Biomechanical and neuromuscular risk factors associated with major running-related injuries and the possible theoretical and clinical implications barefoot (BF) running may have on them
| Variable/injury | Changes associated with injury in published literature | Changes associated with BF running1828 | Theoretical implication | Summary and potential clinical outcomes (if known) |
|---|---|---|---|---|
| Stress fractures of the tibia | Increased hip adduction | Unknown | Unknown | Potential to reduce risk of tibial stress fractures, but only if impact forces are lower, may depend on other factors. Clinical case series suggests increased risk early during adaptation |
| Ref. 29 30 | Increased rearfoot eversion | Increased rearfoot eversion | Increased risk | |
| Increased free moment | Unknown | Unknown | ||
| Increased impact peak | Decreased impact peak in some runners | Reduced risk | ||
| Increased ground reaction force | Decreased ground reaction force in some runners | Reduced risk | ||
| Stress fractures of the metatarsals | Increased peak pressure under metatarsal head | Increased peak pressure under metatarsal heads | Increased risk | BF running may increase risk of metatarsal stress fractures as greater application of force for both initial contact and propulsion is experienced |
| Ref. 21 31 32 | Decreased peak pressure heel, midfoot and hallux | Unknown | ||
| Earlier peak rearfoot eversion | Unknown | Unknown | ||
| Increased forefoot loading | Increased forefoot loading | Increased risk | ||
| Patellofemoral pain | Increased impact peak | Decreased impact peak | Decreased risk | BF running may reduce forces experienced by the knee |
| Ref. 20 33–35 | Increased eccentric load on knee | Unknown for BF but conscious forefoot strike may decrease eccentric load | Decreased risk | |
| Poor gluteal strength | Unknown | Unknown | ||
| Hamstring inflexibility | Unknown | Unknown | ||
| Achilles tendinopathy | Increased rearfoot eversion | Increased rearfoot eversion | Increased risk | BF running may result in greater eccentric loading on the ankle. Chronic high velocity eccentric loading during running may increase the risk of injury. However, eccentric loading may be beneficial in relieving Achilles tendinopathy if controlled35 |
| Ref. 36–38 | Increased ankle dorsiflexion at impact | Increased ankle plantarflexion at impact | Decreased risk | |
| Decrease leg abduction | Unknown | Unknown | ||
| Decreased knee range of motion | Decreased knee flexion at ground contact | Increased risk | ||
| Decreased tibialis anterior, gluteus medius and rectus femoris activity | Increased gastrocnemius activity | Unknown | ||
| Early pronation | Unknown | Unknown | ||
| Plantar fasciitis | Increased vertical ground reaction force | Decreased ground reaction force in some runners, significantly increased in others | Risk dependent on individual response to BF running | BF running may aid in attenuating the associated risk factors. However, these beneficial changes may be acquired only after habituation to BF running in some individuals |
| Ref. 39 | Increased loading rates | Decrease loading rates in some runners, increased in others | Beneficial | |
| Lower medial longitudinal arch | Raised medial longitudinal arch | Decreased risk | ||
| Increased foot pronation | Unknown | – | ||
| Decreased ankle dorsiflexion range of motion at impact | Decreased ankle dorsiflexion range of motion at impact | Increased risk |