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Barefoot and minimalist running: what is left of the injury claims

Do thin shoes or bare feet protect you from running injuries? What the trials found, why surveys of barefoot runners tell another story, and where the load goes when the cushioning comes off.

Published 25 October 2026 30 sources · 9 figures · every number checked against the source
The load does not disappear, it moves
A thick cushioned running shoe and a thin flat running shoe side by side on a gravel park path in morning mist, with a trail of bare footprints in the gravel beside them.
Figure 1. Illustration. A cushioned shoe, a minimalist shoe and bare feet. In the figures, conventional shoes are blue, minimalist shoes amber and barefoot brown; rust marks more load or more injuries, green less load.

No trial has shown that minimalist shoes protect runners from injury, and none of the injury trials tested bare feet. Of three trials of truly minimalist shoes, two saw more injuries than in ordinary shoes and one saw a few fewer, mostly within chance. What does change, at least in the lab, is where the load lands: less on the knee, more on the calf, the Achilles tendon and the sole of the foot. Whether the injuries follow that shift is not settled.

  • The trials found no protection. Pooled by Cochrane, 27 in 100 runners in minimalist shoes got injured over three to six and a half months, against 21 in 100 in ordinary shoes. Two-thirds of that pool is one trial of cushioned shoes with a lower drop.
  • Surveys look better because they count the runners who stayed. In the one survey that also asked those who gave up, only the runners who kept at it had fewer injuries.
  • A barefoot heel strike is the hardest landing of all. Land on the forefoot instead and it is about as soft as a cushioned shoe, not softer.
  • In the lab, the load moves down the leg. In 20 young men landing on the forefoot, the load on the kneecap joint fell by nearly a quarter per step, and on the Achilles tendon it rose by a third.
  • The switch went very differently from study to study. From 12 of 14 runners with pain in one small study to none of 20 on a slow six-month plan in another.
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In 2009 a best-selling book about a tribe of Mexican runners, Born to Run, set off a movement: runners took their shoes off or switched to thin, flat ones.1 A year later a paper in Nature showed that runners who grew up barefoot often land on the forefoot, without the sharp jolt of a heel strike.2 The promise that followed was simple: run the way the body was built to, and you will get hurt less.

The Harvard lab behind that paper wrote on its own website that the idea "has yet to be tested".3 Since then, trials have tested it. If you have wondered whether thinner shoes would spare you injuries, here is what they found. We also show why surveys say something else, and what changes when the cushioning comes off.

1 What counts as minimalist?

There is no clean line. A panel of 42 experts from 11 countries agreed on five things that make a shoe minimalist. They are low weight, a thin sole, little or no drop from heel to toe, flexibility, and no motion control or stability features.4 Each counts for 20% on a scale from 0 to 100%, and the panel could not say where on that scale a shoe becomes minimalist (figure 2).

A horizontal scale from 0% to 100%, coloured from blue (more cushioned, heavier, more support) to amber (lighter, thinner, flatter, more flexible). Below it five equal boxes: weight, stack height, heel-to-toe drop, flexibility, motion control and stability. Marks at 72%, 76% and 78% for the minimalist shoes in the injury trials. Off the scale on the right: barefoot, no shoe at all.
Figure 2. Minimalist is a scale. The index scores five features, each worth 20%. Its authors found no score at which a shoe becomes minimalist. The three marks are the minimalist shoes in two of the injury trials.

Running barefoot is something else again. Even the thinnest shoe cannot fully copy it.5 That matters for what follows, because the trials tested shoes, not bare feet.

2 Did they prevent injuries?

No. In the trials, runners in minimalist shoes had about as many injuries as runners in ordinary shoes, or a few more.

The Cochrane review pooled five trials with 766 runners in all, followed for three to six and a half months.6 With minimalist shoes, 273 in 1,000 got injured; with conventional cushioned shoes, 210 (somewhere between 161 and 276). The review concludes that the type of shoe may change the injury count little or not at all, and that better trials could change that answer (figure 3).

