Running is widely recognised for its substantial health benefits; however, it is frequently associated with lower limb injuries caused by repetitive impact forces. To mitigate such injuries, maximal footwear has been developed; nevertheless, evidence comparing its biomechanical effects with those of other footwear types remains inconclusive. A Bayesian network meta-analysis of 14 studies (222 participants) was conducted, based on systematic searches of PubMed, Web of Science, the Cochrane Library, Scopus, and Embase (from inception to 12 November 2024). Multiple biomechanical parameters were evaluated, including vertical average loading rate, vertical instantaneous loading rate, impact peak, active peak and ankle peak eversion. The results revealed a complex and sometimes contradictory biomechanical profile for maximal footwear. Specifically, maximal footwear resulted in a significantly higher impact peak compared to both conventional and minimal footwear. In contrast, for the vertical average loading rate, it performed significantly better than minimal footwear but showed no significant difference compared to conventional footwear. For other impact metrics, no significant differences were observed. Notably, maximal footwear was associated with a significantly lower ankle peak eversion compared to minimal footwear, suggesting a potential for greater control of ankle motion.

Purpose: This study evaluated tibiofemoral loading and medial meniscal stress distribution in individuals with flexible flatfoot (FFF) during walking under different foot progression angle (FPA) conditions. Methods: This study analyzed the gait of 28 FFF patients (16 males, 12 females) under three FPA conditions (neutral, toe-in, toe-out). Kinematic (Vicon) and kinetic (Kistler) data were used to estimate tibiofemoral forces in OpenSim. Subsequently, joint angles and muscle forces at peak tibiofemoral forces were used to drive a finite element (FE) model of the knee, enabling the comparison of meniscal von Mises stress, maximum shear stress, and contact pressure across FPA conditions. Results: Tibiofemoral force increased during early stance (9–11%) in the toe-in condition with this increase reaching statistical significance in males (p = 0.008, mean partial η2=0.70 within the SPM-identified cluster). FE analysis showed that peak stresses and contact pressure were primarily localized in the anterior region of the medial meniscus. A consistent directional response to FPA was observed with the lowest peak values occurring in the toe-in condition and the highest values in the toe-out condition. Conclusion: Adjusting FPA modulates intra-articular knee loading via the kinetic chain. For FFF patients, neutral FPA provides stable loading. The toe-in condition presents a complex mechanism: despite increasing tibiofemoral force (notably in males), it reduces peak stress by altering contact mechanics and stress distribution. Therefore, FFF gait interventions must be individualized based on factors like foot morphology, sex, and functional goals.