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.