Two grids of 100 dots. Minimalist shoes: 27 of 100 injured. Conventional shoes: 21 of 100 injured, range 16 to 28. Beside them, what is in the pool: Malisoux 2016, 67% of the weight, cushioned shoes with a lower drop, no difference; Fuller 2017, 21%, 26 weeks, 16 of 31 injured in minimalist and 11 of 30 in conventional shoes; Ryan 2014, 7%, 12 weeks, injuries 4 conventional, 7 full (our subtraction) and 12 part-minimalist; two small trials, 5%, Dubois 2015 and Marshall 2013.
Figure 3. No protection in the trials. Pooled by the Cochrane review; per 100 is our rounding of its per 1,000, and the range for conventional shoes is the 95% confidence interval. The review rates the answer as uncertain, mainly because runners often knew which shoe they wore and the range is wide. The weights are the review's own.

There is a catch in that pool. Two-thirds of its weight comes from one trial of 553 runners. Its "minimalist" shoes were ordinary cushioned shoes with a lower heel-to-toe drop, and it found no difference.7 The trials of truly minimalist shoes are smaller. Over 12 weeks, runners in a neutral shoe had 4 injuries and in a part-minimalist shoe 12. In a minimalist toe shoe it was 7, by our subtraction from the 23 in all.8 Over 26 weeks, 16 of 31 men in minimalist shoes got injured, against 11 of 30 in conventional shoes, a difference that could be chance.9

A review of twelve switch studies came out in the same place: 17.9 injuries per 100 runners moving to minimal shoes, against 13.4 in ordinary shoes, again within chance.10 A 2026 trial, too recent for the Cochrane review, found no clear difference after a year either. Its minimalist group had somewhat fewer injuries, within chance, and ran a little under half its distance in the new shoes.11

None of these trials tested running barefoot. One registered barefoot trial fell outside the Cochrane review's question, and the review gives no results from it.6 So for bare feet, all we have are surveys and lab studies.

3 So why do barefoot runners report fewer injuries?

Because surveys compare the runners who stayed.

One survey of 2,509 runners found that 46.7% of runners in traditional shoes reported an injury, against 13.7% of experienced minimalist runners.12 That looks like a strong effect, until you see who was compared. The comparison was made in 888 of them, and everyone who had changed shoes or landing in the past year, 1,363 runners, had been left out.

A 2026 survey of 4,719 Brazilian runners did ask the ones who gave up. Of the 1,042 who had tried minimalist shoes, 31% had stopped, most of them because of pain or discomfort (figure 4).13 Those who stopped had no fewer injuries than runners who had never tried the shoes. Only the 28% who stuck with them did, and the authors name survival bias as one possible explanation.

Left, 100 squares for 1,042 runners who had tried minimalist shoes: about 20 stopped because of pain or discomfort, about 11 stopped for another reason, 41 use them occasionally and 28 habitually; only the habitual users had fewer injuries. Right, bar chart: injuries per runner 1.17 barefoot and 1.66 in shoes; miles run per week 14.9 barefoot and 25.3 in shoes. Per mile run, no difference.
Figure 4. Who stays, answers. Left: the survey asked about the last six months, and runners sorted themselves into the groups. The 20 and 11 are ours: 31% stopped, and 64.6% of those gave pain or discomfort as the reason. Right: the barefoot runners ran about 10 miles a week less.

A one-year study of 107 barefoot and 94 shod runners adds a second twist.14 The barefoot runners had fewer injuries per runner, 1.17 against 1.66. But they also ran about 10 miles a week less, and per mile run there was no difference. The authors note that their study most likely missed the runners who did not get through the switch.

4 What changes when the foot lands?

A barefoot heel strike is the hardest landing of all. Landing on the forefoot takes the jolt away, but leaves it about where a cushioned shoe has it.

The 2010 Nature study measured how fast the force rises in the first instant of contact, in six runners per group.2 Runners who normally wear shoes, landing on their heel without them, reached 463 body weights per second. In their shoes it was 70. Habitual barefoot runners landing on the forefoot reached 65: about as soft as a heel strike in a cushioned shoe, not softer (figure 5).

