JCLB-03755; No of Pages 5

Clinical Biomechanics xxx (2014) xxxxxx

Contents lists available at ScienceDirect

Clinical Biomechanics
journal homepage: www.elsevier.com/locate/clinbiomech

Effects of barefoot and barefoot inspired footwear on knee and ankle

loading during running
Jonathan Sinclair
Centre for Applied Sport and Exercise Sciences, University of Central Lancashire, Lancashire, UK
Darwin Building 217, Centre for Applied Sport Exercise and Nutritional Sciences, School of Sport Tourism and Outdoors, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK

a r t i c l e

i n f o

Article history:
Received 16 December 2013
Accepted 18 February 2014
Keywords:
Barefoot
Minimalist footwear
Achilles tendon load
Patellofemoral contact

a b s t r a c t
Background: Recreational runners frequently suffer from chronic pathologies. The knee and ankle have been
highlighted as common injury sites. Barefoot and barefoot inspired footwear have been cited as treatment
modalities for running injuries as opposed to more conventional running shoes. This investigation examined
knee and ankle loading in barefoot and barefoot inspired footwear in relation to conventional running shoes.
Method: Thirty recreational male runners underwent 3D running analysis at 4.0 ms1. Joint moments,
patellofemoral contact force and pressure and Achilles tendon forces were compared between footwear.
Findings: At the knee the results show that barefoot and barefoot inspired footwear were associated with
signicant reductions in patellofemoral kinetic parameters. The ankle kinetics indicate that barefoot and
barefoot inspired footwear were associated with signicant increases in Achilles tendon force compared
to conventional shoes.
Interpretation: Barefoot and barefoot inspired footwear may serve to reduce the incidence of knee injuries
in runners although corresponding increases in Achilles tendon loading may induce an injury risk at
this tendon.
2014 Elsevier Ltd. All rights reserved.

1. Introduction
Recreational runners are known to be susceptible to injuries;
19.479.3% of all who participate in running activities will suffer
from a chronic pathology over the course of one year (van Gent
et al., 2007). The knee and ankle joint structures have been demonstrated to be the most common injury sites and are associated with
one-fth of all running-related injuries (van Gent et al., 2007).
Recently barefoot (BF) running has been the focus of much attention
in footwear biomechanical research. The rise in popularity of barefoot
locomotion is borne out of the hypothesis that running without shoes
is associated with a reduced incidence of chronic running injuries
(Lieberman et al., 2010). The rationale behind this notion is that the
non-rearfoot strike pattern typically associated with barefoot locomotion serves to attenuate the magnitude and rate of the impact experienced by the musculoskeletal system as a result of the foot striking
the ground (Sinclair et al., 2013a). Taking into account the barefoot
movement's recent rise in popularity and potential propensity to reduce
injury aetiology, shoes have been designed in an attempt to transfer the
prospective benets of barefoot movement into a shod condition

E-mail address: JKSinclair@uclan.ac.uk.

(Sinclair et al., 2013a). Numerous barefoot inspired (BFIS) footwear

models are currently available and vary in design characteristics from
minimalistic e.g. Inov-8 Evoskin and Vibram Five Fingers to more structured designs which offer some midsole interface e.g. Nike Free (Sinclair
et al., 2013a).
A number of studies have investigated the joint kinetics/kinematics
of running BF and BFIS in relation to conventional running shoes.
Sinclair et al. (2013a) showed that running BF was associated with increases in vertical rates of loading and ankle plantarexion angle during
the stance phase of running. Sinclair et al. (2013b) examined several
BFIS models in relation to both BF and conventional running shoes.
It was demonstrated that BF and minimalist BFIS were associated with
increases in vertical rates of loading, ankle plantarexion and also
peak rearfoot eversion. Bonacci et al. (2013a) examined joint kinetics
during BF and BFIS running, and it was demonstrated that BF and BFIS
locomotion are associated with reduced knee extensor and increased
ankle plantarexion moments. Similarly in examinations of rear and
mid/forefoot strike patterns, mid/forefoot runners have also been
shown to exhibit increases in Achilles tendon force (ATF) and reductions in patellofemoral contact force (PTF) and pressure (PP) in comparison to those exhibiting a rearfoot strike pattern (Kulmala et al., 2013).
Similarly, Bonacci et al. (2013b) showed that running without shoes
was linked to signicant reductions in PTF and PP compared to running
footwear. It can be speculated based on these prevalent ndings in

http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004
0268-0033/ 2014 Elsevier Ltd. All rights reserved.

