This review turns 1,815 original studies and 919,224 participants into a structured evidence map showing when barefoot walking/running may improve mechanics, balance, foot strength, or knee loading — and when it becomes clinically risky. It is especially useful for clinicians, runners, coaches, and researchers who need a clear, citation-linked map of barefoot biomechanics, diabetic-foot risk, falls, infection exposure, and safe transition strategies.
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Abstract: To synthesize current evidence regarding the biomechanical, developmental, and clinical impacts of barefoot walking and running compared to shod conditions across diverse populations. The review utilises 1815 original studies with 919224 total participants (topic deduplicated ΣN). The mapped evidence indicates that barefoot running can drive a distal redistribution of mechanical demand, shifting load toward the ankle and longitudinal arch, with ankle joint moments increasing by approximately 5–26% and vertical loading rates rising by around 54% in habitually shod individuals during acute transition. Across topics, barefoot conditions were associated with reduced knee adduction moments in medial knee osteoarthritis, altered foot strike patterns, and greater intrinsic foot muscle development, while simultaneously emerging as a prominent risk factor for diabetic foot ulcer recurrence, soil-transmitted helminth infection, podoconiosis, leptospirosis, and falls in older adults, with reported odds ratios as high as 11.2 for indoor falls and transition success rates near 70.8% over 20 weeks. These convergent signals suggest that barefoot activity is neither uniformly protective nor uniformly harmful but is instead strongly context-, population-, and environment-dependent. Clinically, this supports individualized footwear counseling, particularly strict avoidance of barefoot walking in people with diabetic neuropathy and older adults at fall risk, alongside gradual, supervised gait retraining for runners motivated to transition. The evidence map is constrained by predominantly small samples and heterogeneous protocols, limiting firm conclusions on long-term injury and developmental outcomes. Future research should prioritize standardized longitudinal transition protocols, harmonized plantar pressure measurement across baropodometry systems, and prospective cohorts evaluating whether habitual barefoot exposure during childhood translates into durable musculoskeletal benefits without offsetting environmental harms.
Final search date and database lock: 2026-04-29 23:07:41 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 2464
Downloaded Abstracts/Papers: 2464
Included original and non-original Abstracts/Papers (all): 1979
Included original Abstracts/Papers (Vote counting by direction of effect): 1815
Reference Index (links used in paper): 303
Total participants (topic deduplicated ΣN): 919224
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The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
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[81] Effects of Barefoot and Minimalist Footwear Strength-Oriented Training on Foot Structure and Function in Athletic Populations: A Systematic Review. — https://doi.org/10.3390/jcm14217629
[82] Comparative Acceptability of Weightbearing Physical Activity in Sporting Footwear Versus Barefoot in Habitually Shod Individuals. — https://doi.org/10.7547/20-148
[107] A comparison of young children's spatiotemporal measures of walking and running in three common types of footwear compared to bare feet. — https://doi.org/10.1016/j.gaitpost.2020.07.147
[143] Effects of Barefoot and Shod on the Kinematics of Medial Longitudinal Arch During Running Based on a High-Speed Dual Fluoroscopic Imaging System. — https://doi.org/10.3389/fbioe.2022.917675
[148] Does an acute transition to different footwear conditions affect walking patterns in people with different experiences of minimalist footwear? — https://doi.org/10.1016/j.gaitpost.2024.07.003
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[191] The Effect of Barefoot Running on EMG Activity in the Gastrocnemius and Tibialis Anterior in Active College-Aged Females. — https://doi.org/10.70252/lnvl7215
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[281] Acute Change of Footwear Limits Performance and Alters Foot Strike Patterns During Anticipated and Unanticipated 90° Change of Direction. — https://doi.org/10.1002/jfa2.70103
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[303] Altered gait patterns exacerbate knee injury risk: A cross-sectional observational study of barefoot and high-heeled walking. — https://doi.org/10.1097/md.0000000000046762
[307] The effect of an AFO-shaped elastic band on drop-foot gait in patients with central neurological lesions. — https://doi.org/10.3233/nre-130858
[315] Effects of Surface Inclination on the Vertical Loading Rates and Landing Pattern during the First Attempt of Barefoot Running in Habitual Shod Runners. — https://doi.org/10.1155/2015/240153