Two bar charts of loading rate in body weights per second. Lieberman 2010: heel strike barefoot 463, heel strike in shoes 70, forefoot strike barefoot 65. Rice and Patel 2017: heel strike in a shoe 83, in a minimal shoe 143, barefoot 214; forefoot strike barefoot 96.
Figure 5. Barefoot heel strikes hit hardest. The rate at which the force rises in the first moment of contact. Left: subsamples of six runners who normally wear shoes and six who normally run barefoot. Right: 22 heel strikers trying each condition for the first time; even their barefoot forefoot landing hit faster than a heel strike in the standard shoe.

A later study had 22 heel strikers try each condition for the first time.15 Landing on their heel, the rate went from 83 in a standard cushioned shoe to 143 in a minimal shoe and 214 barefoot. Barefoot on the forefoot it was 96, still above the standard shoe. Take the cushioning away and keep the heel strike, and the force arrives faster with every step.

Whether that jolt causes injuries is a separate question, and an open one. One critical review calls the case for injury prevention through a softer impact "questionable at best".16

5 Does a thin shoe change how you land?

For fewer than half of runners, at least when the shoe was all that changed. Most runners land on their heel: 79% early in a road race and 86% late in it.17

In the 2026 trial, 140 heel strikers were split into three groups.11 One got minimalist shoes, one got coaching on how to land, and one kept running in their own shoes and did a stretching routine. After a year, 45% of the minimalist group landed on the forefoot, against 79.5% of the coached group and none of the third (figure 6). In the first six weeks of the 26-week trial, only two of the 31 runners in minimalist shoes switched to a forefoot landing.18 Many runners simply keep their shod running style in a minimal shoe.10 Even running barefoot, 11 of 19 female runners in one lab study chose a heel strike.19

Line chart of the share of runners landing on the forefoot at the start, 2, 6 and 12 months. Coached to land differently: 0, 91, 81.9 and 79.5%. Minimalist shoes: 0, 38.7, 41 and 45%. Own shoes and stretching: 0% throughout.
Figure 6. Thin shoes alone changed fewer than half. Landing was classed as rearfoot or forefoot strike. The minimalist group ran a little under half its weekly distance in the new shoes at six and twelve months.

Shorter, quicker steps are part of the barefoot style too. In 45 recreational runners, raising the step rate by 5% lowered the energy the knee had to absorb by about 20%, and by 10% about 34%. The ankle did not get off any lighter.20

6 Where does the load go?

Down the leg, at least in the lab. What the knee no longer takes, the calf, the Achilles tendon and the sole of the foot take instead.

A 2025 study had 20 young men who were not regular runners run barefoot with three landings in turn: on the heel, the midfoot and the forefoot.21 Per step, a forefoot landing put 23% less load on the kneecap joint than a heel strike. It put 32% more on the Achilles tendon and 45% more on the plantar fascia, the band under the sole (figure 7). Taking the shoe off did something similar in 30 male runners: kneecap force 22% lower, Achilles tendon force 21% higher.22

Bar chart with three groups. Kneecap joint: 100 with a heel strike, 93 midfoot, 77 forefoot. Achilles tendon: 100, 119, 132. Sole of the foot: 100, 121, 145. Beside it, barefoot against a conventional shoe in 30 male runners: kneecap force 22% lower, Achilles tendon force 21% higher. Note: another study found no higher peak Achilles force.
Figure 7. Down the leg, in the lab. Left: impulse per step, the force on each structure added up over the step, as an index of ours with the heel strike at 100. Right: peak forces, our percentages from the published means. Neither panel measured injuries.

Not every study agrees on the peak. In the 22 heel strikers trying something new, the highest Achilles force did not differ by landing or shoe.15 What does recur is the total load per step. In 19 female runners running barefoot, the 8 who did not land on the heel had 11% more Achilles load per step than the 11 who did.19 The Harvard lab warned about the same tendon.3

7 And where does it hurt?

Less clearly than the lab suggests. The injury counts point partly the same way, and partly not.

