A simple adjustment to your walking pattern may offer relief from knee osteoarthritis pain comparable to over-the-counter medication, without requiring pills, surgery, or devices. Researchers from the University of Utah, New York University, and Stanford University discovered that slightly changing the angle of your foot while walking can ease pain and potentially slow joint damage in people with knee osteoarthritis.

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, and treatment usually focuses on pain relief with joint replacement becoming an option when symptoms become severe.

How Does Changing Your Walking Pattern Help Knee Pain?

In a year-long randomized controlled trial, researchers trained people with mild to moderate knee osteoarthritis to make a small, personalized change in the angle of their foot while walking. The results were striking. Participants who received the real gait retraining reported pain relief comparable to medication, and MRI scans showed they had less knee cartilage deterioration than people in the placebo group.

The study, published in The Lancet Rheumatology, was the first placebo-controlled study to demonstrate that a biomechanical intervention could help treat osteoarthritis symptoms and potentially slow joint damage. The key insight is that higher loads in the knee accelerate progression of osteoarthritis, and changing the foot angle can reduce that load.

Why Does This Approach Need to Be Personalized?

One critical finding from the research is that the best walking adjustment is not the same for everyone. Some people reduce knee loading by 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 part of the knee.

"Previous trials prescribed the same intervention to all individuals, resulting in some individuals not reducing, or even increasing, their joint loading. 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," said Scott Uhlrich.

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

This personalization may explain why earlier studies showed less clear results. The researchers screened participants to identify those unlikely to benefit from any foot angle adjustment and excluded them from the trial, ensuring the study population could actually respond to the intervention.

How the Study Was Conducted

Of the 68 participants enrolled in the trial, half were assigned to the real gait retraining group, and the other half received a sham treatment designed to control for the placebo effect. During their first two visits, all 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 measurements 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. Both groups then returned to the lab for six weekly training sessions, where participants walked on a treadmill while wearing a device on the shin that provided vibration feedback to help them maintain their assigned foot angle.

Steps to Learning Your Personalized Walking Adjustment

• Baseline Assessment: Participants underwent MRI scans and walked on a pressure-sensitive treadmill with motion capture cameras to measure their individual gait mechanics and determine the optimal foot angle adjustment for their body.
• Personalized Prescription: Researchers calculated whether each person would benefit from turning toes inward or outward and determined the ideal degree of adjustment, either 5 or 10 degrees.
• Weekly Training Sessions: Over six weeks, participants practiced their new walking pattern on a treadmill while wearing a vibration feedback device on the shin to help them maintain the correct foot angle.
• Home Practice: After training, participants were encouraged to practice the walking pattern for at least 20 minutes each day to make the movement automatic.
• Follow-up Evaluation: After one year, participants reported their knee pain levels and underwent a second MRI to measure changes in cartilage health.

What Were the Results?

After one year, the results were impressive. Participants who received the real gait retraining reported pain relief that fell somewhere between what you would expect from an over-the-counter medication like ibuprofen and a stronger narcotic like oxycodone. The MRI scans also showed slower degradation of a marker of cartilage health in the intervention group, which researchers found quite exciting.

Follow-up visits showed that, on average, participants stayed within one degree of their prescribed foot angle, demonstrating that people could maintain the new walking pattern long-term. This adherence is crucial because the intervention's biggest strength may be its long-term sustainability.

Why This Matters for People With Knee Arthritis

One of the most appealing aspects of this approach is that it does not require pills, surgery, braces, or a device worn all day. For many people, this represents a significant advantage over traditional treatment options. Many people develop osteoarthritis decades before they are candidates for joint replacement, meaning they may rely heavily on pain medications and other symptom management strategies during that long period.

"Especially for people in their 30s, 40s, or 50s, osteoarthritis could mean decades of pain management before they're recommended for a joint replacement. This intervention could help fill that large treatment gap," explained Scott Uhlrich.

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

One study participant captured the appeal of the approach, saying: "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 I'm thrilled with it".

Important Cautions About This Approach

While the findings are promising, 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 depended on careful measurement and personalization. For some people, the wrong adjustment could increase stress on the painful part of the knee rather than reduce it. This is why working with a healthcare provider who can properly assess your individual gait mechanics is essential before attempting this intervention.

The research remains an active area of study, with continued interest in placebo-controlled trials of foot progression angle retraining. Researchers are still working to determine which gait strategies work best and for whom, but the study published in The Lancet Rheumatology represents one of the strongest clinical demonstrations of a personalized approach to managing knee osteoarthritis without medication or surgery.