Footwear and Osteoarthritis: Minimizing Pain Through Smart Choices
A new clinical trial, published in Annals of Internal Medicine, along with previous research, provides insights into appropriate footwear for individuals with hip and knee osteoarthritis aiming to minimize pain.
Understanding Osteoarthritis
Osteoarthritis is a condition affecting tissues in and around joints, including bone, cartilage, ligaments, and muscles. It is more common in older individuals and those with excess body weight. Symptoms include joint pain and stiffness, which can lead to disability.
Approximately 2.35 million Australians have osteoarthritis, with projections indicating an increase as the population ages and obesity rates rise. The condition frequently impacts hip and knee joints, hindering mobility. As there is no cure, self-management strategies, including footwear choices, are important.
How Footwear Influences Joint Forces
Excessive force within the joint during walking is believed to contribute to osteoarthritis development and progression. Shoes, acting as the interface with the ground, can influence the transmission of forces up the leg.
Shoes, acting as the interface with the ground, can influence the transmission of forces up the leg.
Studies indicate:
- Shoes with six-centimeter heels can increase knee forces by an average of 23% compared to walking barefoot.
- Biomechanical research suggests that shoes with supportive features, such as arch-supporting insoles or stiffer soles/heels, can increase knee force by up to 15%.
- Arch-supporting insoles alone can increase knee force by up to 6% when added to shoes.
These findings challenge the common perception that stable, supportive shoes are always the best option for people with osteoarthritis.
Research Findings on Footwear and Pain
Previous biomechanical research from 2017 indicated that flat flexible shoes reduced knee forces by an average of 9% compared to stable supportive styles. Subsequent clinical trials examining pain levels yielded specific results:
Hip Osteoarthritis
A new clinical trial involving 120 individuals with hip osteoarthritis found no significant difference in hip pain reduction over six months between participants wearing flat flexible shoes (e.g., ballet flats) and those wearing stable supportive shoes (e.g., supportive runners).
Knee Osteoarthritis
A 2021 clinical trial with 164 individuals with knee osteoarthritis demonstrated that wearing stable supportive shoes for six months reduced knee pain during walking by an average of 63% more than wearing flat flexible shoes.
The discrepancy in findings between knee and hip osteoarthritis may be attributed to potentially higher joint forces in the knee, which could allow stable supportive shoes a greater potential to reduce these forces and subsequent pain. Both trials also reported a higher incidence of complications, such as foot pain, among participants who wore flat flexible shoes, possibly due to reduced foot protection.
Footwear Recommendations
- For knee osteoarthritis: Stable supportive shoes are likely to offer more benefits than flat flexible ones.
- For hip osteoarthritis: Neither stable supportive nor flat flexible shoe types demonstrated superior benefits for improving hip pain.
For all older individuals (including those with hip and knee osteoarthritis), it is advised to avoid ill-fitting shoes and those with high or narrow heels to minimize the risk of falls.
For younger individuals with knee or hip osteoarthritis who are not at risk of falls, it is still advisable to avoid high heels due to their potential to increase joint forces.
Individuals with concerns about hip or knee osteoarthritis should consult a general practitioner or other healthcare providers, such as a podiatrist or physiotherapist. Other non-surgical treatments, including exercise, weight management, nutrition, and certain pain medications, can also be helpful.