In a one-year study, runners in shoes had 21 diagnosed hip and knee injuries, the barefoot runners 5. For the lower leg it was the other way round: 27 barefoot against 12 in shoes (figure 8).14 The authors did not test those differences. Plantar fasciitis, a load injury of the sole, went against the barefoot story: 3 barefoot against 11 in shoes. What the barefoot runners did get more of was cuts, blisters and bruises under the foot: 30% of them, against 6%.

One cohort: fewer hip and knee injuries, more lower-leg ones. Mirrored bar chart, barefoot left and in shoes right. Hip and knee: 5 against 21. Plantar fasciitis: 3 against 11. Lower leg: 27 against 12. Beside it: cuts, blisters and bruises on the sole in 30% of barefoot runners and 6% of runners in shoes.
Figure 8. One cohort, two directions. Counts of diagnosed injuries in one year, not adjusted for group size or mileage, and not tested. Plantar fasciitis, a load injury of the sole, was rarer barefoot; the 30% are skin injuries such as cuts and blisters.

The 26-week trial saw more lower-leg and foot injuries in minimalist shoes, 10 against 6. It also saw slightly more knee pain once the runners used them for more than about a third of their running, though below what the authors call clinically meaningful.9 In the 2026 trial, the group coached to land differently had more foot and fewer hip injuries in some of the analyses. The minimalist group did not differ.11 And in one clinic, eight of ten runners who came in injured after switching had a stress fracture in a metatarsal, a long bone of the foot. A clinic series shows what turns up, not how often.23

One review concludes from the lab studies that changing how you land may expose runners to different injury mechanisms, rather than making one landing safer than the other.16

8 What happens during the switch?

It went very differently from study to study, and nobody has compared the first weeks with the years after.

A small study followed 14 runners through the switch. Twelve reported an injury, mostly pain in the calf and Achilles tendon, on average after five to six weeks (figure 9).24 None of them kept to all the switching advice they had been given. In another, 10 of 19 runners showed swelling in at least one foot bone on a scan after ten weeks, and two had a stress fracture. In the group that stayed in its usual shoes it was 1 of 17.25 With a slow build-up of 5% of weekly running a week, the 26-week trial ended with 16 of 31 injured against 11 of 30, within chance.9 And in 20 runners on a six-month plan that included foot and calf exercises, nobody got injured by the switch.26

Timeline in weeks. Salzler 2016, 14 runners followed about 30 weeks: 12 of 14 injured, mostly calf pain, onset on average after about 6 weeks; none kept to the switching advice. Ridge 2013, 19 runners, scan at week 10: 10 of 19 with swelling in a foot bone, against 1 of 17 in their usual shoes. Fuller 2017, 31 runners over 26 weeks, all running in the new shoe from week 20: 16 of 31 injured, against 11 of 30 in conventional shoes. Chen 2016, 20 runners over six months with foot and calf exercises: no injuries from the switch.
Figure 9. Four switches. Salzler's runners got the shoe maker's advice, and none kept to all of it. Ridge used a ten-week plan modelled on the maker's website; swelling was seen on a scan, and pain scores varied widely. Fuller added 5% of weekly running a week. Chen's plan ran six months and added foot and calf exercises.
Who may run more risk: each of these rests on a single study. In one trial, the heavier the runner above about 71 kg, the higher the risk in minimalist shoes, a pattern the authors looked for after the fact.9 In another, a lower heel-to-toe drop went with more injuries in regular runners and fewer in occasional ones. That trial was not designed to test it.7 In the scan study, 8 of the 11 runners with marked swelling were women.25 None of these has been confirmed in a second study.

There is one clear gain. After six months in minimalist shoes, runners had larger muscles in the foot and the lower leg.26 Whether that prevents injuries has not been measured.

