Long-Term Effects of Habitual Barefoot Running and Walking: A Systematic Review.

Introduction: Barefoot locomotion is widely believed to be beneficial for motor development and biomechanics but are implied to be responsible for foot pathologies and running-related injuries. While most of available studies focused on acute effects of barefoot running and walking little is known regarding the effects of long-term barefoot vs. shod locomotion. The purpose of this study was to systematically review the literature to evaluate current evidence of habitual barefoot (HB) vs. habitual shod locomotion on foot anthropometrics, biomechanics, motor performance and pathologies. Methods: Four electronic databases were searched using terms related to habitually barefoot locomotion. Relevant studies were identified based on title, abstract and full text and a forward (citation tracking) and backward (references) search was performed. Risk of bias was assessed, data pooling and meta-analysis (random effects model) performed and finally levels of evidence determined. Results: Fifteen studies with 8399 participants were included. Limited evidence was found for a reduced ankle dorsiflexion at footstrike (pooled effect size -3.47 (95% CI -5.18 to -1.76)) and a lower pedobarographically measured hallux angle (-1.16 (95% CI -1.64 to -0.68)). HB populations had wider (0.55 (95% CI 0.06 to 1.05) but no shorter (-0.22 (95% CI -0.51 to 0.08)) feet compared to habitual shod populations. No differences in relative injury rates were found, with limited evidence for a different body part distribution of musculoskeletal injuries and more foot pathologies and less foot deformities and defects in HB runners. Conclusions: Only limited or very limited evidence is found for long-term effects of HB locomotion regarding biomechanics or health-related outcomes. Moreover, no evidence exists on any beneficial effects for motor performance. Future research should include prospective study designs. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. (C) 2016 American College of Sports Medicine

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