[316] Cutaneous stimulation at the ankle: a differential effect on proprioceptive postural control according to the participants' preferred sensory strategy. — https://doi.org/10.1186/s13047-016-0140-y
[343] Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study. — https://doi.org/10.1017/s0012162201001992
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[358] Sticking the landing: A comparison of shod vs barefoot landing kinetics and foot muscle characteristics in gymnasts, cheerleaders, and non-athletes. — https://doi.org/10.1371/journal.pone.0309157
[370] Effects of dorsiflexor functional electrical stimulation compared to an ankle/foot orthosis on stroke-related genu recurvatum gait. — https://doi.org/10.1589/jpts.31.865
[381] Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking. — https://doi.org/10.1186/s12938-015-0040-6
[401] Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: A biplane fluoroscopy study. — https://doi.org/10.1177/0309364619825607
[456] Immediate Effects of Manipulating Footwear or Cadence on the Lower Limb Biomechanics of Female Masters Runners. — https://doi.org/10.1123/jab.2021-0387
[480] An evaluation of a bespoke modified UCBL foot orthosis on subjects with flat foot using kinetic measurements and user comfort scores: A randomized controlled trial. — https://doi.org/10.1016/j.foot.2024.102127
[507] Immediate effects of wearing knee length socks differing in compression level on postural regulation in community-dwelling, healthy, elderly men and women. — https://doi.org/10.1016/j.gaitpost.2018.08.011
[521] Effects of ankle-foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial. — https://doi.org/10.1186/s40001-024-01835-2
[526] Custom therapeutic insoles based on both foot shape and plantar pressure measurement provide enhanced pressure relief. — https://doi.org/10.2337/dc07-2288
[538] Laetoli footprints reveal bipedal gait biomechanics different from those of modern humans and chimpanzees. — https://doi.org/10.1098/rspb.2016.0235
[604] Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable? — https://doi.org/10.4081/ni.2018.7729
[681] Plantar Static Pressure Distribution in Normal Feet Using Cotton Socks with Different Structures. — https://doi.org/10.7547/14-085
[686] Reliability of the TekScan MatScan(R) system for the measurement of plantar forces and pressures during barefoot level walking in healthy adults. — https://doi.org/10.1186/1757-1146-3-11
[704] Carbon Modular Orthosis (Ca.M.O.): An innovative hybrid modular ankle-foot orthosis to tune the variable rehabilitation needs in hemiplegic cerebral palsy. — https://doi.org/10.3233/nre-161432
[713] Foot and ankle kinematics in chronic ankle instability subjects using a midfoot strike pattern when running, including influence of taping. — https://doi.org/10.1016/j.clinbiomech.2018.02.016
[725] Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial. — https://doi.org/10.1016/j.rehab.2023.101786
[734] The Utility of Gait Deviation Index (GDI) and Gait Variability Index (GVI) in Detecting Gait Changes in Spastic Hemiplegic Cerebral Palsy Children Using Ankle-Foot Orthoses (AFO). — https://doi.org/10.3390/children7100149
[737] Factors influencing cure rates of non-dermatophyte mold and Candida onychomycosis: analysis of outcomes in 81 patients who completed treatment. — https://doi.org/10.1111/ijd.13426
[752] Four-week habituation to simulated barefoot running improves running economy when compared with shod running. — https://doi.org/10.1111/sms.12032
[768] Impact of Ankle-Foot Orthosis on Gait Efficiency in Ambulatory Children With Cerebral Palsy: A Systematic Review and Meta-analysis. — https://doi.org/10.1097/phm.0000000000001185
[781] The effect of two retraining programs, barefoot running vs increasing cadence, on kinematic parameters: A randomized controlled trial. — https://doi.org/10.1111/sms.14091
[790] Discrepancies between plantar pressure devices: Evaluating cross-system reliability for biomechanics, clinical use and predictive modelling. — https://doi.org/10.1016/j.foot.2025.102190
[792] Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal. — https://doi.org/10.1007/s43465-021-00477-4
[813] Rear foot kinematics when wearing lateral wedge insoles and foot alignment influence the effect of knee adduction moment for medial knee osteoarthritis. — https://doi.org/10.1016/j.gaitpost.2017.06.009
[850] Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes. — https://doi.org/10.1016/j.joca.2016.10.001
[897] The effect of arch supports on foot alignment in patients with metatarsalgia based on weight-bearing computed tomography and radiographic parameters. — https://doi.org/10.5152/j.aott.2025.24191
[939] Burden assessment of podoconiosis in Wayu Tuka woreda, east Wollega zone, western Ethiopia: a community-based cross-sectional study. — https://doi.org/10.1136/bmjopen-2016-012308
[954] The effects of restricting the flexion-extension motion of the first metatarsophalangeal joint on human walking gait. — https://doi.org/10.3233/bme-141073
[994] The reliability of plantar pressure assessment during barefoot level walking in children aged 7-11 years. — https://doi.org/10.1186/1757-1146-5-8