9 Do they save energy, and are you faster?

A little more economical, and in one trial slightly faster. Part of the saving is simply a lighter shoe: each 100 grams costs about 1% more oxygen.5

Two meta-analyses found a small gain in running economy for minimalist over conventional shoes.27,28 In one, more than half the runners were already used to running barefoot. In 15 experienced barefoot runners, a minimal shoe was still 2.41 to 3.32% more economical after correcting for its lower weight.29 For a heel striker who changes how they land, a review found no support for a gain.30

Economy is not speed, though. The one trial here that timed runners is the first six weeks of the 26-week trial. The minimalist group improved its 5-km time a little more, a small difference only just clear of chance.18 Running economy gets its own explainer later.

Who pays for this research: the 12-week trial was funded through a partnership grant with Nike, which made two of its three shoes.8 Both shoes in the 26-week trial were Asics. A running store supplied them at reduced cost, Asics donated 20 pairs of the conventional shoe, and Asics had funded separate research by one of the authors.9 The drop trial was cofunded by Decathlon, which supplied the shoes.7 The Nature paper and the economy study from the Harvard lab were funded in part by Vibram, whose toe shoe was used in six of the studies here.2,29 The scan study had no outside funding.25 That does not make any finding wrong. It is a reason to read each next to the others.
Who was measured: small groups, often in a lab on a single day. The 26-week trial was in trained men, and several lab studies used men only or women only. The economy studies mostly used runners already used to thin shoes or bare feet. The biggest trial, 553 runners, tested cushioned shoes with different heel drops.7

10 So what does this leave you with?

Four answers.

  1. Do they prevent injuries? Not in any trial so far. Of three trials of truly minimalist shoes, two saw more injuries and one a few fewer, mostly within chance.
  2. Why do fans say otherwise? Surveys count the runners who stayed. Those who gave up, mostly because it hurt, had no fewer injuries.
  3. What changes? In the lab, where the load goes: less on the knee, more on the calf, the Achilles tendon and the foot. Whether the injuries follow is not settled.
  4. Is it faster? Slightly more economical, partly because the shoe weighs less, and in one six-week trial a little faster over 5 km.

Taking the cushioning away has not made running safer in any trial. What it does, at least in the lab, is move the load from the knee to the calf, the Achilles tendon and the foot.

How we did this (for the curious)

We first mapped how eleven sources (reviews, a consensus statement and a professional society) define the topic, then read the trials and lab studies behind each figure. Every number on this page is in a source we hold. Where we rounded per 1,000 to per 100, turned two means into a percentage, or set a heel strike at 100, we say so. We read 29 of the 30 sources in full, five of them as the authors' own version (a submitted or accepted manuscript), and one as the abstract, as noted.

Sources

30 sources: 29 research papers and reviews (T1) and one lab website (T3), used only for what the lab itself says. We hold every one; we read 29 in full, five as the authors' own version, and one as the abstract, as noted. After each entry: what we took from it.

