From Pressure Patterns to Personalized Insoles: A Systematic Review of Demographic Influences on Plantar Pressure

BACKGROUND: Plantar pressure distribution is a widely used biomechanical measure for characterizing foot-ground loading during gait in research and clinical assessment. Demographic variables, such as sex, age, and body weight, influence plantar loading patterns; however, findings across studies have been inconsistent, limiting direct clinical interpretation. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Science Direct, and Scopus were searched for studies published between 2013 and 2025 that investigated the relationship between plantar pressure and sex, age, or body weight in healthy, asymptomatic individuals. Eligible studies were screened, data were extracted, and subgroup analyses were performed to assess pressure differences across specific foot regions. Protocol registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251083389). RESULTS: Sex-specific differences revealed that women exhibited higher plantar pressure in the hallux, whereas men demonstrated greater loading in the heel and lateral heel regions. In older adults, a posterior-to-anterior shift in pressure was observed, with decreased heel loading and increased pressure in the forefoot, midfoot, and fifth metatarsal. Obesity was associated with significantly elevated plantar pressure in the first, fourth, and fifth metatarsals as well as in the heel, midfoot, and forefoot, whereas hallux pressure was relatively reduced compared to individuals of normal weight. Across all subgroup analyses, six foot regions, namely, the hallux, first, fourth, and fifth metatarsals, midfoot, and total heel consistently showed moderate to strong effect sizes. CONCLUSIONS: This study summarizes population-specific plantar pressure patterns associated with sex, age, and body weight. The hallux, selected metatarsals, midfoot, and heel consistently demonstrated pooled differences across studies and are highlighted as regions of interest for future research. These findings provide descriptive biomechanical reference patterns that may support hypothesis-driven investigations into plantar load redistribution and comfort-related outcomes. These findings should therefore be interpreted as providing comparative biomechanical context rather than direct clinical decision-making criteria.