Table 1

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/injuryChanges associated with injury in published literatureChanges associated with BF running1828Theoretical implicationSummary and potential clinical outcomes (if known)
Stress fractures of the tibiaIncreased hip adductionUnknownUnknownPotential 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 30Increased rearfoot eversionIncreased rearfoot eversionIncreased risk
Increased free momentUnknownUnknown
Increased impact peakDecreased impact peak in some runnersReduced risk
Increased ground reaction forceDecreased ground reaction force in some runnersReduced risk
Stress fractures of the metatarsalsIncreased peak pressure under metatarsal headIncreased peak pressure under metatarsal headsIncreased riskBF running may increase risk of metatarsal stress fractures as greater application of force for both initial contact and propulsion is experienced
Ref. 21 31 32Decreased peak pressure heel, midfoot and halluxUnknown
Earlier peak rearfoot eversionUnknownUnknown
Increased forefoot loadingIncreased forefoot loadingIncreased risk
Patellofemoral painIncreased impact peakDecreased impact peakDecreased riskBF running may reduce forces experienced by the knee
Ref. 20 33–35Increased eccentric load on kneeUnknown for BF but conscious forefoot strike may decrease eccentric loadDecreased risk
Poor gluteal strengthUnknownUnknown
Hamstring inflexibilityUnknownUnknown
Achilles tendinopathyIncreased rearfoot eversionIncreased rearfoot eversionIncreased riskBF 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. 36–38Increased ankle dorsiflexion at impactIncreased ankle plantarflexion at impactDecreased risk
Decrease leg abductionUnknownUnknown
Decreased knee range of motionDecreased knee flexion at ground contactIncreased risk
Decreased tibialis anterior, gluteus medius and rectus femoris activityIncreased gastrocnemius activityUnknown
Early pronationUnknownUnknown
Plantar fasciitisIncreased vertical ground reaction forceDecreased ground reaction force in some runners, significantly increased in othersRisk dependent on individual response to BF runningBF 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. 39Increased loading ratesDecrease loading rates in some runners, increased in othersBeneficial
Lower medial longitudinal archRaised medial longitudinal archDecreased risk
Increased foot pronationUnknown
Decreased ankle dorsiflexion range of motion at impactDecreased ankle dorsiflexion range of motion at impactIncreased risk