[1001] Footwear Affects Biomechanical Work And Knee Adduction Moment During Stance Phase In Medial Knee Osteoarthritic Male Pakistani Adults. — https://doi.org/10.1109/embc.2018.8512591
[1033] Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil. — https://doi.org/10.1371/journal.pntd.0004514
[1101] Two-dimensional metric comparison between dynamic bare and sock-clad footprints for its forensic implications - A pilot study. — https://doi.org/10.1016/j.scijus.2018.09.001
[1130] Effects of muscular deficiency on postural and gait capacities in patients with Charcot-Marie-Tooth disease. — https://doi.org/10.2340/16501977-1113
[1211] Non-dermatophyte mould onychomycosis: a clinical and epidemiological study at a dermatology referral centre in Bogota, Colombia. — https://doi.org/10.1111/myc.12157
[1228] The Podoprint® plantar pressure platform: Evaluation of reliability and repeatability, and determination of the normality parameters. — https://doi.org/10.1016/j.jtv.2022.07.005
[1351] Prevalence and risk factors related to intestinal parasites among children in Department of Rio San Juan, Nicaragua. — https://doi.org/10.1093/trstmh/tru160
[1369] Characteristics of human leptospirosis in three different geographical and climatic zones of Vietnam: a hospital-based study. — https://doi.org/10.1016/j.ijid.2022.04.011
[1398] Effects of Foot-Strike Patterns During Running on Cumulative Load of Achilles Tendon Force, Plantar Fascia Force, and Patellofemoral Joint Stress. — https://doi.org/10.52082/jssm.2025.747
[1448] Assessment Through the Short Physical Performance Battery of the Functionality in Individuals With Metabolic Syndrome Exposed to Whole-Body Vibration Exercises. — https://doi.org/10.1177/1559325818794530
[1501] Factors associated with clinical leptospirosis: a population-based case-control study in the Seychelles (Indian Ocean). — https://doi.org/10.1093/ije/28.3.583
[1508] Leptospirosis Cases among Outpatients with Non-Malaria Fever Attending Primary Care Clinics during the Rainy Season in Bobo Dioulasso, Burkina Faso. — https://doi.org/10.4269/ajtmh.23-0044
[1532] Acute effects of whole-body vibration with resistance exercise on postexercise blood pressure and oxygen consumption in prehypertensive adults. — https://doi.org/10.1016/j.jesf.2015.12.001
[1561] Prevalence of bovine brucellosis in slaughtered cattle and barriers to better protection of abattoir workers in Ibadan, South-Western Nigeria. — https://doi.org/10.11604/pamj.2017.28.68.10925
[1600] Effects of two different degrees of lateral-wedge insoles on unilateral lower extremity load-bearing line in patients with medial knee osteoarthritis. — https://doi.org/10.1016/j.aott.2016.06.004
[1619] Impaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis. — https://doi.org/10.1016/j.msard.2023.104767
[1628] One-year persistence of individual gait patterns identified in a follow-up study - A call for individualised diagnose and therapy. — https://doi.org/10.1016/j.gaitpost.2017.09.003
[1661] Gait Parameters Alterations Under Dual-Task Conditions in Patients With Acquired and Hereditary Peripheral Neuropathies. — https://doi.org/10.1111/ene.70518
[1663] Hip Muscle Activity and Frontal Plane Lower Extremity Kinematics in Long-Distance Runners With Plantar Fasciitis. — https://doi.org/10.1123/jab.2023-0296
[1671] Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial. — https://doi.org/10.1016/j.gaitpost.2024.05.030
[1682] Changes in sub-calcaneal fat pad composition and their association with dynamic plantar foot pressure in people with diabetic neuropathy. — https://doi.org/10.1016/j.clinbiomech.2021.105441
[1731] Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration. — https://doi.org/10.1016/j.gaitpost.2024.10.015
[1738] Development of a multivariable prediction model for plantar foot ulcer recurrence in high-risk people with diabetes. — https://doi.org/10.1136/bmjdrc-2020-001207
[1740] Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil. — https://doi.org/10.1371/journal.pntd.0006662
[1776] Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability. — https://doi.org/10.1016/j.gaitpost.2018.06.001
[1778] Effect of floor reaction ankle-foot orthosis on crouch gait in patients with cerebral palsy: What can be expected? — https://doi.org/10.1177/0309364617716240
[1794] Effect of increased running speed and weight carriage on peak and cumulative tibial loading. — https://doi.org/10.1111/sms.14476
[1795] The pressure time integral: An underused, clinically significant parameter as a determinant of neuropathic ulceration in diabetes. — https://doi.org/10.1016/j.gaitpost.2022.12.018
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[1914] Development of the Relationships Among Dynamic Balance Control, Inter-limb Coordination, and Torso Coordination During Gait in Children Aged 3-10 Years. — https://doi.org/10.3389/fnhum.2021.740509
[1932] Magnitude of Intestinal Parasite Infection and Associated Factors Among Pregnant Women Attending Antenatal Care Service in Shewarobit Town Health Facilities, North Shoa Zone, Amhara Region, Ethiopia. — https://doi.org/10.2147/idr.s338326
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