Individuals suffering from hip and knee osteoarthritis are recommended to wear “suitable footwear” to help alleviate their discomfort.
This leads to questions like, should high heels be avoided? Does the choice between running shoes and something firmer really matter? What about insoles?
Our research, including a recent clinical trial published in Annals of Internal Medicine, sheds light on these concerns.
Interestingly, we found that shoes that are stable and supportive may not actually be the ideal choice, which might surprise some people.
Understanding Osteoarthritis
Osteoarthritis affects the tissues in and around joints, including bones, cartilage, ligaments, and muscles. It’s more prevalent among older adults and those with excess weight. The condition causes joint pain and stiffness and can even result in disability.
Approximately 2.35 million Australians are affected by osteoarthritis, with numbers expected to rise as the population ages and obesity rates increase.
The hip and knee joints are commonly impacted, making walking challenging. Because there’s no cure, self-management strategies are key.
This includes selecting appropriate footwear.
The Role of Shoes in Symptoms
Osteoarthritis has various origins, but excessive force within the joint during walking is thought to contribute to its development. Increased joint forces might also heighten the risk of the condition worsening over time.
Shoes serve as our connection to the ground, and they play a role in how forces transmit through the legs with each step. Certain features of shoes are noteworthy.
For example, shoes with higher heels can elevate joint forces. Specifically, a six-centimeter heel can increase knee forces by an average of 23% compared to walking barefoot.
Some shoes come with added support, like insoles that help with arches, or are constructed from stiffer materials.
Many believe that these stable and supportive features are the best option for those with osteoarthritis. However, biomechanical studies reveal that such shoes can actually increase knee force by up to 15% compared to less supportive options. Adding arch-supporting insoles can also elevate knee force by about 6%.
This raises a question: Are flatter, more flexible shoes, like ballet flats, better for those with knee and hip osteoarthritis?
Not necessarily. Pain levels must also be considered.
Our Findings
Our biomechanical study from 2017 showed that flat, flexible shoes reduced knee forces by an average of 9% compared to stable supportive styles. This might suggest that flat shoes are beneficial for osteoarthritis. To explore this, we conducted two clinical trials focused on pain levels.
In our latest trial, we involved 120 participants with hip osteoarthritis.
Participants were assigned to wear either flat flexible shoes, like ballet flats, or various stable supportive shoes, such as supportive sneakers. They were instructed to wear their selected shoes for at least six hours daily. After six months, we assessed whether there were any changes in hip pain during walking.
The results showed that flat flexible shoes weren’t more effective than stable supportive shoes in reducing hip pain.
This outcome contrasts with findings from our 2021 trial with 164 participants suffering from knee osteoarthritis, where stable supportive shoes resulted in knee pain reduction by an average of 63% more than flat flexible options.
It’s puzzling as to why these results diverged between knee and hip conditions. It could be that joint forces are generally more significant in knee osteoarthritis, allowing stable supportive shoes to have a greater impact on reducing those forces and, consequently, knee pain.
In both trials, participants wearing flat, flexible shoes reported more foot pain. This might be due to their lower level of protection for the feet.
Which Shoes Are Best?
For those with knee osteoarthritis, stable supportive shoes likely provide greater benefits compared to flat, flexible ones.
When it comes to hip osteoarthritis, there doesn’t seem to be a significant difference in hip pain relief between either type of shoe.
However, for older adults—including those with hip and knee osteoarthritis—it’s sensible to steer clear of poorly fitting shoes and those with high or narrow heels, as these increase the risk of falls.
For younger individuals with osteoarthritis who aren’t at risk of falling, it may be wise to avoid high heels due to their potential to heighten joint forces.
Consulting Professionals
If you’re worried about your hip or knee osteoarthritis, it’s a good idea to speak with your GP or another healthcare provider, such as a podiatrist or physiotherapist.
Exploring non-surgical treatments like exercise, weight management, nutrition, and certain pain medications can also be helpful.
