What minimalist shoes actually deliver: a modest gain in toe strength, conflicting evidence on muscle size, and low to very low certainty
Much less than the marketing, and not nothing
Key Findings
Randomized controlled trials lasting 4 weeks or more; 28 trials, n=1399 participants, 17 meta-analyses (standardized mean differences). Foot core exercises and minimalist footwear were examined as separate interventions.
Minimalist shoes: greater toe strength (toes 2-5), CI 0.02-0.76 — a positive effect whose confidence interval only barely clears zero.
Foot strength, systematic (non-pooled) synthesis: supported both exercises and minimalist shoes for increasing foot strength.
Foot muscle size: evidence conflicting. The popular claim that minimalist footwear reliably grows the intrinsic foot muscles is not what the pooled evidence shows.
Foot exercises produced lower medial longitudinal arch motion during running (CI 0.08-0.82) — i.e. the exercise route has its own biomechanical effect. Otherwise the interventions only occasionally modified walking and running biomechanics.
Authors' conclusion: foot exercises and minimalist shoes may be appropriate to increase foot strength and induce biomechanical changes during dynamic tasks — with certainty rated low to very low, mainly due to few studies and high risk of bias.
Practical Application
Across 28 RCTs (n=1399), minimalist shoes increased the strength of toes 2-5 (95% CI 0.02-0.76) and foot exercises reduced arch motion during running (CI 0.08-0.82), but the evidence on foot muscle size was conflicting and certainty was low to very low. This is a foot-strength case for minimalist footwear, not a running-injury case.
Not from this paper; the base's own practice: use minimalist shoes as a strength stimulus — walking, drills, warm-up, short easy segments — rather than as the shoe for training volume, and dose it like strength work: small volumes, forgiving surfaces, slow progression.
Foot core exercises are the alternative route to the same target. Inference, not tested: they avoid the bone-loading exposure of a running transition (REF-715), so for an athlete with any bone stress history they are the natural first choice.
Do not promise muscle growth. Size evidence is conflicting; the measurable pooled gain is toe strength, and its interval barely clears zero.
This review measured no injury outcomes; the injury question is answered separately (REF-716) — stronger feet are worth having on their own terms.
Limitations
Certainty low to very low, stated by the authors: few studies per outcome and high risk of bias. Effect sizes should be read as direction, not magnitude.
The toe-strength confidence interval (0.02-0.76) barely excludes zero — a real effect at the small end is entirely compatible with these data.
Foot core exercises and minimalist footwear were reviewed together; the pooled results are reported per intervention, but the narrative synthesis statements (e.g. "supported exercises and minimalist shoes to increase foot strength") cover both.
The abstract does not describe the populations or training status; transfer to a high-mileage athlete is inference.
No injury or performance outcomes — this review is about foot structure, strength and biomechanics only.
How this entry was checked and changed
Why this level
regraded 2026-09-27 from A: meta-analysis of few, small trials with high risk of bias; certainty low to very low
Content correction 2026-09-27
Level A -> A-: meta-analysis of few, small trials with high risk of bias, certainty low to very low (rubric).
Lead rewritten as the pooled findings with CIs; added the RCT/≥4-week inclusion and the narrative synthesis supporting strength gains.
Dosing and use advice relabelled as the base's own practice; the bone-loading point labelled as inference; "mostly healthy general populations" removed (not in the abstract).
Byline co-authors were wrong (Bourgeois, Roy, Zamalloa, Dubois, Bouyer) -> Peters-Dickie et al. per the DOI record.