSE/HYPOTHESIS

The purpose was to investigate the effects of a habituation to barefoot versus shod running on running biomechanics. It was hypothesized that a habituation to barefoot running would induce different adaptations of running kinetics and kinematics as compared with a habituation to cushioned footwear running or no habituation.

STUDY DESIGN

Controlled laboratory study.

METHODS

Young, physically active adults without experience in barefoot running were randomly allocated to a barefoot habituation group, a cushioned footwear group, or a passive control group. The 8-week intervention in the barefoot and footwear groups consisted of 15 minutes of treadmill running at 70% of VO₂ max (maximal oxygen consumption) velocity per weekly session in the allocated footwear. Before and after the intervention period, a 3-dimensional biomechanical analysis for barefoot and shod running was conducted on an instrumented treadmill. The passive control group did not receive any intervention but was also tested prior to and after 8 weeks. Pre- to posttest changes in kinematics, kinetics, and spatiotemporal parameters were then analyzed with a mixed effects model.

RESULTS

Of the 60 included participants (51.7% female; mean ± SD age, 25.4 ± 3.3 years; body mass index, 22.6 ± 2.1 kg·m^-2), 53 completed the study (19 in the barefoot habituation group, 18 in the shod habituation group, and 16 in the passive control group). Acutely, running barefoot versus shod influenced foot strike index and ankle, foot, and knee angles at ground contact (P < .001), as well as vertical average loading rate (P = .003), peak force (P < .001), contact time (P < .001), flight time (P < .001), step length (P < .001), and cadence (P < .001). No differences were found for average force (P = .391). After the barefoot habituation period, participants exhibited more anterior foot placement (P = .006) when running barefoot, while no changes were observed in the footwear condition. Furthermore, barefoot habituation increased the vertical average loading rates in both conditions (barefoot, P = .01; shod, P = .003) and average vertical ground-reaction forces for shod running (P = .039). All other outcomes (ankle, foot, and knee angles at ground contact and flight time, contact time, cadence, and peak forces) did not change significantly after the 8-week habituation.

CONCLUSION

Changing acutely from shod to barefoot running in a habitually shod population increased the foot strike index and reduced ground-reaction force and loading rates. After the habituation to barefoot running, the foot strike index was further increased, while the force and average loading rates also increased as compared with the acute barefoot running situation. The increased average loading rate is contradictory to other studies on acute adaptations of barefoot running.

CLINICAL RELEVANCE

A habituation to barefoot running led to increased vertical average loading rates. This finding was unexpected and questions the generalizability of acute adaptations to long-term barefoot running. Sports medicine professionals should consider these adaptations in their recommendations regarding barefoot running as a possible measure for running injury prevention.

REGISTRATION

DRKS00011073 (German Clinical Trial Register).

The relationship between static and dynamic foot posture and running biomechanics: A systematic review and meta-analysis

BACKGROUND

Medial longitudinal arch characteristics are thought to be a contributing factor to lower limb running injuries. Running biomechanics associated with different foot types have been proposed as one of the potential underlying mechanisms. However, no systematic review has investigated this relationship.

RESEARCH QUESTION

The aim of this study was to conduct a systematic literature search and synthesize the evidence about the relationship between foot posture and running biomechanics.

METHODS

For this systematic review and meta-analysis different electronic databases (Pubmed, Web of Science, Cochrane, SportDiscus) were searched to identify studies investigating the relationship between medial longitudinal arch characteristics and running biomechanics. After identification of relevant articles, two independent researchers determined the risk of bias of included studies. For homogenous outcomes, data pooling and meta-analysis (random effects model) was performed, and levels of evidence determined.

RESULTS

Of the 4088 studies initially identified, a total of 25 studies were included in the qualitative review and seven in the quantitative analysis. Most studies had moderate and three studies a low risk of bias. Moderate evidence was found for a relationship between foot posture and subtalar joint kinematics (small pooled effects: -0.59; 95%CI -1.14 to - 0.003) and leg stiffness (small pooled effect: 0.59; 95%CI 0.18 to 0.99). Limited or very limited evidence was found for a relationship with forefoot kinematics, tibial/leg rotation, tibial acceleration/shock, plantar pressure distribution, plantar fascia tension and ankle kinetics as well as an interaction of foot type and footwear regarding tibial rotation.