Please cite this article as: Sinclair, J., Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running, Clin. Biomech.
(2014), http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004

J. Sinclair / Clinical Biomechanics xxx (2014) xxxxxx

relation to joint kinetics at the knee and ankle joints that BF and BFIS
may alter loading patterns at these joints, however currently there is
a paucity of information investigating PTF and PP at the knee and ATF
patterns of the ankle during BFIS in comparison to conventional
running footwear.
The aim of the current investigation was therefore to determine
whether running in BF and BFIS footwear caused different levels
of PTF and PP at the knee and ATF at the ankle in comparison to conventional running trainers. Specically it was hypothesized that running BF
and in minimalist BFIS would be associated with reduced PTF and PP in
relation to conventional footwear.
2. Methods
2.1. Participants
Thirty recreational male runners, who engage in running activities a
minimum of three times per week, were recruited for this investigation.
The participants' mean characteristics were: age = 26.21, SD =
5.52 years, body mass = 73.45, SD = 6.00 kg, height = 1.77, and
SD = 0.09 m. Participants were all free from pathology at the
time of data collection and provided informed consent in written
form. The procedure for the study was approved by a university
ethical panel.
2.2. Procedure
The participants completed ten running trials over a 22 m walkway
at 4.0 ms1 in a biomechanics laboratory. A maximum deviation from
the pre-determined velocity of 5% was allowed. The participants struck
an embedded piezoelectric force platform (Kistler Instruments, Model
9281CA; Winterthur, Switzerland, Dimensions = 0.6 0.4 m) sampling
at 1000 Hz with their right foot (Sinclair et al., 2013c). Running velocity
was monitored using infra-red timing gates (SmartSpeed Ltd, Cardiff,
UK). The stance phase of the running cycle was delineated as the time
over which a minimum of 20 N vertical force was applied to the force
platform (Sinclair et al., 2013d). An eight camera optoelectric motion
capture system was used to collect 3D kinematics. The synchronised
kinematic and ground reaction force data were obtained using
Qualisys Track Manager software (Qualisys Medical AB, Goteburg,
Sweden) with a capture frequency of 250 Hz.
The calibrated anatomical system technique (CAST) was utilised to
quantify joint kinematics (Cappozzo et al., 1995). To dene the anatomical frames of the right foot, shank and thigh, retroreective markers
were positioned onto the calcaneus, 1st and 5th metatarsal heads,
medial and lateral malleoli, medial and lateral epicondyle of the femur
and greater trochanter. Rigid carbon-bre tracking clusters comprising
of four retroreective markers were positioned onto the thigh and
shank segments and secured using tape. The foot was tracked using
the calcaneus, rst and fth metatarsal markers. Static calibration
trials (not normalized to standing posture) were obtained with the
participant in the anatomical position in order for the positions of
the anatomical markers to be referenced in relation to the tracking
clusters/markers. Separate static trials were obtained for each
footwear condition.
2.3. Data processing
GRF and 3D kinematic data were ltered at 50 and 12 Hz respectively using a low pass Butterworth 4th order zero-lag lter and
subsequently analysed using Visual 3D (C-Motion, Germantown,
MD, USA). 3D kinematics of the knee and ankle were calculated using
an XYZ Cardan sequence of rotations (where X = sagittal plane;
Y = coronal plane and Z = transverse plane). Kinematic curves
were normalized to 100% of the stance phase then processed trials
were averaged. Joint kinetics were computed using NewtonEuler

inverse-dynamics. To quantify net joint moment anthropometric

data, ground reaction forces and angular kinematics were used.
The net joint moments were normalized to body mass and kgNm.
A previously utilized algorithmic model was used to determine
patellofemoral contact force and pressure (Ward and Powers, 2004).
This algorithm has been utilized previously to resolve differences in
PTF and PP when wearing different footwear (Bonacci et al., 2013b;
Ho et al., 2012; Kulmala et al., 2013) and between those with and without patellofemoral pain (Heino and Powers, 2002). Patellofemoral joint
contact force (BW) during running was then estimated as a function of
knee exion angle (fa) and knee extensor moment (ME) according to
the biomechanical model described by Ho et al. (2012). Firstly, an effective moment arm of the quadriceps muscle (mq) was calculated as a
function of knee exion angle using non-linear equation, which is
based on cadaveric information presented by van Eijden et al. (1986):
3

mq 0:00008f a 0:013f a 0:28fa 0:046:

