Barefoot or Shod? The Impact of Footwear on Children’s Gait: A Systematic Review with an Exploratory Meta-Analysis

Abstract

Background: Footwear may influence paediatric gait biomechanics, yet evidence across footwear types and barefoot conditions remains heterogeneous. This review aimed to synthesise evidence on how footwear affects gait biomechanics in children and adolescents compared with barefoot walking, and to conduct exploratory meta-analyses when feasible. Methods: We performed a PRISMA-guided systematic review (PubMed and Scopus; inception to November 2025) including participants < 18 years with gait outcomes assessed under barefoot and/or defined footwear conditions. Outcomes included spatiotemporal, kinematic, kinetic, and plantar-pressure variables. Risk of bias was assessed with ROBINS-I. Random-effects meta-analyses (inverse-variance) were conducted only when ≥2 studies reported comparable outcomes. Results: Twenty-two studies were included; most were observational with overall moderate-to-serious risk of bias, mainly due to confounding and participant selection. Quantitative synthesis (exploratory): Meta-analyses were possible only for ankle plantarflexion (k = 2) and stride length (k = 3) and showed non-significant pooled effects with extreme heterogeneity (I2 > 90%) and wide prediction intervals. Narrative synthesis: For other outcomes, heterogeneity in designs, footwear definitions, and measurement protocols precluded pooling; conventional footwear may reduce metatarsophalangeal mobility and alter kinematics and plantar pressure in some contexts, while minimalist/biomimetic features may approximate barefoot-like values for selected parameters without implying equivalence. Conclusions: Footwear exposure in childhood may affect several gait-related parameters, but the certainty of evidence is low to moderate due to risk of bias, inconsistency, and imprecision. Standardised footwear classifications, harmonised gait protocols, and longitudinal studies are needed to clarify developmental implications and inform evidence-based guidance.