Table 1 A summary of key factors from the research papers included in this review. Studies are ordered from the shortest to longest transition period. Age ranges estimated from mean ± 1 SD are given because not all studies reported the mean age of participants
Source | Participant’s information | Groups (size of final N) | Transition period | Transition footwear | Training log used | Transition schedule (in MFW) [week] | Exercises included | Gait retraining included | Main study outcomes | Injuries experienced | Participant attrition |
|---|---|---|---|---|---|---|---|---|---|---|---|
Willson et al. [9] | N = 19 Female, 18–35 years Running > 24 km/week | MFW (N = 17, tested in MFW and CRS) | 2 weeks | Vibram FiveFingers (Bikila) | No | No other training | No | No. of participants informed that they were “not compelled to continue with a rearfoot strike pattern” | Runners that retained a rearfoot strike (9 of 12) showed 3 times greater LR in MFW vs. those who converted to non-rearfoot strike No change in kinetics over time across all participants | 1 injury—lateral knee pain (was 1 of 2 that dropped out of study) | 2/19 = 11% |
Warne and Warrington [38] | N = 15 Male Well-trained runners, 19–29 years > 50 km/week | MFW (N = 15, tested in MFW and CRS) | 4 weeks | Vibram FiveFingers (classic) | No | Calf raises, golf ball rolling on the foot sole | No | 1.05% more economical in MFW at pre-tests (ns), 6.9% at post-tests | Not reported | None = 0% | |
Maintained total volume (substituted some CRS volume for MFW) | |||||||||||
Warne et al. [7] | N = 10 Female, 19–23 years Running average 45 km/week | MFW (N = 10) tested in MFW and CRS) | 4 weeks | Vibram FiveFingers (KSO) (lab testing performed in Vivo Barefoot EVO) | No | 3 × 5–8-min barefoot activity [1], 3 × 10–15 min [2], 3 × 20–25 min [3], 3 × 30–35 min [4] Maintained CRS volume Used grass and pavement | Foot sole and calf rolling, ankle mobility, calf raises, toe grabs, static balance | Shorten stride and increase cadence, run light and quiet, non-rearfoot landing, upright posture Encouraged for MFW and CRS | Reduction in plantar forces at post-tests in both MFW and CRS Higher mean and regional pressures in MFW vs. CRS | None | None = 0% |
Bellar and Judge [34] | N = 13, 7 male, 6 female, 21–23 years Distance not reported Could run for 30 min continuously | MFW (N = 13, tested in MFW, barefoot and CRS) | 5 weeks | Kigo Edge/Drive | Yes | 5 × 30 min running/week, 1 of these in MFW and others in CRS [1], progress to all 5 in MFW [5] | No | No | 3% improved running economy pre to post, likely a training effect | Not reported | None = 0% |
Warne et al. [8] | N = 28 Male, 25–43 years Running > 40 km/week | MFW (N = 12, tested in MFW and CRS) CRS (N = 12, tested in CRS) | 6 weeks | Vibram FiveFingers (KSO) | Yes | 3 × 5–8-min barefoot activity [1], 3 × 10–18 min [2], 3 × 25–28 min [3], 3 × 30–35 min [4], 2–3 × 40–45 min [5, 6] Maintained CRS volume Used grass and pavement | Foot sole and calf rolling, ankle mobility, calf raises, toe grabs, static balance | Shorten stride and increase cadence, run light and quiet, non-rearfoot landing, upright posture | 33% reduction in loading rate in the MFW group after transition Loading rate significantly higher in MFW vs. CRS at pre-tests | 2 injuries in the MFW group (hamstring tear, calf tear) No injuries in the CRS group | 4/28 = 14% (2 in the MFW group due to injury; 2 in the CRS group lost to follow-up) |