SIGNIFICANCE

While there is evidence for an association between foot posture and subtalar joint kinematics and leg stiffness, no clear relationship was found for other biomechanical outcomes. Since a comprehensive meta-analysis was limited by the heterogeneity of included studies future research would benefit from consensus in foot assessment and more homogenous study designs.

Validity and Reliability of 2-Dimensional Video-Based Assessment to Analyze Foot Strike Pattern and Step Rate During Running: A Systematic Review

CONTEXT

Two-dimensional (2D) video-based analysis is often used by clinicians to examine the foot strike pattern (FSP) and step rate in runners. Reliability and validity of 2D video-based analysis have been questioned.

OBJECTIVE

To synthesize the psychometric properties of 2D video-based analysis for assessing runners' FSP and step rate while running.

DATA SOURCES

Medline/PubMed, Science Direct, Embase, EBSCOHost/CINAHL, and Scielo were searched from their inception to August 2018.

STUDY SELECTION

Studies were included if (1) they were published in English, French, Portuguese or Spanish; (2) they reported at least 1 psychometric property (validity and/or reliability) of 2D video-based analysis to assess running kinematics; and (3) they assessed FSP or step rate during running.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Studies were screened for methodological (MacDermid checklist) and psychometric quality (COSMIN checklist) by 2 independent raters.

RESULTS

Eight studies, with a total of 702 participants, were included. Seven studies evaluated the reliability of 2D video to assess FSP and found very good to excellent reliability (0.41 ≤ κ ≤ 1.00). Two studies reported excellent reliability for the calculation of step rate (0.75 ≤ intraclass correlation coefficient [ICC] ≤ 1.00). One study demonstrated excellent concurrent validity between 2D and 3D (gold standard) motion capture systems to determine FSP (Gwet agreement coefficient [AC] > 0.90; ICC > 0.90), and another study found excellent concurrent validity between 2D video and another device to calculate step rate (0.84 ≤ ICC ≤ 0.95).

CONCLUSION

Strong evidence suggests that 2D video-based analysis is a reliable method for assessing FSP and quantifying step rate, regardless of the experience of the assessor. Limited evidence exists on the validity of 2D video-based analysis in determining FSP and calculating step rate during running.

Relationships between Habitual Cadence, Footstrike, and Vertical Load Rates in Runners

Excessive vertical ground reaction force (VGRF) load rates have been linked with running injuries. Increasing cadence (CAD) has been shown to reduce load rates; however, relationships between habitual cadence and load rates across a population of runners have not been examined.

PURPOSE

To examine the relationships between habitual running cadence and vertical load rates in healthy and injured runners using habitual footstrike patterns. As CAD increased, we expected vertical load rates would decrease.

METHODS

Healthy runners (n = 32, 25 men) and injured runners (n = 93, 45 men) seeking treatment were analyzed. Footstrike classifications were heel at initial contact (rearfoot strike [RFS]) or forefoot at initial contact (forefoot strike [FFS]). Runners were divided into four injury status/footstrike pattern (FSP) subgroups: healthy RFS (n = 19), injured RFS (n = 70), healthy FFS (n = 13), and injured FFS (n = 23). The VGRF and CAD were recorded as participants ran on an instrumented treadmill at self-selected speed (x¯ = 2.6 m·s ±0.12). Healthy runners used laboratory footwear similar to their habitual footwear, and injured runners used habitual footwear. The vertical average load rates and vertical instantaneous load rates of the VGRF of each runner's right leg were calculated and correlated with CAD for four injury status-FSP subgroups and for all runners combined.

RESULTS

There were no differences in CAD between all runners or any subgroup (P > 0.05). Vertical average load rates and vertical instantaneous load rates were significantly higher (P ≤ 0.01) in the injured RFS group compared with all other subgroups. Injured FFS and healthy FFS had similar load rates (P = 1.0).

