Minimalist Footwear Acutely Alters Running Kinematics in Runners With Medial Tibial Stress Syndrome

Purpose To assess immediate biomechanical changes in runners with medial tibial stress syndrome (MTSS) when transitioning from standard to minimalist running shoes. Methods Active runners diagnosed with MTSS ran on a treadmill at 10 km/h using standard and minimalist running shoes. Hip, knee, and ankle joint kinematics were captured using a 16‐infrared‐camera Vicon motion capture system. Strike patterns were estimated from the foot strike angle. Comparison between footwear types was performed using Wilcoxon signed‐rank tests for continuous variables and Stuart‐Maxwell tests for categorical variables. Results In total, 25 runners (19 male, 6 female, 30.1 ± 6.4 years old) participated in data collection throughout June 2025. Footwear change resulted in a significant decrease in peak stance‐phase flexion of left (1.7° ± 4.7°, P = .040) and right (2.7° ± 6.6°, P = .024) knees, decreased stride length (2.9° ± 3.6 cm, P < .001), and increased cadence (2.7 ± 3.4 steps/minute, P < .001). No significant alteration was observed for peak stance‐phase hip internal rotation, frontal‐plane pelvic tilt, and foot strike patterns. Conclusions Although changes in stride length and cadence were favorable, decreased knee flexion might compromise the knee shock‐absorbing function of minimalist running shoes. Absence of change in strike patterns and proximal joint kinematics indicated that short‐term footwear modification alone might be insufficient to alter running kinematics in patients with MTSS. Clinical Relevance MTSS, also referred to as shin splints, is a common overuse injury. Adjusting running biomechanics by selecting appropriate footwear has been recommended for injury prevention; however, the best type of footwear remains unknown for this population. The results of this study may help inform evidence‐based recommendations and strategic interventions to improve MTSS outcomes in affected runners.