Quadriceps force (QF) was then calculated using the below formula:
QF ME=mq:

PTF was estimated using the QF and a constant (K):

PTF QF K:

The constant was described in relation to the fa using a curve tting

technique based on the non-linear equation described by van Eijden
et al. (1986):


2
2
K 0:462 0:00147f a 0:0000384f a =10:0162fa
2

0:000155 f a 0:000000698f a :

PP (MPa) was calculated as a function of the PTF divided by

the patellofemoral contact area. The contact area was described in
accordance with the Ho et al. (2012) recommendations by tting a
second-order polynomial curve to the data of Powers et al. (1998)
who documented patellofemoral contact areas at varying levels of
knee exion (83 mm2 at 0, 140 mm2 at 15, 227 mm2 at 30,
236 mm2 at 45, 235 mm2 at 60, and 211 mm2 at 75 of knee exion).
PP PTF=contact area

Achilles tendon force (ATF) (BW) was determined by dividing

the plantarexion moment (MPF) by the estimated Achilles tendon
moment arm (mat). The moment arm was quantied as a function of
the ankle sagittal plane angle (ak) using the procedure described by
Self and Paine (2001):
ATF MPF=mat

mat 0:5910 0:08297ak0:0002606ak :

PTF and ATF loading rates (BWs1) were calculated as a function

of the change in tendon force from initial contact to peak force divided
by the time to peak force.
2.4. Footwear
The experimental footwear utilized during this study consisted of a
Saucony Pro Grid Guide II, Vibram Five Fingers, Inov-8 Evoskin and
Nike Free 3.0 in sizes 810 men's UK (Fig. 1). The Saucony footwear
were selected to provide a good representation of commercially available conventional footwear as they provide both midsole cushioning
and medial support. The Nike Free 3.0, Vibram Five Fingers and Inov-8

Please cite this article as: Sinclair, J., Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running, Clin. Biomech.
(2014), http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004

J. Sinclair / Clinical Biomechanics xxx (2014) xxxxxx

Fig. 1. Experimental footwear (a. =conventional, b. Nike Free 3.0, c. Vibram Five Fingers
and d. Inov-8 Evoskin).

Evoskin were chosen for similar reasons to represent the variety of

commercially available BFIS footwear.
2.5. Statistical analysis
Differences in knee and ankle loading parameters across the
footwear conditions were examined using one-way repeated measures
ANOVA. The alpha criterion for statistical signicance adjusted to P =
0.008 using a Bonferroni correction to control type I error. Effect sizes
were calculated using an Eta2 (2). Post-hoc pairwise comparisons
were conducted on all signicant main effects. The data was screened
for normality using a ShapiroWilk which conrmed that the normality
assumption was met. All statistical actions were conducted using SPSS
21.0 (SPSS Inc., Chicago, USA).
3. Results
Fig. 2 presents the knee and ankle joint angles/kinetics obtained as
a function of footwear and Table 1 exhibits the discrete kinematic
parameters. The results indicate that footwear signicantly inuenced
both knee and ankle kinetic parameters.
3.1. Knee load
A signicant main effect P b 0.006, 2 = 0.48 was found for ME
(Table 1; Fig. 1b). Post-hoc analysis showed that ME was signicantly
greater in the conventional footwear in comparison to BF and Inov-8.
A signicant main effect P b 0.006, 2 = 0.52 was also observed for
PTF (Table 1; Fig. 2c). Post-hoc analysis showed that PTF was signicantly greater in the conventional and Nike Free footwear in comparison
to BF, Vibram Five Fingers and Inov-8. A further main effect P b 0.006,
2 = 0.41 was found for PP (Table 1; Fig. 1d). Post-hoc analysis showed
that PP was signicantly greater in conventional and Nike Free
footwear in comparison to BF and Vibram Five Fingers. A nal main
effect P b 0.006, 2 = 0.40 was also shown for PTF load rate
(Table 1). Post-hoc analysis showed that PTF load rate was