CONCLUSIONS

We found no relationships between habitual running cadence and vertical load rates. The highest load rates were in injured RFS runners, and the lowest load rates were in FFS runners, regardless of injury status. Future studies of gait retraining to increase CAD and reduce load rates should follow runners long term to examine this relationship once CAD has become habituated.

"How are running shoes assessed? A systematic review of characteristics and measurement tools used to describe running footwear"

Background: Many footwear characteristics are argued as risk factors for running related injuries (RRI). Several footwear assessment tools are available; however, their use in studies of RRI is unknown. Objective: This systematic review evaluated the characteristics and methods of assessing footwear in studies of RRI. Design: Five online databases were searched for studies on adult runners, in running style footwear, who experienced running-related pain or injury. The methodological quality of included articles was independently assessed by two raters using a modified Downs and Black checklist. Study and participant characteristics, footwear assessment tools used, and footwear characteristics reported were extracted for qualitative synthesis. Results: Twenty-four articles were included in the review. Low risk of bias was determined for 11 (44%) of the included studies. Twenty-eight different footwear characteristics were grouped into four categories: nomenclature, measurements, qualitative features, and subjective features. Fifteen different methods for assessing the 28 footwear characteristics were reported among the included studies. Only three methods were described previously, as valid and reliable. Conclusion: Differences in assessing footwear may mask the link between footwear characteristics and injury risk. Systematic footwear assessments and nomenclature are needed to evaluate the effects of footwear characteristics on RRI.

The effect of running on foot muscles and bones: A systematic review

Despite the widespread evidence of running as a health-preserving exercise, little is known concerning its effect on the foot musculature and bones. While running may influence anatomical foot adaptation, it remains unclear to what extent these adaptations occur. The aim of this paper is to provide a systematic review of the studies that investigated the effects of running and the adaptations that occur in foot muscles and bones. The search was performed following the PRISMA guidelines. Relevant keywords were used for the search through PubMed/MEDLINE, Scopus and SPORTDiscus. The methodological quality of intervention studies was assessed using the Downs and Black checklist. For cross-sectional studies, the Newcastle-Ottawa scale was used. Sixteen studies were found meeting the inclusion criteria. In general, the included studies were deemed to be of moderate methodological quality. Although results of relevant literature are limited and somewhat contradictory, the outcome suggests that running may increase foot muscle volume, muscle cross-sectional area and bone density, but this seems to depend on training volume and experience. Future studies conducted in this area should aim for a standard way of reporting foot muscle/bone characteristics. Also, herein, suggestions for future research are provided.

Effect of habitual foot-strike pattern on the gastrocnemius medialis muscle-tendon interaction and muscle force production during running

The interaction between gastrocnemius medialis (GM) muscle and Achilles tendon, i.e., muscle-tendon unit (MTU) interaction, plays an important role in minimizing the metabolic cost of running. Foot-strike pattern (FSP) has been suggested to alter MTU interaction and subsequently the metabolic cost of running. However, metabolic data from experimental studies on FSP are inconsistent, and a comparison of MTU interaction between FSP is still lacking. We, therefore, investigated the effect of habitual rearfoot and mid-/forefoot striking on MTU interaction, ankle joint work, and plantar flexor muscle force production while running at 10 and 14 km/h. GM muscle fascicles of 9 rearfoot and 10 mid-/forefoot strikers were tracked using dynamic ultrasonography during treadmill running. We collected kinetic and kinematic data and used musculoskeletal models to determine joint angles and calculate MTU lengths. In addition, we used dynamic optimization to assess plantar flexor muscle forces. During ground contact, GM fascicle shortening ( P = 0.02) and average contraction velocity ( P = 0.01) were 40-45% greater in rearfoot strikers than mid-/forefoot strikers. Differences in contraction velocity were especially prominent during early ground contact. Moreover, GM ( P = 0.02) muscle force was greater during early ground contact in mid-/forefoot strikers than rearfoot strikers. Interestingly, we did not find differences in stretch or recoil of the series elastic element between FSP. Our results suggest that, for the GM, the reduced muscle energy cost associated with lower fascicle contraction velocity in mid-/forefoot strikers may be counteracted by greater muscle forces during early ground contact. NEW & NOTEWORTHY Kinetic and kinematic differences between foot-strike patterns during running imply (not previously reported) altered muscle-tendon interaction. Here, we studied muscle-tendon interaction using ultrasonography. We found greater fascicle contraction velocities and lower muscle forces in rearfoot compared with mid-/forefoot strikers. Our results suggest that the higher metabolic energy demand due to greater fascicle contraction velocities might offset the lower metabolic energy demand due to lower muscle forces in rearfoot compared with mid-/forefoot strikers.

