six hours a day over six months, while the other half was assigned stable supportive footwear. (The team did not compare shoes distributed in the study with the ones patients regularly wore.)
All footwear was commercially available. For the flat variety, the brands included: Merrell Bare Access (for men and women); Vivobarefoot Primus Lite (men and women); Vivobarefoot Mata Canvas (men); Converse Dainty Low (women); and Lacoste Marice.
Stable variety brands included ASICS Kayano (for men and women); Merrell Jungle Moc (men); Nike Air Max 90 Ultra (women); Rockport Edge Hill (men); and New Balance 624 (women).
Each patient was able to switch between two brands throughout the trial. Investigators kept track of reported knee pain levels while walking, functional ability, overall quality of life indicators and overall physical activity levels.
In the end, the team determined that while stable supportive shoes did not restore greater mobility to patients than flat flexible shoes, they did offer a leg up on knee and hip pain reduction and improved quality of life.
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‘A Rolls-Royce over potholes’
As well, Hinman notes that “sturdy supportive shoes were much less likely to cause adverse effects at the knee and other joints, such as ankle/foot pain [or] knee swelling.” Moreover, people who wore flat flexible shoes reported twice as many adverse effects as people who wore sturdy supportive shoes, she says.
The upshot: “Shoes are an easy option that can help people self-manage their knee osteoarthritis pain,” Hinman shares. “Patients with knee osteoarthritis should think carefully about their footwear and choose shoes that are most likely to reduce their knee pain.”
Schildhorn agrees.
“For someone with knee arthritis,” he says, “a structured shoe is almost like a Rolls-Royce going over potholes. Because the problem with an arthritic knee is that the joints aren’t aligned correctly, and aren’t nearly as supple anymore. And it has cartilage with gaps, like cobblestones, which wear away.”
A structured shoe can absorb those issues, says Schildhorn. But an unstructured shoe or a barefoot “relies on all of the joints of the body to work just as they were designed. They all have to be aligned correctly, the ligaments have to be functional, and the joints have to be supple in order to absorb loads when walking in uneven areas. Because you need your body to be able to adjust to variances.”
The U.S.-based Arthritis Foundation agrees that patients should pay attention to the style and fit of the shoes they wear. But it cites mixed findings as to best practices.
For example, foundation experts acknowledge that stable shoes and boots (without heels) can indeed be helpful for some.
However, they also highlight prior knee research indicating that some flat shoes — such as flip-flops — may trigger less knee stress than more stable shoes. Others, however, such as loosely strapped sandals and so-called “foot gloves,” may prove problematic.
But the foundation has one piece of overriding advice: Never favor style over function and comfort.