  1. T1 Rixe JA, Gallo RA, Silvis ML. The barefoot debate: can minimalist shoes reduce running-related injuries? Current Sports Medicine Reports. 2012;11(3):160–165. doi:10.1249/JSR.0b013e31825640a6. The rise of the minimalist movement after the 2009 book Born to Run, and that the claims of fewer injuries were not yet backed by studies.
  2. T1 Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531–535. doi:10.1038/nature08723. The loading rate at contact (463, 70 and 65 body weights per second for a barefoot heel strike, a heel strike in shoes and a barefoot forefoot strike), measured in subsamples of six runners per group; funded in part by Vibram USA.
  3. T3 Lieberman DE, et al. Running barefoot, forefoot striking and training tips. Website of the Skeletal Biology Lab, Harvard University, barefootrunning.fas.harvard.edu, read in the Wayback Machine snapshot of 22 November 2021 (the site no longer resolves). That the lab's hypothesis on injury "has yet to be tested", the warning about the Achilles tendon, and its funding disclaimer (Harvard University and, in part, Vibram USA).
  4. T1 Esculier JF, Dubois B, Dionne CE, Leblond J, Roy JS. A consensus definition and rating scale for minimalist shoes. Journal of Foot and Ankle Research. 2015;8:42. doi:10.1186/s13047-015-0094-5. The consensus definition of a minimalist shoe, the Minimalist Index of five features at 20% each from 0 to 100%, and that no cut-off between minimalist and not could be set.
  5. T1 Perkins KP, Hanney WJ, Rothschild CE. The risks and benefits of running barefoot or in minimalist shoes: a systematic review. Sports Health. 2014;6(6):475–480. doi:10.1177/1941738114546846. That a minimalist shoe cannot entirely replicate barefoot running, and that each 100 grams added to a shoe raises oxygen use by about 1%.
  6. T1 Relph N, Greaves H, Armstrong R, et al. Running shoes for preventing lower limb running injuries in adults. Cochrane Database of Systematic Reviews. 2022;8:CD013368. doi:10.1002/14651858.CD013368.pub2. Five trials in 766 runners: 273 per 1,000 injured with minimalist shoes against 210 (161 to 276) with conventional ones, risk ratio 0.77 (0.59 to 1.01), low certainty; and the exclusion of a registered barefoot trial.
  7. T1 Malisoux L, Chambon N, Urhausen A, Theisen D. Influence of the heel-to-toe drop of standard cushioned running shoes on injury risk in leisure-time runners: a randomized controlled trial with 6-month follow-up. American Journal of Sports Medicine. 2016;44(11):2933–2940. doi:10.1177/0363546516654690. In 553 runners, the trial behind two-thirds of the Cochrane pool: no difference in injury risk with a lower drop overall; a higher risk in regular runners and a lower one in occasional runners in a secondary analysis the trial was not powered for; cofunded by Decathlon.
  8. T1 Ryan M, Elashi M, Newsham-West R, Taunton J. Examining injury risk and pain perception in runners using minimalist footwear. British Journal of Sports Medicine. 2014;48(16):1257–1262. doi:10.1136/bjsports-2012-092061. Three shoes over 12 weeks in 99 analysed runners: 4 injuries in the neutral shoe and 12 in the partial minimalist shoe, more shin and calf pain in the full minimalist shoe, and funding through an industry partnership grant with Nike.
  9. T1 Fuller JT, Thewlis D, Buckley JD, et al. Body mass and weekly training distance influence the pain and injuries experienced by runners using minimalist shoes: a randomized controlled trial. American Journal of Sports Medicine. 2017;45(5):1162–1170. doi:10.1177/0363546516682497. Injuries in 16 of 31 runners in minimalist shoes against 11 of 30 in conventional shoes (hazard ratio 1.64, 0.63 to 4.27), 10 against 6 in the lower leg and foot, more knee pain from week 7, the shoe's score of 72% on the index, the build-up of 5% a week, a post hoc finding of higher risk with body mass above 71.4 kg, and the Asics disclosure.
  10. T1 Warne JP, Gruber AH. Transitioning to minimal footwear: a systematic review of methods and future clinical recommendations. Sports Medicine Open. 2017;3(1):33. doi:10.1186/s40798-017-0096-x. Across 12 transition studies, 17.9 injuries per 100 runners switching to minimal footwear against 13.4 per 100 in conventional shoes (not significant), and that many runners keep a shod running style in minimal shoes.