Fig. 2. Knee and ankle kinetics and kinematics as a function of footwear, black = BF,
Grey = Vibram Five Fingers, Dash = Nike Free, Dot = conventional, black outline =
Inov-8 (a = knee angle, b = knee moment c = PTF, d = PP, e = ankle angle, f = ankle
moment, g = ATF).

signicantly greater in the conventional footwear in comparison to

BF and Vibram Five Fingers.
3.2. Ankle load
A signicant main effect P b 0.006, 2 = 0.43 was found for peak
MPF (Table 1; Fig. 2f). Post-hoc analysis showed that MPF was signicantly greater in BF and Inov-8 compared to the conventional and
Nike Free footwear. A signicant main effect P b 0.006, 2 = 0.48 was
also found for ATF (Table 1; Fig. 2g). Post-hoc analysis showed that
ATF was signicantly greater in BF and Inov-8 compared to the conventional and Nike Free footwear. A nal main effect P b 0.006, 2 = 0.49
was found for ATF load rate (Table 1). Post-hoc analysis showed that
ATF load rate was signicantly greater in BF compared to the conventional and Nike Free footwear.

Please cite this article as: Sinclair, J., Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running, Clin. Biomech.
(2014), http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004

J. Sinclair / Clinical Biomechanics xxx (2014) xxxxxx

Table 1
Mean & SD, joint kinetic information as a function of footwear.
Barefoot

Peak ME (kgNm)
PTF (BW)
Time to PTF (s)
PP (Mpa)
PTF load rate (BWs1)
Peak MPF (kgNm)
ATF (BW)
Time to ATF (s)
ATF load rate (BWs1)

Vibram Five Fingers

Inov-8

Mean

SD

Mean

SD

Mean

SD

Mean

Nike Free
SD

Mean

Conventional
SD

2.58
3.19
0.08
9.24
42.20
3.10
6.17
0.13
41.38

0.70
1.04
0.01
3.37
12.14
0.29
0.66
0.01
6.49

2.74
3.43
0.08
9.35
42.79
3.03
5.80
0.14
39.03

0.75
1.28
0.01
3.69
14.79
0.29
0.64
0.01
7.03

2.69
3.56
0.08
9.65
43.43
2.94
5.91
0.13
40.79

0.82
1.29
0.01
3.77
18.34
0.40
0.85
0.02
9.46

2.89
4.02 ABC
0.08
10.15 AB
45.34
2.44 AC
4.84 AC
0.14
35.53 A

0.75
1.25
0.01
3.28
13.20
0.55
1.14
0.02
11.44

3.15 AC
4.11 ABC
0.08
10.28 AB
46.43 AB
2.52 AC
5.09 AC
0.14
37.26 A

0.73
1.19
0.01
3.33
13.52
0.42
0.87
0.01
7.27

*
*
*
*
*
*
*

Notes: * = signicant main effect (p b 0.006).

A = signicantly different from barefoot, B = signicantly different from Vibram Five Fingers, C = signicantly different from Inov-8.

