Stepping Back to Minimal Footwear: Applications Across the Lifespan

Local and non-local effects (on the posterior chain) of four weeks of foot exercises: a randomized controlled trial

This study investigated the local, remote, and contralateral effects of a four-week intrinsic foot muscle exercise intervention in recreationally active participants on foot parameters, flexibility, and performance of the posterior chain (PC). Twenty-eight healthy participants (12f, 16m) were randomly assigned to a control group or performed 2 × 6 min of foot exercises twice daily unilaterally at least five days/week for four weeks. At baseline (M1), after the intervention (M2), and after a four-week wash-out period (M3), we assessed bilateral Foot Posture Index-6, medial longitudinal arch mobility, single-leg stance balance, range of motion (ROM) (first metatarsophalangeal joint and ankle), and flexibility and performance of the PC. The FPI-6 score changes over time differed significantly between groups for both legs, improving by 26% in the trained- (p < .001) and 11% in the untrained leg (p = .02) in the intervention group from M1 to M2. Improvements were maintained at M3 for the trained leg (p = .02). Ankle range of motion and balance of the trained leg improved from M1 to M2, yet only became significant at M3 (ROM: p = .02; balance: p = .007). The other parameters did not change significantly. A four-week foot exercise intervention might have local but no remote effects in healthy young adults.German Clinical Trial Register (DRKS00027923) (24/08/2022).

Effects of shoe heel height on ankle dynamics in running

Shoes affect the evolved biomechanics of the foot, potentially affecting running kinematics and kinetics that can in turn influence injury and performance. An important feature of conventional running shoes is heel height, whose effects on foot and ankle biomechanics remain understudied. Here, we investigate the effects of 6-26 mm increases in heel height on ankle dynamics in 8 rearfoot strike runners who ran barefoot and in minimal shoes with added heels. We predicted higher heels would lead to greater frontal plane ankle torques due to the increased vertical moment arm of the mediolateral ground reaction force. Surprisingly, the torque increased in minimal shoes with no heel elevation, but then decreased with further increases in heel height due to changes in foot posture. We also found that increasing heel height caused a large increase in the ankle plantarflexion velocity at heel strike, which we explain using a passive collision model. Our results highlight how running in minimal shoes may be significantly different from barefoot running due to complex interactions between proprioception and biomechanics that also permit runners to compensate for modifications to shoe design, more in the frontal than sagittal planes.

Identifying the Number of Steps Required for Familiarisation to Athletic Footwear in Healthy Older Adults

INTRODUCTION

Research on athletic footwear familiarisation within an older population is sparse. This is problematic because unfamiliar footwear may act as a new perturbation and modify older adults' walking gait and stability. In addition, while athletic footwear has been suggested to enhance older adults' comfort and support during activities of daily living, the necessary period for familiarisation with athletic footwear is unknown. Therefore, this study aimed to identify the number of steps required for older adults to be familiarised with athletic footwear of different midsole thicknesses.

METHODS

Twenty-six healthy and physically active community-dwelling older adults, 21 females (71.1 ± 4.5 years; 164.5 ± 5.3 cm; 68.4 ± 11.4 kg) and five males (70.6 ± 2.3 years; 175.2 ± 7.8 cm; 72.8 ± 9.7 kg), completed a walking-based protocol. Participants walked two trials of 200 steps at their habitual speed on a 10-m track of an optical measurement system in three footwear conditions: (1) New Balance® REVlite 890v6 (thick midsole); (2) New Balance® REVlite 1400v5 (moderate midsole); and (3) New Balance® Minimus 20v7 (thin midsole). Gait speed (m.s-1) and walking time (min) were analysed for each participant over the 400 steps. Number of required familiarisation steps were established over three analysis phases, consisting of steady-state gait assessment, averaging and analysis of blocks of 40 steps, and sequentially comparing these steps with a predetermined threshold. Footwear familiarisation was assumed when the mean gait speed fell within an acceptable level (±2 SD from 320 to 360 step values) and subsequently maintained.

RESULTS

Most participants were familiarised with all three footwear conditions (thick n = 18; moderate and thin n = 20) after walking 80 steps. For all participants, the moderate midsole had the shortest familiarisation period (160 steps). The highest number of familiarisation steps was found in the thick (320 steps) and thin midsoles (240 steps) for some participants.

CONCLUSION

A minimum of 320 familiarisation steps is recommended to account for both individual differences and midsole thicknesses. Implementing this walking-based footwear familiarisation protocol would improve validity of future studies, ensuring they analyse footwear effects rather than familiarisation with the footwear.

Effects of technological running shoes versus barefoot running on the intrinsic foot muscles, ankle mobility, and dynamic control: a novel cross-sectional research

BACKGROUND

Technological running shoes have become increasingly popular, leading to improvements in performance. However, their long-term effects on foot musculature and joint mobility have not been thoroughly studied.