Khowailed et al. [35] | N = 12 Female, 23–29 years Running average 25 km/week | MFW (N = 12, tested in MFW and CRS) | 6 weeks | Vibram FiveFingers (Bikila) | No | 3 × 5–8-min barefoot activity [1], 3 × 10–15 min [2], 3 × 20–25 min [3], 3 × 30–35 min [4] Maintained CRS volume Used grass and pavement | Running form drills, proprioceptive exercises, flexibility, strength, polymeric activities | Shorten stride and increase cadence, run light and quiet, non-rearfoot landing, upright posture Encouraged for MFW and CRS | Reduced loading rates and impact peak in transitioned MFW vs. CRS Decreased tibialis anterior activation and increase gastrocnemius activation with habituation to MFW | Not reported | Not reported |
Moore et al. [36] | N = 10, 9 male, 1 female, 20–22 years 5–16 km/week | MFW (N = 10, tested in MFW and CRS) | 7 weeks | Vibram FiveFingers (Komodo Sport) | No | Exercises only [1, 2], 20% progression in MFW per week [3,4,5,6,7] Not specified if participants maintained CRS volume | [1–2 only] heel raise, toe grip, dorsiflexion and plantar flexion, toe spread, exaggerated eversion and inversion, towel grabs | No | Higher peak pressures, loading rate and impact peak in MFW and barefoot vs. CRS However, loading rate and peak pressures decrease as a result of the transition in all footwear types | None | None = 0% |
Warne et al. [32] | N = 23 Male, 33–53 years Running average 52 km/week | MFW (N = 12, tested in MFW and CRS) CRS (N = 8) | 8 weeks | Vibram FiveFingers (KSO) | Yes | 3 × 5–8-min barefoot activity [1], 3 × 13–18 min [2], 3 × 25–28 min [3], 3 × 30 min [4], 3 × 35 min [5, 6], 3 × 45 min [7, 8] Maintained CRS volume Used grass and pavement | Foot sole and calf rolling, ankle mobility, calf raises, toe grabs, static balance | Shorten stride and increase cadence, run light and quiet, non-rearfoot landing, upright posture | No change in running economy during transition | 1 injury in the MFW group (metatarsal stress fracture) No injuries in the CRS group | 3 of 23 = 13% (1 in the MFW group due to injury, 2 in the CRS group lost to follow-up) |
Johnson et al. [11] | N = 44, 18–32 years Running average 24–48 km/week | MFW (N = 18) | 10 weeks | Vibram FiveFingers (not specified) | Yes | 1.6–3.2 km [1] + 1.6–3.2 km/week [2, 3] Then increase as tolerated Maintained CRS volume | No | No | Abductor hallucis cross-sectional area significantly increased in the MFW group, but no difference in size for the 3 other muscles tested | The same participants as Ridge et al. [24] | 7 of 44 = 16% (non-compliance) |
Control (N = 19) | |||||||||||
Ridge et al. [24] | N = 43, 21 male, 15 female, 19–32 years Running 24–48 km/week | MFW (N = 19) Control (N = 17) | 10 weeks | Vibram FiveFingers (not specified) | Yes | 1.6–3.2 km [1], 1.6–3.2 km × 2 [2], at least 4.8 km [3] Then increase as tolerated Maintained CRS volume | No | No | Increased risk of stress fracture and bone marrow oedema in the MFW group following transition | 10/19 classified as injured in the MFW group based on imaging results, and 2/19 of these with diagnosed stress fractures | 7/43 = 16% |
No injuries or oedema in the control group | |||||||||||
Ridge et al. [25] | N = 25, 14 male, 11 female, 22–34 years Running 24–48 km/week | MFW (N = 10, tested in MFW and CRS) Control (N = 15, tested in MFW and CRS) | 10 weeks | Vibram FiveFingers (not specified) | Yes | 1.6–3.2 km [1], 1.6–3.2 km × 2 [2], at least 4.8 km [3] Then increase as tolerated Maintained CRS volume | No | No | Both groups improved RE over time, no interaction reported | The same participants as Ridge et al. [24] | 6/25 = 24% (due to injury) |
