Best Shoes for Hip and Knee Osteoarthritis: What the Science Says

People with hip and knee osteoarthritis are often advised to wear “appropriate footwear” to minimize pain. But what does that actually mean? Are heels out of the question? Does the type of shoe – running shoes versus stiffer styles – matter? And what about insoles? Recent research, including a clinical trial published in Annals of Internal Medicine, is providing clearer answers, challenging some long-held beliefs about supportive footwear.

Understanding Osteoarthritis

Osteoarthritis (OA) is a common condition affecting the tissues in and around joints, including bone, cartilage, ligaments, and muscles. It’s more prevalent in older adults and individuals with excess body weight, causing joint pain, stiffness, and potential disability. Approximately 2.35 million Australians currently live with osteoarthritis, a number projected to rise with an aging population and increasing obesity rates . The hip and knee are commonly affected, making walking difficult. While there’s no cure, self-management strategies, including footwear choices, are crucial.

How Shoes Impact Osteoarthritis Symptoms

Excessive force within a joint during walking is thought to contribute to both the development and worsening of osteoarthritis. Shoes act as our connection to the ground, influencing how forces are transmitted up the leg with each step. Certain shoe features are particularly important. For example, shoes with six-centimeter (approximately 2.36 inch) heels can increase knee forces by an average of 23% compared to barefoot walking .

The Myth of Supportive Shoes

Many people, and even clinicians, assume that stable, supportive shoes – those with features like arch supports or stiffer soles – are best for osteoarthritis. However, biomechanical research suggests otherwise. Studies have shown that shoes with these supportive features can actually increase knee force by up to 15% compared to shoes without them, and arch-supporting insoles can increase knee force by up to 6% .

Are Flat, Flexible Shoes the Answer?

While flat, flexible shoes might seem like a better option, the answer isn’t quite that simple. Pain levels too need to be considered. Research from 2017 indicated that flat, flexible shoes reduced knee forces by an average of 9% compared to stable, supportive styles .

Recent Clinical Trial Findings

A recent clinical trial involving 120 people with hip osteoarthritis explored this further. Participants were randomly assigned to wear either flat, flexible shoes (like ballet flats) or stable, supportive shoes (like running shoes) for at least six hours a day over six months. The study measured changes in hip pain during walking. The results showed that flat, flexible shoes were no better than stable, supportive shoes for reducing hip pain.

This contrasts with a 2021 trial involving 164 people with knee osteoarthritis, which found that wearing stable, supportive shoes for six months reduced knee pain by an average of 63% more than wearing flat, flexible shoes . The difference in findings between hip and knee osteoarthritis may be due to higher joint forces in the knee, potentially making it more responsive to the force-reducing effects of stable supportive shoes.

Importantly, more complications, such as foot pain, were reported by those wearing flat, flexible shoes, possibly because they offer less foot protection.

Which Shoes Should You Wear?

• Knee Osteoarthritis: Stable, supportive shoes are likely more beneficial than flat, flexible shoes.
• Hip Osteoarthritis: Neither shoe type appears to be superior for improving hip pain.

Regardless of whether you have hip or knee osteoarthritis, it’s wise to avoid ill-fitting shoes, as well as those with high or narrow heels, to reduce the risk of falls. For younger individuals with osteoarthritis who aren’t at high risk of falls, avoiding high heels is still advisable due to their potential to increase joint forces.

When to Seek Professional Advice

If you’re concerned about hip or knee osteoarthritis, consult your doctor or a healthcare professional such as a podiatrist or physiotherapist. Other non-surgical treatments, including exercise, weight management, nutrition, and pain medication, can also help manage symptoms.