OBJECTIVE

To compare the activation of the intrinsic foot muscles between runners wearing technological footwear and barefoot runners. Secondary objectives included assessing ankle dorsiflexion (DF) range of motion (ROM) and dynamic postural control in both groups.

METHODS

A cross-sectional study was conducted involving 22 technological footwear runners and 22 barefoot runners. Ultrasonography was used to measure the thickness of the plantar fascia (PF) and the quadratus plantae (QP), abductor digiti minimus (ADM), abductor hallucis (AH), and flexor hallucis longus (FHL) muscles. Ankle mobility and dynamic postural control were also recorded.

RESULTS

Ultrasonography measurements showed statistically significant differences for PF thickness (mean difference [MD]: -0.10 cm; 95% CI: -0.13, -0.05 cm), QP cross-sectional area (CSA) (MD: -0.45 cm2; 95% CI: -0.77, -0.12 cm2), ADM CSA (MD: -0.49 cm2; 95% CI: -0.70, -0.17 cm2), and FHL thickness (MD: 0.82 cm; 95% CI: 0.53, 1.09 cm), with all measurements being lower in the group wearing technological footwear compared to the barefoot runners. Ankle DF ROM was also significantly greater for the barefoot runners (MD: -5.1°; 95% CI: -8.6, -1.7°).

CONCLUSIONS

These findings suggest potential implications for the foot musculature and ankle mobility in runners using technological footwear.

A four-week minimalist shoe walking intervention influences foot posture and balance in young adults-a randomized controlled trial

INTRODUCTION

Minimalist shoes (MS) are beneficial for foot health. The foot is a part of the posterior chain. It is suggested that interventions on the plantar foot sole also affect the upper segments of the body. This study aimed to investigate the local and remote effects along the posterior chain of four weeks of MS walking in recreationally active young adults.

METHODS

28 healthy participants (15 female, 13 male; 25.3 ± 5.3 years; 70.2 ± 11.9 kg; 175.0 ± 7.8 cm) were randomly assigned to a control- or intervention group. The intervention group undertook a four-week incremental MS walking program, which included 3,000 steps/day in the first week, increasing to 5,000 steps/day for the remaining three weeks. The control group walked in their preferred shoe (no MS). We assessed the following parameters in a laboratory at baseline [M1], after the four-week intervention [M2], and after a four-week wash-out period [M3]: Foot parameters (i.e., Foot Posture Index-6, Arch Rigidity Index), static single-leg stance balance, foot-, ankle-, and posterior chain range of motion, and muscle strength of the posterior chain. We fitted multiple hierarchically built mixed models to the data.

RESULTS

In the MS group, the Foot Posture Index (b = -3.72, t(51) = -6.05, p < .001, [-4.94, 2.51]) and balance (b = -17.96, t(49) = -2.56, p = .01, [-31.54, 4.37]) significantly improved from M1 to M2, but not all other parameters (all p >.05). The improvements remained at M3 (Foot Posture Index: b = -1.71, t(51) = -2.73, p = .009, [-4,94,0.48]; balance: b = -15.97, t(49) = -2.25, p = .03, [-29.72, 2.21]).

DISCUSSION

Walking in MS for four weeks might be advantageous for foot health of recreationally active young adults but no chronic remote effects should be expected.

Biomechanical Tradeoffs in Foot Function From Variations in Shoe Design

There is debate and confusion over how to evaluate the biomechanical effects of running shoe design. Here, we use an evolutionary perspective to analyze how key design features of running shoes alter the evolved biomechanics of the foot, creating a range of tradeoffs in force production and transmission that may affect performance and vulnerability to injury.

Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis

BACKGROUND

Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA).

PURPOSE

To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used.

RESULTS

Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF [P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [P = .015]; propulsion, ↑MF, NF, ↓BF [P = .039]).

CONCLUSION

Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.

Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes

Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Transitioning to Barefoot Running Using a Minimalist Shoe Intermediary: A Prospective Cohort Study

OBJECTIVES

The objectives of this study are, first, to investigate the probability of runners successfully transitioning from running in a traditional shoe to barefoot. Second, to identify prognostic indicators of failure of transition to barefoot running.

METHODS

Over 20 wk, 76 healthy runners (female, 40; age, 35.04 yr [SD, 8.9 yr]; body weight, 69.9 kg [SD 13.4 kg]) attempted to transition from running in traditional shoes to running barefoot. A minimalist shoe was used as an intermediary. Participants ran for 4 wk exclusively in provided traditional shoes followed by 4 wk of transitioning to minimalist shoes. This process was repeated to transition to barefoot running. Participants were followed up until they withdrew from the study or successfully transitioned to running barefoot. A survival analysis examined the weeks of successful transition. Along with sex and age, baseline measures of traditional shoe overall comfort, footstrike pattern, midfoot width mobility and plantar foot pressure pain threshold were examined as prognostic variables for failure to transition using Cox regression.