Ryan et al. [31] | N = 103, 39 male, 64 female, 19–50 years Able to run 60 min | MFW (N = 35) CRS (N = 32) | 12 weeks | Vibram FiveFingers (Bikila) | Yes | 1 week “break-in period” [1], 10% of volume in MFW [2], up to 58% [10] Then increase as tolerated Gradually increased running volume from 160 to 225 min until a 2-week taper [11, 91], leading into a 10-km event Included a longer run and interval training each week All training controlled | No | No | 23% injury rate over 12 weeks in all participants No significant difference in injury comparing MFW and CRS Increased calf/shin pain in MFW | 7 injuries in the MFW group (specific injuries not reported) 4 injuries in the CRS group (specific injuries not reported) | 12/103 = 12% (lost to follow-up) |
McCarthy et al. [28] | N = 30 Female,18–35 years Running > 15 km/week | MFW (N = 9, tested barefoot and CRS) Control (N = 10, tested barefoot and CRS) | 12 weeks | Vibram FiveFingers (Classic) | Yes | Walking [1], 5-min walk, 1-min jog × 3, × 3/week [2], 3 × 5 min/week + 5 min/week [3,4,5,6,7,8], 1-day rec between [9,10,11, 91], individualised Maintained CRS volume | [1–2 only] from manufacturer’s recommendations Stretching calf muscles and self-massage of the calf and foot were also encouraged | Advised to avoid over-striding or use a rearfoot strike pattern No feedback provided | Shorter ground contact time, more anterior foot strike, greater ankle ROM, greater knee flexion at contact in the MFW group post-transition | 4 injuries in the MFW group (calcaneal stress fracture [not related to running], hip and calf pain, 2nd metatarsal pain, metatarsal stress fracture) | 11/30 = 37% (7/11 due to injury related to study) |
4 injuries in control (sciatica, anterior knee pain, ITB syndrome, back pain) | |||||||||||
Miller et al. [29] | N = 33, 17 male, 16 female, 24–36 years Running 48 km/week | MFW (N = 16, tested in CRS pre; CRS and MFW post) Control (N = 13) | 12 weeks | New Balance (Road Minumus 10) or Merrel (Pace/Trail Glove) randomly paired | No | Comprehensive 12-week programme (controlling CRS volume also) Week 1: 2 1-mile runs in MFW, increase by 1 mile/week Increased to 3 MFW runs/week by week 4 | No | Encouraged to maintain vertical trunk posture, use high cadence, and avoid over striding No foot strike instruction | Increases in foot musculature volume post-tests in both groups Greater stiffening of arch post-tests in the MFW group after outlier removed | No injuries in the MFW group | 4/33 = 12% (3 due to injury, 1 lost to follow-up) |
3 injuries in control (Achilles tendonitis, plantar fascia tear, lower back pain) | |||||||||||
Joseph et al. [37] | N = 29, 7 male,15 female, 18–28 years Running 16–48 km/week | MFW (N = 22) | 12 weeks of transition followed by additional 12 weeks of study participation | Newton Gravity | Yes | 10% of total mileage in MFW for weeks 1 and 2 Increase by 10%/week until 100% reached in week 12 Maintained 100% through week 24 | No | Instruction given for forefoot strike pattern, decreased stride length, increased stride frequency, forward trunk lean Video of running style provided | No change in plantar flexion force, Achilles tendon cross-sectional area, mechanical characteristics or material properties between baseline, 6, 12, and 24 weeks | 4 injuries (exacerbated previous knee pain) | 7/29 = 24% (7% relocation, 14% knee pain, 3% non-compliance) |
Other volume maintained in CRS until 100% in MFW | |||||||||||
Dubois et al. [30] | N = 26, 8 males, 18 female, 18–55 years Running distance not reported Could run 20 min continuously Running experience of one half or full marathon | MFW (N = 11) CRS (N = 9) | 16 weeks (pilot study) | Inov-8 (F-lite 195/Bare X-lite 150/Road X-lite 155), Mizuno (Wave Universe), Saucony (A5) | Yes | Comprehensive 16-week programme Progressed from 3 to 7 × 1 min [1], to one half marathon [15] All training in MFW | No | No | 15.4% drop out rate after randomisation, N too small to detect the injury difference between groups | 3 injuries in the MFW group (metatarsal, stress fracture, iliotibial band syndrome, plantar fasciitis) 3 injuries in CRS (low back pain, medial tibial stress syndrome × 2) Missed training due to pain the same in groups | 6/26 = 23% (2 prior to randomisation, 4 during study) |
