Beating osteoarthritis knee pain: Beyond special shoes

Heidi Godman
Heidi Godman, Executive Editor, Harvard Health Letter

We have plenty of fairy tales about shoes that work magic in people’s lives: glass slippers that brought love to Cinderella, and sparkly red heels that gave Dorothy powers in MGM’s version of The Wizard of Oz.

In real life, footwear magic is limited to “unloading” shoes that may help relieve knee pain from osteoarthritis. These unloading shoes have stiffer soles, and slightly tilted insoles that reposition the foot, intended to reduce (or unload) strain on the knee. But a study published online July 12, 2016, in Annals of Internal Medicine suggests that unloading shoes are no better than a good pair of walking shoes at making pain disappear.

About the study

Researchers randomly assigned 164 people with knee arthritis (age 50 or older) to wear either new unloading shoes or new conventional walking shoes every day for six months. By the end of the study, it appeared that both types of shoes were equally effective at reducing pain and improving physical function, with pain reduced an average of about 25%, and function improved by about 22%. It didn’t prove that both shoes are equally effective, but an editorial accompanying the study says the findings highlight “the promise of simple biomechanical interventions” to address knee pain.

Both shoes used in the study cost $180. But custom-made unloading shoes, and even custom-made insoles that can be inserted into a shoe, can cost many hundreds of dollars.

What to look for in a walking shoe

If you’re going to try a walking shoe to reduce your knee pain, look for certain features, such as:

  • a “stability-type” sneaker with a rigid sole and supportive insole
  • a slightly curved “rocker” sole that helps distribute the body more weight evenly as you walk. This sole may not be right for you if you have balance problems.

And remember that fit is important, too. Seek out:

  • a wide, roomy toe area (what shoe salespeople call the toe box)
  • length at least half an inch beyond your longest toe
  • a sturdy area around your heel (called a heel counter), so your foot stays in place and doesn’t slip around, which can cause friction and pain.

“Most of the sneaker brands make this shoe (New balance, Brooks, Saucony, Asics), so they are widely available. The take home here is that any supportive, rocker-bottom type shoe makes walking with knee osteoarthritis easier,” says Dr. Holly Johnson, an orthopaedic surgeon and instructor at Harvard Medical School. “The other important thing is that keeping physically active is so crucial to bone and joint health. If the shoes make people feel better when they walk, and therefore they walk more, this leads to so many health benefits. Find something comfortable and go with it.”

Other options

Walking shoes aren’t the only way to relieve knee pain without surgery. “I see success stories without surgery every day,” says Dr. Clare Safran-Norton, Clinical Supervisor of Rehabilitation Services at Harvard-affiliated Brigham and Women’s Hospital.

Her top recommendations include:

  • Physical therapy: Dr. Safron-Norton suggests that a person with knee arthritis undergo at least three months of physical therapy as a first line of treatment. The program should include a series of exercises to strengthen and stretch the muscles that support the knee.
  • Weight loss: Shedding pounds reduces the pressure you place on your knee. That’s significant, since the force you place on your joints can be up to six times your body weight.
  • Injections: Corticosteroid injections can temporarily reduce pain and swelling, which can make it less painful to take part in physical therapy.
  • Acupuncture: The studies about whether acupuncture relieves knee pain are mixed, but Safran-Norton says the treatment is helpful to some people. “If the problem is pain, it may work. If the problem is biomechanical or weak muscles, it probably won’t.”
  • Supplements: Research has provided mixed results on chondroitin and glucosamine supplements to relieve pain, but Safran-Norton says some of her patients feel the pills make a difference. Chondroitin sulfate helps to keep cartilage from deteriorating. Glucosamine stimulates cartilage formation and repair.

Don’t expect these things to work magic overnight. “You’ll feel a difference after going to physical therapy once or twice a week for two-to-four weeks,” says Safran-Norton. The rest of the methods are used best in conjunction with physical therapy, not in place of it, she advises.

With a little trial and error, you have a good chance of finding knee pain relief without surgery — and you may get a fairy tale ending. If knee pain persists, you may need to speak with an orthopaedic expert about surgery. But save that for a last resort.

Comments:

  1. Melissa Ewan

    Hi,

    How we should regret knee pain relieve?

    I heard that “Protection of the knee from any sort of trauma is very important”
    Is that true?