The influence of high-intensity interval training on anthropometric variables of adults with overweight or obesity: a systematic review and network meta-analysis

OBJECTIVE

The goal of this study was to evaluate the influence of high-intensity interval training (HIIT) on anthropometric variables in adults afflicted with overweight or obesity and to compare the effects with those of moderate-intensity continuous training.

METHODS

A computer literature search was performed for HIIT intervention studies that evaluated anthropometric variables in adults afflicted with overweight or obesity.

RESULTS

Of the 857 articles retrieved in the electronic search, 48 met the inclusion criteria. The analyses demonstrated that HIIT was effective in decreasing body mass (-1.45 kg [95% CI: -1.85 to -1.05 kg]), body mass index (-0.44 kg m^-2 [95% CI: -0.59 to -0.30 kg m^-2 ]), waist circumference (-2.3 cm [95% CI: -3.1 to -1.4 cm]), waist/hip ratio (-0.01 [95% CI: -0.02 to -0.00]), body fat percentage (-1.29% [95% CI: -1.70% to -0.87%]) and abdominal visceral fat area (-6.83 cm² [95% CI: -11.95 to -1.71 cm² ]). When considering equalization between the two methods (energy expenditure or workload matched), no differences were found in any measure except body mass (for which HIIT was superior).

CONCLUSIONS

High-intensity interval training and moderate-intensity continuous training results were similar, particularly when equalization between the two methods was considered. Thus, HIIT can be used as a secondary method for the treatment of obesity in adults.

Effects of barefoot and footwear conditions on learning of a dynamic balance task: a randomized controlled study

PURPOSE

Although barefoot balancing has shown to be more challenging compared to shod balancing, it is still unclear whether this may also influence the balance learning effects. The purpose of this study was to explore the impact of barefoot and shod exercising on learning of a dynamic balance task.

METHODS

Sixty healthy and physically active adults (mean age 25.3 ± 3.4 years) were randomly allocated into one of three groups (barefoot, shod and controls). The barefoot and shod intervention groups exercised once weekly over 7 weeks on a stability platform with an unstable surface. Each training session included 15 trials over 30 s. Before and after the intervention period, all participants completed two balance tests (stability platform and Balance Error Scoring System = BESS) under barefoot and shod conditions. Group effects in stability gains (pre to post-test differences) were analysed using ANOVA. Development of balance learning curves during the intervention period was analysed using a mixed effects model.

RESULTS

Balance times improved in both intervention groups (p < 0.001, 95% CI barefoot 5.82-9.22 s, shod 7.51-10.92 s) compared to controls. The barefoot intervention group showed a significantly less sloped balance learning curve compared to the shod intervention group (p = 0.033). No changes over time or differences between groups were found for the BESS test.

CONCLUSIONS

Improvements in the dynamic balance task did not differ between individuals exercising barefoot or with footwear although the progression was slower in the barefoot group. The lack of changes in the BESS supports the task-specificity of balance learning effects.

Being barefoot. Prevalence at home, in school and during sport: a cross-sectional survey of 714 New Zealand secondary school boys

Background

It may be assumed that a combination of culture, climate and economic resource are the major reasons that non-industrialised countries have a higher prevalence of barefoot activity. New Zealand is an industrialised country with comparable resources to that of many European countries; however, it seems to remain socially acceptable to carry out barefoot activities. A chance observation of students competing barefoot on a tartan track, prompted us to determine the prevalence of barefoot activity in an all-boys secondary school in Auckland New Zealand.

