The effect of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics: A systematic review

Highlights

• We included symptomatic and symptomatic populations in our review.

• Evidence of smaller stride length, reduced hip flexion, hip and knee joint ROM.

• Evidence of decreases in internal joint moments and power at hip and knee.

• Evidence of increases in plantar force within the foot.

Abstract

This systematic review evaluated the available evidence for the effects of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics during gait. Electronic databases (MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PubMed) were searched in January 2015. Methodological quality of included studies was evaluated using the Quality Index. Standardised mean differences and 95% confidence intervals were calculated, and meta-analysis was conducted where possible. 17 studies satisfied the inclusion criteria; 16 cross-sectional studies and one randomised control trial (RCT). Quality Index scores ranged from 7 to 12 (out of 15). All 17 studies investigated walking gait only. Evidence showed that MBT footwear caused asymptomatic individuals to walk with a shorter stride length, reduced peak hip flexion, increased peak knee extension, and reduced hip and knee range of motion throughout gait. All kinematic effects occurred in the sagittal plane. There was a trend towards a decrease in internal and external joint moments and power, except for the foot, where increases in force were observed. There were only a small number of changes to lower limb muscle amplitude and timing. No statistically significant effects were observed in symptomatic individuals with knee osteoarthritis or following total knee replacement, but there was an increase in cadence and a decrease in step length in individuals following tibiotalar arthrodesis. These findings suggest that MBT footwear does change lower limb biomechanics in both asymptomatic and symptomatic individuals during gait. However, further clinical trials need to be undertaken to determine whether these changes are therapeutically beneficial.

Introduction

Shoes have traditionally been used to protect the foot, but more recently, the function of shoes has evolved to improve foot and lower limb function. There are several shoes types which are now commercially available that are able to control and potentially change lower limb biomechanics. The Masai Barefoot Technology (MBT) shoe, constructed with a shock-absorbing cushioned heel and rounded sole in the anterior–posterior direction (known as a rocker sole), is designed to improve walking by transforming a flat, hard, surface into an unstable surface [1].

MBT footwear has been reported to improve upright walking posture [2], reduce lower limb joint motion and loading [2], [3], [4], [5], increase tactile sensory feedback [6] and alter muscle activation patterns [2], [3]. These effects have been shown to be useful for the prevention and treatment of a number of musculoskeletal conditions including lower back and knee pain [1].

Several studies have investigated the effect of MBT shoes on lower limb biomechanics predominantly in asymptomatic populations, with few studies investigating symptomatic populations, such as those with knee osteoarthritis [6], [7], knee implants [8] and those with tibiotalar arthrodesis [9]. However, to date, no study has systematically reviewed the effects of MBT footwear on lower limb biomechanics. Therefore, the aims of this systematic review were to (i) identify, appraise and summarise the available evidence for the effects of MBTs on lower limb biomechanics in asymptomatic and symptomatic populations, and (ii) provide guidance for further research in this area.