It is clear that physical activity is one of the best ways to combat osteoarthritis pain—but how important are your shoes, and which should you be wearing?
In addition to traditional treatment methods for OA, which include medication, physical therapy and even surgery, doctors now know that footwear can play an important role in knee OA.
Marian T. Hannan, an associate professor of medicine at Harvard Medical School in Boston, Mass., has conducted research about foot mechanics and pain in the knee. “It is impressive to think that [footwear] makes a difference,” says Hannan. “Whether it’s their foot or brain or the whole package, it appears to work. As a proof of concept it is very appealing.”
There are a wide variety of shoe options available to consider, including stability sneakers, flat walking shoes, minimalist/barefoot sneakers, and rocker-soled sneakers, and an increasing amount of research that can help you decide which is right for you.
Stability shoes offer cushion and support for the foot, protecting you from the impact of each step. According to a survey led by Kade Paterson, MD, a sports podiatrist and post-doctoral fellow at the University of Melbourne, stability shoes are most frequently recommended to OA patients by podiatrists. However, a study lead by Najia Shakoor, MD, a rheumatologist and associate professor of medicine at Rush University Medical Center in Chicago, strongly disagrees. Her team looked closely at joint loading among various types of shoes, and found that stability shoes cause the most joint loading at the knee. This joint loading might have a negative impact on disease progression. “We want to focus on shoes that decrease joint loads,” says Shakoor. “While the immediate benefit is pain relief, the optimal goal is to prevent progression.”
Flat Walking Shoes
Flat-soled walking shoes are flat sneakers that have relatively thin, rigid soles that offer very little cushioning or arch support. Unlike stability shoes, which offer cushion and support for the foot but increase knee loading, Dr. Shakoor’s study found that flat-soled walking shoes did not significantly increase knee loading. However, her research suggests that differences between different walking shoes could make one better than another. Dr. Shakoor’s team examined two identical walking shoes—one with the sole modified to be more flexible—and found that the more flexible sole carried a lower joint load.
Minimalist/barefoot shoes are thin sneakers that mimic barefoot walking and have highly flexible soles. Minimalist shoes differ from thin-soled walking shoes in that their incredibly flexible soles are specifically designed to mimic barefoot walking, and offer no arch support or cushioning. Many researchers regard them as the best option for preventing pain and progression of knee OA. One study, led by Saulat Mushtaq, MD, a rheumatologist at St. Louis Medical Clinic, examined OA treatment alternatives in the elderly and concluded that barefoot walking reduces both hip and knee joint loads. Dr. Shakoor agrees, “Flat, flexible shoes are the most beneficial, and we have found no evidence to the contrary. This is becoming common knowledge among doctors—students we send for board exams are now even finding this on the exam.”
It is suggested that rocker-bottom shoes function by promoting a natural heel-to-toe motion, thereby keeping weight off the forefoot and reducing pain. However, one study showed that rocker-soled shoes did indeed reduce knee loading compared to a non-rocker-soled shoe, but the load was still significantly higher than in barefoot walking. In addition, they did not yield a significant difference in walking pain. For people with OA knee pain who need more cushion, support, or protection from the elements than barefoot shoes can offer, rocker-bottom shoes are worth consideration.
While current research definitely favors the flat, flexible sole of minimalist and barefoot shoes, they might not be the best option for everyone. Ultimately, the ideal shoe depends on factors unique to each individual.
For instance, proper arch support is critical for people living with foot pain due to conditions such as plantar fasciitis. In this case, according to Dr. Shakoor, “It is important to weigh what’s affecting you more, and determine the best approach. Anyone making a change should slowly transition. Try it out, not necessarily with the most expensive option. See how it feels.”
If the foot pain is a more urgent priority than the knee pain, and a flexible sole is not an option, Dr. Shakoor reassures that all is not lost. “Treatment is not about curing pain with a single approach, but an added-up effect of several contributors.”
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