Stepping Back to Minimal Footwear

Applications Across the Lifespan

Irene S. Davis; Karsten Hollander; Daniel E. Lieberman; Sarah T. Ridge; Isabel C.N. Sacco; Scott C. Wearing


Exerc Sport Sci Rev. 2021;49(4):228-243. 

In This Article

Abstract and Introduction


Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.


The barefoot condition is our most natural state, and the foot is well adapted for walking and running gaits without footwear. Although footwear originally was developed more than 10,000 yr ago to protect the sole of the foot, footwear over the past 50–60 yr has become both more cushioned and supportive.[1] This type of footwear often is recommended for athletes, as well as elderly with musculoskeletal dysfunction. However, we will review how these shoes have been shown to interfere with natural foot and lower extremity mechanics in ways that may increase the risk for injury. The purpose of this article is to present the novel hypothesis that minimal footwear may lead to improved musculoskeletal health across the lifespan. To evaluate this hypothesis, we will review evidence regarding the relation between minimal footwear, foot strength, mechanics, and injuries in both athletic and nonathletic populations. Here, we define minimal shoes as those lacking any support or cushioning. We begin with an evolutionary perspective on foot development and footwear. We then address studies of minimal footwear in children. This is followed by a review of minimal footwear and lower extremity mechanics in adult runners. Next, we address minimal footwear and the foot musculoskeletal system. The relation between foot strike pattern and tissue properties (tendons and fat pads) is then reviewed. Finally, the use of minimal footwear for healthy older individuals, as well as those with pathology such as knee osteoarthritis (OA) and diabetes, is discussed. We conclude with a summary of recommendations for future studies needed to address current research gaps. The topic of minimal footwear is one that is hotly debated in both clinical and scientific arenas. We hope this perspective article will begin to create a paradigm shift in the way we think about footwear, spark debate, and be a catalyst for additional research.