A personalized change in how you walk could offer relief from knee osteoarthritis pain comparable to over-the-counter medications, without requiring pills, surgery, or devices. In a year-long clinical trial, researchers discovered that adjusting the angle of your foot while walking reduced pain and slowed the deterioration of cartilage inside the joint.

Nearly one in four adults over 40 lives with painful knee osteoarthritis, a condition that gradually wears down the cartilage cushioning joints and is one of the major causes of adult disability. Once cartilage damage occurs, doctors currently cannot reverse it, so treatment usually focuses on pain relief, with joint replacement becoming an option when symptoms become severe. This new research points to a different possibility: a biomechanical intervention that could help fill the decades-long treatment gap for people who develop arthritis in their 30s, 40s, or 50s.

How Does Changing Your Walking Pattern Help Knee Pain?

Researchers at the University of Utah, New York University, and Stanford University conducted a randomized controlled trial with 68 participants who had mild to moderate osteoarthritis in the medial compartment of the knee, which is the inner side of the joint. This area typically carries more weight than the outer side, making it a common site for knee osteoarthritis. The study, published in The Lancet Rheumatology, was the first placebo-controlled study to show that a biomechanical intervention could help treat osteoarthritis symptoms and potentially slow joint damage.

The key insight is that changing foot angle reduces the load, or stress, placed on the painful part of the knee. However, the best adjustment is not the same for everyone. Some people benefit from turning their toes slightly inward, while others benefit more from pointing them outward. For some individuals, the wrong change can fail to help or even increase stress on the painful area.

"We used a personalized approach to selecting each individual's new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effect on pain and cartilage that we saw," explained Scott Uhlrich, an assistant professor of mechanical engineering at the University of Utah's John and Marcia Price College of Engineering.

Scott Uhlrich, Assistant Professor of Mechanical Engineering, University of Utah

What Were the Study Results?

Half of the 68 participants received real gait retraining with a personalized foot angle adjustment, while the other half received a sham treatment designed to control for the placebo effect. During six weekly training sessions, participants walked on a treadmill while wearing a device on the shin that provided vibration feedback to help them maintain their assigned foot angle. After the training period, participants were encouraged to practice the walking pattern for at least 20 minutes each day until it became automatic.

The results were striking. After one year, participants in the intervention group reported pain relief comparable to medication. One researcher noted that the reported decrease in pain was somewhere between what you would expect from an over-the-counter medication like ibuprofen and a narcotic like oxycontin. Additionally, MRI scans showed slower degradation of a marker of cartilage health in the intervention group compared to the placebo group, which was particularly exciting because it suggested the intervention could slow joint damage, not just mask pain.

How Was the Personalized Approach Determined?

The personalized approach was critical to the study's success. During their first two visits, participants received a baseline MRI and walked on a pressure-sensitive treadmill while motion capture cameras measured the mechanics of their gait. Researchers used those data to determine whether each person would benefit more from turning their toes inward or outward, and whether a 5-degree or 10-degree adjustment would be best. This screening also identified people who were unlikely to benefit because none of the tested foot angle changes reduced loading in their knees, and those participants were excluded from the trial.

This screening step may explain why previous studies on gait retraining showed less clear results. By including only people who could actually benefit from the intervention, researchers were able to demonstrate its effectiveness more clearly. Follow-up visits showed that, on average, participants stayed within one degree of their prescribed foot angle, indicating they successfully maintained the new walking pattern.

Steps to Understanding If Gait Retraining Might Help You

• Assessment Phase: A healthcare provider would need to perform baseline measurements including an MRI and gait analysis on a pressure-sensitive treadmill with motion capture cameras to determine your specific foot angle adjustment.
• Personalization Step: Based on your individual biomechanics, researchers would test whether turning your toes inward or outward by 5 or 10 degrees would reduce knee loading in your specific joint.
• Training Period: You would attend six weekly training sessions where you walk on a treadmill while wearing a vibration feedback device on your shin to help you maintain your prescribed foot angle.
• Daily Practice: After the training period, you would practice the new walking pattern for at least 20 minutes each day until it becomes automatic and part of your natural movement.

Why Is This Different From Other Pain Management Options?

One of the most appealing aspects of this approach is that it does not require pills, surgery, braces, or a device worn all day. One study participant said, "I don't have to take a drug or wear a device...it's just a part of my body now that will be with me for the rest of my days, so that I'm thrilled with." This long-term adherence could be one of the intervention's biggest strengths, especially for people in their 30s, 40s, or 50s who may face decades of pain management before they become candidates for joint replacement.

The approach fills a significant treatment gap. Many people develop osteoarthritis decades before they are candidates for joint replacement, and during that time they may rely heavily on pain medications and other symptom management strategies. A drug-free option that can be maintained indefinitely could reduce the burden of long-term medication use while potentially slowing disease progression.

Important Cautions About Trying This Approach

Researchers emphasized that this is not a simple "turn your toes in" or "turn your toes out" recommendation that people should try on their own. The benefit depends on careful measurement and personalization. For some people, the wrong adjustment could increase stress on the painful part of the knee rather than relieve it. This is why the study included a screening phase to identify people who would not benefit from any of the tested foot angle changes.

If you are interested in exploring gait retraining for knee osteoarthritis, it is important to work with healthcare providers who have the proper equipment and expertise to perform the necessary biomechanical assessment and personalization. This is not a treatment you can self-prescribe based on general advice, as the specific adjustment that helps one person may not help another.