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“Unloading shoes” are no better than walking shoes for knee osteoarthritis, trial finds

BMJ 2016; 354 doi: (Published 13 July 2016) Cite this as: BMJ 2016;354:i3870
  1. Jacqui Wise
  1. London

New walking shoes seem to be as effective as specially designed “unloading” shoes for patients with knee osteoarthritis, a randomised controlled trial published in the Annals of Internal Medicine has found.1

Unloading shoes have modified, stiffer soles designed to reposition the foot and reduce the load on the knee. Clinical guidelines for knee osteoarthritis recommend appropriate footwear alongside exercise and weight loss. However, little evidence exists from clinical trials to inform appropriate footwear choices, and the National Institute for Health and Care Excellence has identified footwear trials as a research priority.

Knee osteoarthritis affects 10-25% of women and 5-15% of men aged over 60. It results in pain, physical dysfunction, and reduced quality of life.

The Australian study included 164 people with medial knee osteoarthritis who were randomly assigned to new shoes with modified mid-soles to unload the knee or to new conventional walking shoes. The participants were asked to wear the shoes as much as possible every day, for at least four hours a day, for six months.

After six months both groups showed large and clinically relevant improvements in pain and function. Overall pain was improved in 54% of participants in both groups, and overall function was improved in 44% of the group wearing unloading shoes and in 48% of the control group. Unloading shoes were not associated with increased probability of improved pain (odds ratio 0.99 (confidence interval 0.53 to 1.86)) or improved function (0.85 (0.45 to 1.61)).

The authors examined the participants’ most frequently worn shoes and observed that most were old or well worn. “Thus both types of shoes that we provided probably represented a considerable improvement over normal footwear for most participants,” they wrote.

In an accompanying editorial Marian Hannan,2 from the Institute for Aging Research in Boston, Massachusetts, and colleagues noted that the patients in both treatment groups received new shoes to wear during the study period. They wrote, “It has been said that ‘Cinderella is proof that a new pair of shoes can change your life.’ Wouldn’t it be wonderful if a simple pair of new shoes could help your patients with knee osteoarthritis?”


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