Biomechanical Effects of Socks on Plantar Loading and Foot Function: A Systematic Review.

BACKGROUND

The biomechanical interaction within the foot-footwear system plays a critical role in load distribution, impact attenuation, and locomotor function. While footwear and orthoses have been widely studied, the role of socks as an interface component remains poorly understood.

OBJECTIVE

This study aimed to systematically review the evidence on the biomechanical effects of socks on human gait, including their influence on plantar pressure, impact attenuation, postural control, and functional performance.

METHODS

A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420261344641). PubMed, Scopus, and Web of Science were searched from inception to March 2026. Experimental, observational, and clinical studies evaluating the effects of socks on foot or lower limb biomechanical variables were included. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers using adapted Cochrane RoB domains.

RESULTS

Twenty-five studies were included. Socks with cushioning or specific designs consistently reduced plantar pressure, particularly in the forefoot, with peak pressure reductions of up to 49% in high-risk populations. Socks also contributed to impact attenuation, reducing peak forces by 6-20%, although this was less than that of footwear. Effects on postural control were heterogeneous: compression socks improved balance and neuromuscular response, whereas thick socks impaired plantar sensitivity and stability. Regarding functional performance, high-friction socks improved performance in sports settings by reducing in-shoe foot displacement, although results were inconsistent. Overall risk of bias was high, mainly due to limitations in randomization.

CONCLUSIONS

Socks are an active component of the foot-footwear system, capable of influencing key biomechanical parameters, such as plantar pressures. However, further high-quality studies are needed to strengthen the evidence.