  11. T1 Abran G, Schwartz C, Dardenne N, Delvaux F, Croisier JL. Minimalist footwear and softer running technique alter injury location but not incidence in recreational endurance runners. American Journal of Sports Medicine. 2026;54(1):109–117. doi:10.1177/03635465251392242. Read as the submitted version. No clear difference in injury rate after 12 months (fewer injuries in the minimalist group, within chance), the new shoes used for a little under half the weekly distance, the index scores of the trial shoes (76 and 78%), the share landing on the forefoot over time, and that the shift in injury location was in the technique group.
  12. T1 Goss DL, Gross MT. Relationships among self-reported shoe type, footstrike pattern, and injury incidence. US Army Medical Department Journal. 2012;Oct–Dec:25–30. A survey of 2,509 runners: 46.7% of runners in traditional shoes against 13.7% of experienced minimalist runners reported an injury, in 888 runners, after 1,363 who had changed shoe or landing in the past year were left out.
  13. T1 Cardoso Filho CA, et al. Adherence, motivational factors, and injury rates in runners using minimalist vs. conventional shoes: a cross-sectional study of 4719 Brazilian runners. Brazilian Journal of Physical Therapy. 2026;31(1):101650. doi:10.1016/j.bjpt.2026.101650. Of 1,042 runners who had tried minimalist shoes, 31% former, 41% occasional and 28% habitual users; most who stopped (64.6%) gave pain or discomfort; no lower odds of injury in former users (odds ratio 1.14) and lower odds only in habitual users (odds ratio 0.72), with survival bias named by the authors as one possible explanation.
  14. T1 Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. British Journal of Sports Medicine. 2016;50(8):476–480. doi:10.1136/bjsports-2014-094482. A year of 107 barefoot and 94 shod runners: injuries per runner 1.17 against 1.66 but no difference per mile, 14.9 against 25.3 miles a week, injuries by location, and that the study most likely missed runners who did not get through the switch.
  15. T1 Rice H, Patel M. Manipulation of foot strike and footwear increases Achilles tendon loading during running. American Journal of Sports Medicine. 2017;45(10):2411–2417. doi:10.1177/0363546517704429. Read as the accepted manuscript. In 22 habitual heel strikers, the loading rate of a heel strike in a standard shoe, a minimal shoe and barefoot (83, 143 and 214 body weights per second), 96 for a barefoot forefoot landing, and no difference in peak Achilles tendon force by landing or shoe.
  16. T1 Hamill J, Gruber AH. Is changing footstrike pattern beneficial to runners? Journal of Sport and Health Science. 2017;6(2):146–153. doi:10.1016/j.jshs.2017.02.004. That the case for preventing injuries through a lower impact is questionable, and that switching landing may expose runners to different injury mechanisms rather than one landing being safer.
  17. T1 Bovalino SP, Kingsley MIC. Foot strike patterns during overground distance running: a systematic review and meta-analysis. Sports Medicine Open. 2021;7(1):82. doi:10.1186/s40798-021-00369-9. In races over 10 km, 79% of runners landed on the heel at the first checkpoint and 86% at the last.
  18. T1 Fuller JT, Thewlis D, Tsiros MD, Brown NAT, Buckley JD. Six-week transition to minimalist shoes improves running economy and time-trial performance. Journal of Science and Medicine in Sport. 2017;20(12):1117–1122. doi:10.1016/j.jsams.2017.04.013. Abstract. Read as the abstract; an earlier analysis of the same trial (50 runners) is chapter 6 of the first author's PhD thesis (University of South Australia, 2016). The first six weeks of the 26-week trial in 61 trained runners: a small gain in 5-km time-trial performance (effect size 0.24, 0.01 to 0.48) and in running economy, and only two runners landing on the forefoot in minimalist shoes.
  19. T1 Almonroeder T, Willson JD, Kernozek TW. The effect of foot strike pattern on Achilles tendon load during running. Annals of Biomedical Engineering. 2013;41(8):1758–1766. doi:10.1007/s10439-013-0819-1. In 19 female runners running barefoot, 11 preferred a heel strike; the 8 who did not had 11% more Achilles tendon impulse per step.
  20. T1 Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise. 2011;43(2):296–302. doi:10.1249/MSS.0b013e3181ebedf4. Read as the author manuscript (PMC3022995). In 45 recreational runners, about 20% and 34% less energy absorbed at the knee with a step rate 5% and 10% above their own, and no less at the ankle.