  2. John H

    I had arthroscopic surgery 13 years ago, and experience periodic knee pain now. My “magic shoe” is the Hoka Clifton. Before Hokas, I couldn’t walk more than a half mile without pain. After, I walked all over Rome and Florence for days on end with no pain-at least not in my knee-I got blisters on my big toe instead, as toe box is not wide enough. I DISPUTE the recommendation for stiff soles. The Hoka Clifton is somewhat flexible, much better than the stiff-soled Hoka Mafate. Another good shoe is the Newton AHA. My previous favorite shoe was the Nike Free – very flexible. I agree that the rocker sole is good, but it needs to be marshmallow soft as well

  3. Neli

    For a long time, I have had arthritis in my knees and I ‘v suffered. Knee pain wasn’t my only problem during my childhood but it’s was definitely the main thing Why I couldn’t play with my friends. Then I discovered Knee support brace and This was absolutely helpful for my knees, I found knee brace for arthritis here and now I can do everything , include playing my favorite game tennis. Thanks for this awesome article. I am really glad to read this helpful articles from you. Thanks again.

    • Jeanette

      quando studiavo a Genova mi facevo quasi quotidianamente il viaggio di andata e di ritorno al buio pesto dentro alle gallerie perché la luce saltava negli scompartimenti dopo due metri dalla partenza…Era tutto buio, però a parte quando dormivo, l'altra cosa che mi piaceva era seguire la riga bianca che va su e giù sui muri delle gallerie abbinandola alle cose rittfsse…eulto ciò poteva bastare…

  4. Sarabjit Romana

    I am working as Chinese Medicine Practitionor for almost ten years, and I can proudly say that Acupuncture really works for Knee Pain related with injury, arthritis, Pulled ligament or weak muscles, torn miniscus etc. Acupuncture is not only good for to relieve pain , actually it can rejuvenate the muscles , promot the blood circulation and reduce the swelling. Acupuncture actually can do wonders but if done properly with the good understanding of the problem.As a chinese Medicine practitioner I am very passionate about Acupuncture and its results.

    • Jenny

      As a patient of a very accomplished Acupuncturist practicing “Japanese” Acupuncture in Australia, I certainly agree with Sarabjit
      Romana. The pain relief was amazing. I also exercise with walking and pilates to help stabilise and build muscles in my leg and back. My Orthopaedic Surgeon was amazed at my result.

  5. Bernie Jasmin

    I have tried all those mentioned remedies except operation on my
    knees and shoulder joints but no relief. Few years ago I was using a
    cane. Now I use two crutches to make few paces, hence a house-
    bound. Is there any more effective remedy to rehabilitate my joints?

    • Diane

      Dr Axe’s Collagen Powder has done wonders for all my joints. I mix 1 heaping tablespoon twice daily in my hot green tea. It doesn’t change the taste of the beverage. You could mix it in coffee or anything warm to make it dissolve. Give it a month, and you will see improvement. Check it out at draxe.com

    • Cheryl

      Bernie, I don’t know if your issues are the same as mine, but here is what worked for me. I am bone-on-bone now, having had most of my cartilage removed in 1993 during arthoscopy. 2 years ago I began having deep achy pain and diminished range of motion. Losing 20 pounds helped, along with walking, bike riding, taking spinning classes, water aerobics, working out in the gym, and using a rowing machine. But what worked the most for me has been taking 500 mg of turmeric curcumin 3 times a day. It took about 2 months to notice a difference, but it has been wonderful! If I don’t take it for more than a week the achiness will slowly return. I can’t bend my knee very deeply and will definitely need a knee replacement but hope to avoid it for at least 5 more years, when I am 55. I have also lost another 50 pounds and have not tried the lubricating injections, as I am terrified of needles. Whatever you do, always stay active and don’t ever stop moving. Good luck!

  6. Marge Musser

    Wearing customs orthotics since 1981 has enabled me to keep walking
    Comfortably all these years. Very little barefoot walking even in the house. Going even three days without them shows a big difference . Most of my shoes are ASICS, and they hold up well. Also wear cotton “footies”.

  7. Terri

    I find many of your articles seem to be biased and not include other alternative therapies like chiropractic.

  8. Anonymous

    “Research has provided mixed results on chondroitin and glucosamine supplements to relieve pain”

    Interesting that you phrase it this way, as an actual summary of 19 studies of glucosamine shows that they’ve produced highly consistent results:

  9. Marc

    What about orthotics?

  10. Inspiresavvy

    This is informational