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Changing how you angle your foot when walking might help decrease knee pain and joint damage
Researchers from University of Utah found that, after analyzing current gait, that changing the angle at which you allow your foot to strike the ground can, over a year-long study, decrease pain level by as much as standard pain medicines.
More importantly, if you are in the group that analysis suggested would benefit from gait change (sadly, not all would) that the resultant unloading the knee joint reduced the rate of cartilage deterioration as measured by MRI.
The following is from the ScienceDaily news article "One small walking adjustment could delay knee surgery for years"
...Osteoarthritis degrades joint-cushioning cartilage, and there is currently no way of reversing this damage: the only option is to manage pain with medication, and eventually, joint replacement....
We've known that for people with osteoarthritis, higher loads in their knee accelerate progression, and that changing the foot angle can reduce knee load," said Uhlrich, an assistant professor of mechanical engineering. "So the idea of a biomechanical intervention is not new, but there have not been randomized, placebo-controlled studies to show that they're effective."...
Moreover, after their initial intake sessions, half of the 68 participants were assigned to a sham treatment group to control for the placebo effect. These participants were prescribed foot angles that were actually identical to their natural gait. Conversely, participants in the intervention group were prescribed the change in foot angle that maximally reduced their knee loading....
"The reported decrease in pain over the placebo group was somewhere between what you'd expect from an over-the-counter medication, like ibuprofen, and a narcotic, like oxycontin," Uhlrich said. "With the MRIs, we also saw slower degradation of a marker of cartilage health in the intervention group, which was quite exciting."...
https://www.sciencedaily.com/releases/2025/08/250814094656.htm
There is MUCH MORE information in the ScienceDaily news story than can be included in a DU excerpt. This includes answers to questions such as how difficult was it for the participants to learn and maintain their new gaits, how they felt about it, how this could be moved from a resource and labour intensive research study to something which a Physical Therapist might be able to evaluate and manage...
We've known that for people with osteoarthritis, higher loads in their knee accelerate progression, and that changing the foot angle can reduce knee load," said Uhlrich, an assistant professor of mechanical engineering. "So the idea of a biomechanical intervention is not new, but there have not been randomized, placebo-controlled studies to show that they're effective."...
Moreover, after their initial intake sessions, half of the 68 participants were assigned to a sham treatment group to control for the placebo effect. These participants were prescribed foot angles that were actually identical to their natural gait. Conversely, participants in the intervention group were prescribed the change in foot angle that maximally reduced their knee loading....
"The reported decrease in pain over the placebo group was somewhere between what you'd expect from an over-the-counter medication, like ibuprofen, and a narcotic, like oxycontin," Uhlrich said. "With the MRIs, we also saw slower degradation of a marker of cartilage health in the intervention group, which was quite exciting."...
https://www.sciencedaily.com/releases/2025/08/250814094656.htm
There is MUCH MORE information in the ScienceDaily news story than can be included in a DU excerpt. This includes answers to questions such as how difficult was it for the participants to learn and maintain their new gaits, how they felt about it, how this could be moved from a resource and labour intensive research study to something which a Physical Therapist might be able to evaluate and manage...
The study itself was published in Lancet Rheumatology [paywalled] Here are the Findings and Interpretations parts of the [free] Summary:
...Findings
Between Aug 1, 2016, and June 25, 2019, 1582 individuals were screened for eligibility. 107 participants completed an initial gait analysis and 68 were randomly assigned to either the intervention (n=34) or the sham (n=34) group. 41 (60%) of 68 participants were female, 27 (40%) were male, and 54 (79%) were White; mean age was 64·4 years (SD 7·6). After 1 year, participants in the intervention group had greater reductions in medial knee pain (between-group difference –1·2, 95% CI –1·9 to –0·5; p=0·0013) and knee adduction moment peak (between-group difference –0·26 % bodyweight × height, 95% CI –0·39 to –0·13; p=0·0001) than participants in the sham group. The MRI-estimated change in cartilage microstructure (T1ρ
in the medial compartment was less in the intervention group than the sham group (between-group difference –3·74 ms, 95% CI –6·42 to –1·05). There were no significant between-group differences in T2. There were no severe adverse events; however, two (6%) of 34 participants in the intervention group and one (3%) of 34 participants in the sham group dropped out of the study due to increased knee pain.
Interpretation
Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them a promising non-surgical treatment option for some individuals with medial compartment knee osteoarthritis.
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(25)00151-1/abstract
This study was noted as being funded by the VA, so who knows if there will ever be follow up.
Between Aug 1, 2016, and June 25, 2019, 1582 individuals were screened for eligibility. 107 participants completed an initial gait analysis and 68 were randomly assigned to either the intervention (n=34) or the sham (n=34) group. 41 (60%) of 68 participants were female, 27 (40%) were male, and 54 (79%) were White; mean age was 64·4 years (SD 7·6). After 1 year, participants in the intervention group had greater reductions in medial knee pain (between-group difference –1·2, 95% CI –1·9 to –0·5; p=0·0013) and knee adduction moment peak (between-group difference –0·26 % bodyweight × height, 95% CI –0·39 to –0·13; p=0·0001) than participants in the sham group. The MRI-estimated change in cartilage microstructure (T1ρ
in the medial compartment was less in the intervention group than the sham group (between-group difference –3·74 ms, 95% CI –6·42 to –1·05). There were no significant between-group differences in T2. There were no severe adverse events; however, two (6%) of 34 participants in the intervention group and one (3%) of 34 participants in the sham group dropped out of the study due to increased knee pain.
Interpretation
Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them a promising non-surgical treatment option for some individuals with medial compartment knee osteoarthritis.
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(25)00151-1/abstract
This study was noted as being funded by the VA, so who knows if there will ever be follow up.
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