Impact attenuation during weight bearing activities in barefoot vs. shod conditions: a systematic review.

Although it could be perceived that there is extensive research on the impact attenuation characteristics of shoes, the approach and findings of researchers in this area are varied. This review aimed to clarify the effect of shoes on impact attenuation to the foot and lower leg and was limited to those studies that compared the shoe condition(s) with barefoot. A systematic search of the literature yielded 26 studies that investigated vertical ground reaction force, axial tibial acceleration, loading rate and local plantar pressures. Meta-analyses of the effect of shoes on each variable during walking and running were performed using the inverse variance technique. Variables were collected at their peak or at the impact transient, but when grouped together as previous comparisons have done, shoes reduced local plantar pressure and tibial acceleration, but did not affect vertical force or loading rate for walking. During running, shoes reduced tibial acceleration but did not affect loading rate or vertical force. Further meta-analyses were performed, isolating shoe type and when the measurements were collected. Athletic shoes reduced peak vertical force during walking, but increased vertical force at the impact transient and no change occurred for the other variables. During running, athletic shoes reduced loading rate but did not affect vertical force. The range of variables examined and variety of measurements used appears to be a reason for the discrepancies across the literature. The impact attenuating effect of shoes has potentially both adverse and beneficial effects depending on the variable and activity under investigation.