Method

An 11-question survey was administered at an Auckland boys secondary school, of high socioeconomic status, to determine the footwear habits of students (n = 714) during: a) daily life b) school life (c) physical education class and (d) sport. To classify students as habitually barefoot or shod, students were asked to select whether they were barefoot most of the time (2-points), half of the time (1-point) or none of the time (0-points) in three settings: around the house, during sport and during school. A score of ≥3 was required to be considered habitually barefoot. Participants were also asked to specify, when running at their most recent athletics event (100 m – 3000 m) on a track, whether they ran barefoot, in shoes, in spikes or another type of footwear. Finally, participants were asked to indicate if leg pain had interrupted running during the previous 12-months. Analysis was conducted using IBM SPSS.

Results

45% (95% CI: 41.5–49.5%) of the participants in our sample were classified as habitually barefoot. More than half of the sample reported being barefoot most of the time at home (n = 404, 56.6%) and during PE class (n = 420, 58.8%). Over 50% of the sample reported being barefoot half of the time or more during sport (n = 380, 53.2%). A smaller amount went to the supermarket (n = 140, 19.6%) or took the bus (n = 59, 8.3%) whilst barefoot around half of the time or more. The percentage of barefoot competitors declined with increasing distance: 100 m (46.5%), 200 m (41.8%), 400 m (38%), 800 m (31%), 1500 m (31%) and 3000 m (20%). The prevalence of leg pain interfering with running was 23.5%. There was no difference in the prevalence of leg pain between those classified as habitually barefoot and shod (Χ²(1, N = 603) = 0.005, p = 0.946).

Conclusion

The results of this survey demonstrate that over 50% of students at an all-boys secondary school in Auckland, of high socioeconomic status, are barefoot at home, during physical education and sport half of the time or more. These results may point towards a cultural difference between New Zealand and other modern industrialised countries.

The Effect of a Curved Non-Motorized Treadmill on Running Gait Length, Imbalance and Stride Angle

Running on a non-motorized, curved-deck treadmill is thought to improve gait mechanics. It is not known, though, whether the change in gait carries over to running on a motorized treadmill on level ground. To determine the effect of running on a curved non-motorized treadmill (CNT) on gait characteristics, measured during a subsequent bout of running on a traditional motorized treadmill (TMT), sixteen healthy college-aged participants, aged (mean ± SD) 20.4 ± 1.6 years, volunteered to have their gait analyzed while running on a TMT and CNT. After familiarization with, and a warm-up on, both treadmills, each subject completed five 4-min bouts of running, alternating between traditional motorized and curved non-motorized treadmills: TMT-1, CNT-1, TMT-2, CNT-2, and TMT-3. Variables of interest included step length (m), stride length (m), imbalance score (%), and stride angle (°), and were measured using Optogait gait analysis equipment. We found differences in gait characteristics among TMT-1, TMT-2, and TMT-3, which can be attributed to running on the CNT. The results show that running on a CNT resulted in significant changes in gait characteristics (step length, stride length, imbalance score and stride angle). These findings suggest that running on a CNT can significantly influence running gait.

Estimation of vertical ground reaction force during running using neural network model and uniaxial accelerometer

Wearable technology has been viewed as one of the plausible alternatives to capture human motion in an unconstrained environment, especially during running. However, existing methods require kinematic and kinetic measurements of human body segments and can be complicated. This paper investigates the use of neural network model (NN) and accelerometer to estimate vertical ground reaction force (VGRF). An experimental study was conducted to collect sufficient samples for training, validation and testing. The estimated results were compared with VGRF measured using an instrumented treadmill. The estimates yielded an average root mean square error of less than 0.017 of the body weight (BW) and a cross-correlation coefficient greater than 0.99. The results also demonstrated that NN could estimate impact force and active force with average errors ranging between 0.10 and 0.18 of BW at different running speeds. Using NN and uniaxial accelerometer can (1) simplify the estimation of VGRF, (2) reduce the computational requirement and (3) reduce the necessity of multiple wearable sensors to obtain relevant parameters.