Lorena Canosa-Carro

Pelvic floor, hormones, and performance: trying to fill in the gap

Background/Objectives: The popularity of barefoot and minimalist footwear training has increased in recent years, yet its impact on foot strength, morphology, and functional outcomes remains unclear, particularly in strength-training contexts beyond running-focused studies. Although some biomechanical and anecdotal evidence exists, no systematic review has specifically addressed the effects of foot-specific strength training interventions performed barefoot or with minimalist footwear. This review aimed to evaluate the effects of barefoot and minimalist footwear strength training interventions on foot muscle structure, force production, and neuromuscular function in healthy and athletic adults. Methods: A systematic review was conducted in accordance with the PRISMA and PICOS guidelines (PROSPERO number CRD420251134329). Comprehensive database searches were performed in July 2025. Eligible studies included barefoot or minimalist strength interventions in healthy and sportive adults, assessing outcomes related to foot muscle morphology, strength, functional performance, or neuromuscular adaptations. Methodological quality was evaluated using the PEDro and MINORS scales. Results: Seven studies involving 213 participants met the inclusion criteria. Most interventions led to significant improvements in intrinsic and extrinsic foot muscle volume, medial arch function, toe flexor strength, and neuromuscular control. Adaptations were particularly evident in interventions combining strength, balance, and agility exercises over multiple weeks. However, heterogeneity in protocols and outcome measures limited comparability. Some studies reported morphological gains without proportional improvements in strength or function. Conclusions: Barefoot and minimalist strength training can elicit beneficial morphological and functional adaptations in the foot. Nevertheless, inconsistencies in study design, small sample sizes, absence of follow-up assessment and lack of standardized protocols highlight the need for high-quality research to guide training recommendations beyond running-focused populations.