  21. T1 Nishiguchi H, Takabayashi T, Kikumoto T, Kubo M. Effects of foot-strike patterns during running on cumulative load of Achilles tendon force, plantar fascia force, and patellofemoral joint stress. Journal of Sports Science and Medicine. 2025;24(4):747–754. doi:10.52082/jssm.2025.747. Impulse per step with a heel, midfoot and forefoot strike in 20 young men running barefoot: Achilles tendon 7.7, 9.2 and 10.2; plantar fascia 6.20, 7.53 and 8.96; patellofemoral joint 1.50, 1.39 and 1.15.
  22. T1 Sinclair J. Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running. Clinical Biomechanics. 2014;29(4):395–399. doi:10.1016/j.clinbiomech.2014.02.004. In 30 male runners, peak Achilles tendon force 6.17 body weights barefoot against 5.09 in a conventional shoe, and patellofemoral contact force 3.19 against 4.11.
  23. T1 Salzler MJ, Bluman EM, Noonan S, Chiodo CP, de Asla RJ. Injuries observed in minimalist runners. Foot & Ankle International. 2012;33(4):262–266. doi:10.3113/FAI.2012.0262. A case series from one clinic: ten experienced runners injured within a year of switching to minimalist shoes, eight with a metatarsal stress fracture.
  24. T1 Salzler MJ, Kirwan HJ, Scarborough DM, Walker JT, Guarino AJ, Berkson EM. Injuries observed in a prospective transition from traditional to minimalist footwear: correlation of high impact transient forces and lower injury severity. The Physician and Sportsmedicine. 2016;44(4):373–379. doi:10.1080/00913847.2016.1238282. Read as the accepted author version. Twelve of 14 runners injured during the switch, mostly with calf and Achilles pain, on average after 6 weeks (range 1 to 27) in the abstract and 5 weeks (range 1 to 19) in the results; none kept to all the switching advice; followed about 30 weeks.
  25. T1 Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Medicine & Science in Sports & Exercise. 2013;45(7):1363–1368. doi:10.1249/MSS.0b013e3182874769. Swelling in at least one foot bone on MRI in 10 of 19 runners after a ten-week switch against 1 of 17 in the control group, two stress fractures, 8 women among the 11 with marked swelling, and no external funding.
  26. T1 Chen TL, Sze LK, Davis IS, Cheung RT. Effects of training in minimalist shoes on the intrinsic and extrinsic foot muscle volume. Clinical Biomechanics. 2016;36:8–13. doi:10.1016/j.clinbiomech.2016.05.010. Read as the accepted manuscript. Larger leg and foot muscles after six months of switching to minimalist shoes, in 20 runners against 18 runners in standard shoes, and no transition-related injuries on a plan with foot and calf exercises.
  27. T1 Fuller JT, Bellenger CR, Thewlis D, Tsiros MD, Buckley JD. The effect of footwear on running performance and running economy in distance runners. Sports Medicine. 2015;45(3):411–422. doi:10.1007/s40279-014-0283-6. A small benefit for running economy with minimalist against conventional shoes (standardised mean difference 0.29).
  28. T1 Cheung RT, Ngai SP. Effects of footwear on running economy in distance runners: a meta-analytical review. Journal of Science and Medicine in Sport. 2016;19(3):260–266. doi:10.1016/j.jsams.2015.03.002. Better economy barefoot and in minimalist shoes, with more than half of the runners in the studies already used to running barefoot.
  29. T1 Perl DP, Daoud AI, Lieberman DE. Effects of footwear and strike type on running economy. Medicine & Science in Sports & Exercise. 2012;44(7):1335–1343. doi:10.1249/MSS.0b013e318247989e. In 15 experienced barefoot or minimal-shoe runners, 2.41 to 3.32% better economy in a minimal shoe after correcting for shoe mass and stride frequency; funded in part by a gift from Vibram USA.
  30. T1 Anderson LM, Bonanno DR, Hart HF, Barton CJ. What are the benefits and risks associated with changing foot strike pattern during running? A systematic review and meta-analysis of injury, running economy, and biomechanics. Sports Medicine. 2020;50(5):885–917. doi:10.1007/s40279-019-01238-y. No support for better economy from changing the landing, more load on the ankle and calf, and that a change of landing cannot be recommended to an uninjured heel striker.

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