4. Discussion
The current study aimed to determine whether running in BF and
BFIS footwear caused different levels of knee and ankle loading patterns
in comparison to conventional running trainers. This represents the rst
to investigate inuence of BF and BFIS on PTF, PP and ATF in relation to
conventional running footwear.
In support of our hypothesis, the rst key observation of the current
investigation is that BF, Vibram Five Fingers and Inov-8 conditions were
associated with signicantly lower EM, PTF, PP and PTF load rate in relation to conventional footwear. This supports the ndings of Bonacci
et al. (2013a) who observed reduced eccentric quadriceps work during
BF compared with conventional footwear. Bonacci et al. (2013b) hypothesized that this observation due to the reductions in stride length
associated with barefoot running (Sinclair et al., 2013a). This positions
the stance limb closer to the centre of mass, which reduces the moment
arm of the quadriceps. This description may help clarify the mechanism
by which increases in PTF and PP were observed when running in the
conventional running footwear. This nding may also have clinical signicance regarding the aetiology of injury as the widely accepted consensus regarding the development of patellofemoral pathology is that
the symptoms are the function of excessive patellofemoral joint kinetics
(Kulmala et al., 2013). Given the high incidence of patellofemoral disorders in runners (van Gent et al., 2007), running BF and in minimalist
BFIS may be a potential mechanism by which runners area able to attenuate knee injury risk through reductions in knee joint loading.
With respect to the ankle joint kinetics the ndings suggest that
conventional and Nike Free footwear were associated with reductions
in MPF, ATF and ATF load rate in relation to BF and Inov-8. This observation may have clinical relevance for the pathogenesis of Achilles
tendinopathy, a further pathology that is commonplace amongst recreational runners (Kulmala et al., 2013). The aetiology of Achilles
tendinopathy is believed to be associated with repeated mechanical
loading of the tendon. Repetitive tendon loads such as those experienced during distance running initiate collagen and extracellular matrix
synthesis and tissue degradation. The results of the current investigation are in line with the observations of Bonacci et al. (2013a), suggesting signicantly higher ankle plantarexor moment during BF and BFIS.
Reduced impact loading associated with BF is attributable to enhanced ankle joint energy absorption during the early stance phase
(Lieberman et al., 2010). This increased plantarexion contribution
from the ankle joint may be the mechanism by which the reduced PTF
and PP in BF and minimalist BFIS are accounted for. The knee joint function as an energy absorber during the stance phase is reduced in BF and
BFIS, which results in reduced knee exion excursion (Sinclair et al.,
2013a, 2013b, 2013c, 2013d). The results of this investigation therefore
suggest that this may be at the expense of greater loading of the Achilles
tendon. As such, this study advocates that BF and minimalist BFIS
may not be appropriate for runners who are predisposed to Achilles
tendon pathology.

In addition the reduction in knee load associated should be contextualised taking into account the increased stride and step frequency,
typically associated with BF and BFIS (Lieberman et al., 2010; Sinclair
et al., 2013a, 2013b, 2013c, 2013d). As would be expected increased
stride/step frequency is associated with reductions in joint energy absorption during the impact phase of running (Kulmala et al., 2013).
Therefore whilst reductions in PTF and PP were noted per step during
BF and BFIS, the amount of cumulative knee load may be minimally affected between BF, BFIS and conventional footwear, as the total number
of footfalls required to achieve the same distance is greater. This is an
interesting concept and there is currently a lack of epidemiological information regarding the effects of cumulative and magnitudal loads experienced by the musculoskeletal structures during gait with respect to
the aetiology of chronic pathologies.
The prevailing observation from the current investigation is that differences occurred chiey between conventional/Nike Free running
shoes in comparison to BF, whereas inconsistent deviations were
found for the minimalist BFIS. It is likely that this nding relates to the
greater divergence in midsole characteristics between conventional
and Nike Free footwear compared to BF (Sinclair et al., 2013a), which results in the distinct running mechanics that lead to variations in knee
and ankle kinetics (Sinclair et al., 2013a, 2013b). This also re-enforces
the notion that BFIS footwear models are not analogous but most
importantly shows that they may not necessarily replicate the
characteristics of running BF.
In conclusion, the observations of the current investigation show
that running BF and in minimalist BFIS exhibit signicant reductions
in knee PTF and PP compared to running in conventional footwear.
Given the proposed relationship between knee joint loading and
patellofemoral pathology, the risk of the developing running-related
knee injuries may be attenuated through BF and BFIS. However, taking
into account the corresponding increase in ATF during BF and minimalist BFIS, this may in turn enhance the likelihood of chronic injuries to
Achilles tendon. It is clear that additional analyses are required in
order to provide prospective epidemiological analyses of BF and BFIS
in relation to conventional running footwear and the inuence of different knee and ankle load patterns on the aetiology of running injuries.
Competing interests
No conict of interest will arise from any of the authors involved in
this paper.
Author contributions
Both named authors have made a signicant and substantial contribution to all aspects of the study. Each of the named authors provided a
meaningful contribution to the conception, design, execution and interpretation of the study data in addition to writing, drafting and revising

Please cite this article as: Sinclair, J., Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running, Clin. Biomech.
(2014), http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004

J. Sinclair / Clinical Biomechanics xxx (2014) xxxxxx

the paper itself. This paper is submitted with the agreement and
approval of both authors.
Funding
No external funding was provided for this paper.
Acknowledgements
The authors would like to thank Glen Crook for his technical assistance during data collection and to wish him a very happy retirement.
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Please cite this article as: Sinclair, J., Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running, Clin. Biomech.
(2014), http://dx.doi.org/10.1016/j.clinbiomech.2014.02.004