RESULTS

The cumulative probability of successful transition to running barefoot was 70.8% (95% confidence interval [CI], 61%-83%). The primary footwear-related reason for withdrawal was pain, primarily in the foot ( n = 7), two runners had confirmed injuries. Runners exhibiting a rearfoot strike pattern and higher midfoot width mobility were more likely to fail to transition (hazard ratios [HR], 4.02; 95% CI, 1.33-12.16 and HR, 1.22; 95% CI, 1.05-1.42).

CONCLUSIONS

Most runners who wish to run barefoot will be able to transition. Our study indicates that there may be biomechanical and anatomical characteristics that are prognostic of failing to transition when using a 20-wk transition period and an intermediary minimalist shoe. Whether a different transition process increases the probability of a success remains to be seen.

Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective

The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.

Acute effects of footwear on running impact loading in the preschool years

The aim of this study was to assess acute effects of footwear conditions (barefoot, minimalist and standard running shoes) on running impact loading in the preschool years. Fourty-eight habitually shod preschool children (26 males and 22 females) were divided into four age groups (3-, 4-, 5- and 6-year-old). Children performed a simple running game in three different conditions. Three-dimensional biomechanical analysis was carried out during overground running. Statistical parametric mapping was performed on the vertical ground reaction force profiles during the stance phase and one-way repeated measures ANOVA on the vertical instantaneous loading rate. Three-year-old children displayed significantly lower vertical ground reaction force values in the barefoot condition compared to minimalist (3-7% stance) and standard running shoes (7-11% stance). There were also differences in vertical instantaneous loading rate, where 3-year-olds had lower loading when barefoot than in minimalist (p = 0.010, d = 1.19) or running shoes (p = 0.045, d = 0.98), despite no differences in the footstrike pattern (mostly rearfoot-midfoot strike). No differences were found for the older children. Running in minimalist shoes did not imitate barefoot running in 3-year-old children. On the contrary, increased loading was observed in minimalist shoes in early running developmental stages.

Age differences in running biomechanics during footstrike between preschool children and adults

This study aimed to compare impact loading between two age groups of preschool children (3-4 and 5-6 years old) and one group of young adults representing mature level of running skill (n = 15 per group). Three-dimensional biomechanical data were collected during running barefoot, in minimalist and running shoes. A two-way mixed ANOVA was performed to assess age and footwear differences in vertical instantaneous loading rate (VILR). An interaction was found in VILR. Older (5-6) preschoolers had 30-31% lower VILR than younger (3-4) (p = 0.012, d = 1.02; p = 0.001, d = 1.18) and adults had 51-77% lower VILR than younger preschoolers (p = 0.001, d = 1.85; p = 0.001, d = 2.82) in minimalist and running shoes, respectively. Additionally, adults had lower VILR than older preschoolers in running shoes (p = 0.001, d = 2.68). No differences were found between older children and adults in barefoot and minimalist shoes. Loading decreased with increasing age, particularly in minimalist and running shoes. Unchanged cadence and running speed did not explain the decrease of VILR during preschool age. The explanation likely underlies in lower limb alignment during footstrike and developmental ontogenetic changes.

Bone stress injuries

Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.

Effect of training volume on footstrike patterns over an exhaustive run

BACKGROUND

Although footstrike pattern (FP) may not be a factor influencing running performance, 11-75% of world-class distance runners use a non-rearfoot FP. However, little attention has been paid to describe the effect of running volume on FP changes when a runner is fatigued.

RESEARCH QUESTION

Does the training volume provide an adequate stimulus to mitigate FP changes during an exhaustive run in non-rearfoot, habitual minimalist footwear runners?

METHODS

The objective of this study was to compare FP between non-rearfoot, habitual minimalist footwear runners with a moderate training volume (MT) and a high training volume (HT) during an exhaustive run on a motorized treadmill. Based on their weekly training volume (distance), twenty-eight runners were arranged into two groups paired by height and age. At the first visit, runners underwent a VO2max test to acquire their velocity for the exhaustive run. During the second visit, biomechanical and physiological analysis of the beginning and the end phase of the exhaustive run was done.

RESULTS

The frontal plane foot angle, the sagittal plane ankle angle at the initial contact (IC), and the foot eversion ROM showed a significant interaction effect (P < 0.05). Additionally, the sagittal plane footstrike angle, the frontal plane foot angle, the sagittal plane ankle angle, knee flexion angle at IC and foot eversion ROM showed a significant effect of fatigue (P < 0.05). Finally, the frontal plane foot angle, the sagittal plane footstrike angle, the sagittal plane ankle angle, and the knee flexion angle showed significant group effects (P < 0.05).

SIGNIFICANCE

The training volume affects the footstrike pattern of non-rearfoot, habitual minimalist footwear runners when they are fatigued. The highly trained runners maintained their ankle angle throughout the exhaustive running protocol, whereas the moderately trained group changed the frontal and sagittal plane characteristics of their footstrike pattern.