Alterations in foot position, such as heel elevation, can alter squat multi-joint kinematics, though a definitive dose-response meta-analysis is unavailable. This systematic review and meta-analysis investigated the effect of heel elevation magnitude on sagittal-plane range of motion (ROM) during squatting. Databases were searched until September 2025. Fourteen studies (n = 177 participants) were included. Random-effects meta-analysis revealed that heel elevation significantly increased ankle (Hedges' g = 0.370, p = 0.020, mean difference (MD) = 4.33°) and knee ROM (Hedges' g = 0.288, p 2.5 cm or >5°; MD = 5.09°). Knee ROM increased with both low and high elevations (MD = 3.39° and 6.65°, respectively). Meta-regression suggested greater heel height was associated with reduced hip (β = -0.028, p = 0.030) and trunk ROM (β = -0.067, p = 0.018). The findings elucidate kinematic adaptations to heel elevation, highlighting a proximal-to-distal gradient in joint responsiveness. This evidence can inform the prescription of heel elevations in biomechanical applications to modify loading patterns during rehabilitation and training.
ghasemi et al. (2026) studied this question.