Best Shoes for Hip & Knee Arthritis: Science-Backed Choices

People with hip and knee osteoarthritis are often advised to wear “appropriate footwear” to minimize pain, but determining what constitutes “appropriate” can be confusing. Does this mean avoiding heels? Is there a benefit to choosing running shoes over more rigid styles? And what about the use of insoles?

Recent research, including a clinical trial published today in Annals of Internal Medicine, is beginning to provide some answers. Contrary to common belief, stable, highly supportive shoes aren’t necessarily the best option for managing osteoarthritis symptoms.

What is Osteoarthritis?

Osteoarthritis is a degenerative condition affecting the tissues within and surrounding a joint – including bone, cartilage, ligaments, and muscles. It’s more prevalent in older adults and individuals with higher body weights, leading to joint pain, stiffness, and potential disability. Currently, approximately 2.35 million Australians live with osteoarthritis, a number projected to rise with the aging population and increasing obesity rates.

The hip and knee are commonly affected joints, making walking particularly challenging. While there is no cure for osteoarthritis, self-management strategies, including footwear choices, are crucial for mitigating symptoms.

How Do Shoes Affect Osteoarthritis Symptoms?

While multiple factors contribute to osteoarthritis, excessive force within the joint during activities like walking is believed to play a significant role. These excessive forces can also accelerate the worsening of osteoarthritis over time. Shoes, as our primary connection to the ground, influence how forces are transmitted up the leg with each step.

Certain shoe features are particularly important. For example, shoes with higher heels demonstrably increase joint forces. A six-centimeter heel can increase knee forces by an average of 23% compared to barefoot walking. Supportive features, such as arch-supporting insoles or stiffer sole materials, are also commonly thought to be beneficial.

However, biomechanical research challenges this assumption. Studies have shown that shoes with these supportive features can actually increase knee force by up to 15% compared to shoes without them. Similarly, arch-supporting insoles can increase knee force by up to 6%.

So, are flatter, more flexible shoes – like ballet flats – a better choice for individuals with hip or knee osteoarthritis?

The answer, it turns out, is nuanced.

What the Research Reveals

A 2017 biomechanical study involving individuals with knee osteoarthritis demonstrated that flat, flexible shoes reduced knee forces by an average of 9% compared to more stable, supportive shoe styles. This suggests a potential benefit to choosing less structured footwear for knee osteoarthritis.

To investigate this further, researchers conducted two clinical trials focusing on pain levels. The most recent clinical trial, involving 120 participants with hip osteoarthritis, randomized individuals to wear either flat, flexible shoes (such as flexible ballet flats) or stable, supportive shoes (like supportive runners) for at least six hours daily. After six months, researchers measured changes in hip pain during walking. The results showed no significant difference in hip pain between the two groups.

These findings contrast with a 2021 clinical trial involving 164 individuals with knee osteoarthritis. That trial revealed that wearing stable, supportive shoes for six months reduced knee pain during walking by an average of 63% more than wearing flat, flexible shoes.

The reasons for these differing results between hip and knee osteoarthritis remain unclear. However, it’s hypothesized that higher joint forces in the knee compared to the hip may mean that stable supportive shoes have a greater potential to reduce knee forces, and knee pain.

Importantly, both trials reported a higher incidence of complications, such as foot pain, among those wearing flat, flexible shoes. This may be due to the reduced protection these shoe styles offer to the feet.

Which Shoes Should You Choose?

For individuals with knee osteoarthritis, stable, supportive shoes are likely to be more beneficial than flat, flexible options. For those with hip osteoarthritis, neither shoe type demonstrated a clear advantage in reducing hip pain.

However, for all older adults – including those with hip and knee osteoarthritis – avoiding ill-fitting shoes and those with high or narrow heels is prudent due to the increased risk of falls. Younger individuals with osteoarthritis, but not at risk of falls, may also want to avoid high heels given their potential to increase joint forces.

When to Seek Professional Advice

If you are concerned about hip or knee osteoarthritis, it’s important to consult with your primary care physician or another healthcare provider, such as a podiatrist or physiotherapist. Other non-surgical treatments, including exercise, weight management, nutrition, and pain medication, can also play a vital role in managing the condition.