Campitelli et al. [26] | N = 48 (96 ft), 25 male, 16 female completed study, 20–33 years, no barefoot or MFW experience Control group had to be running 10–40 miles/week | MFW (N = 12) Control (N = 12) | 24 weeks (assessments at 0, 12, and 26 weeks) | Vibram FiveFingers (Bikila) | No | Training restricted in the MFW group only: 4 training sessions per week; increased mileage or time in MFW by 10% each week starting with 0.25 time/mileage restriction week 1 up to 6.0 in week 24 CRS worn for any additional time/mileage | No | Brochure on proper running form (not specified) | Increase in abductor hallucis longus thickness between 0 and 24 weeks in the MFW group No difference in thickness over the study period in the control group No group differences in muscle thickness | No injuries reported | 7/48 = 15% |
(2/12 = 17% in the MFW group, 3/12 = 25% in the control group) | |||||||||||
Azevedo et al. [39] | N = 34, 25 male, 9 female, 23–37 years Running 44–88 km/week | Barefoot (N = 6), MFW (N = 8) | 6 months | New Balance (Minimus MR10BG) | Yes | 3 training sessions per week in the MFW In each 2 months, a more “minimal” shoe was used Maintained CRS volume | No | No | In the MFW group, 6/14 participants dropped out due to pain/injury | 6 injuries in the MFW group (“injury/pain”—specific injuries not reported) | 20/34 = 59% (70% in the barefoot group, 30% in the MFW group) |
2 injuries in the barefoot group (“injury/pain”) | 40% injury/pain, 40% time/place, 15% fear of injury, 5% accident | ||||||||||
Chen et al. [27] | N = 47, 21 male, 17 female, 20–45 years Running average 26 km/week (MRS), average 35 km/week (CRS) | MFW (N = 20) Control (N = 18) | 6 months | Vibram FiveFingers (not specified) Minimalist Index 92% [12] | Yes | Transition adopted from the Spaulding Natural Running Centre [13] | [1–3 only] 30× calf raises, dynamic balance, foot placement, calf/Achilles stretches | Land gently, with your foot relatively horizontal and under your hips (this will shorten your stride) | Increase in muscle volume in intrinsic and extrinsic foot muscles in the MFW group Muscle volume associated with compliance to MFW transition | No injuries | 9/47 = 19% (8 conflicts, 1 lost to follow-up) |
Stage 0: pre-entry barefoot activity | |||||||||||
Stage 1: walk and jog | |||||||||||
Stage 2: jogging every other day | |||||||||||
Stage 3: jogging multiple days | |||||||||||
Stage 4: five loading days in 1 week | |||||||||||
Stage 5: full activity | |||||||||||
It was not clear what volume of CRS running was maintained | |||||||||||
Fuller et al. [33] | N = 61 All male, aged 18–40 Running at least 15 km/week Maximum 5k time = 23 min | MFW (N = 31) | 6 months | Asics (Piranha SP4) | Yes | 6 weeks of training standardised for both groups (long slow distance and intervals included) 5% of each run in MFW [1] maintained CRS volume Increase MFW volume by 5% each week until 100% MFW [19] | No | No | Shoe × body mass interaction for time to running-related injury | Training in MFW increased knee and calf pain; 11/30 (37%) in CRS became injured; 16/30 (51%) in MFW became injured Time to injury was not affected by shoe type In MFW, injury was statistically more likely with body mass > 71.4 kg | 5/30 (17%) in the CRS group, 4/31 (13%) in the MFW group |
CRS (N = 31) |