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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

From: Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations

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 20 min, 3 times a week [1, 2]
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 2 × 15 min [1], increase to 3–4 × 30 min [4] 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)
  1. MFW minimal footwear, CRS conventional running shoes