Nearly one in four people over 40 suffers from painful osteoarthritis, a condition that damages the cartilage in joints and often leads to disability.
Currently, there is no way to reverse this damage. Treatment usually involves managing pain with medication and, eventually, joint replacement.
However, researchers from the University of Utah, New York University, and Stanford University may have found a promising new approach—gait retraining.
A year-long clinical trial published in The Lancet Rheumatology shows that simply changing the angle of the foot while walking can offer pain relief similar to that provided by medication.
Even more importantly, participants who adjusted their gait experienced slower cartilage damage in the knee compared to those who received a placebo treatment.
The study, co-led by Dr. Scott Uhlrich from the University of Utah’s College of Engineering, is the first placebo-controlled trial to show that a biomechanical approach can help manage osteoarthritis.
Dr. Uhlrich explained that past research has shown increased pressure in the knee can make osteoarthritis worse. Adjusting the angle of the foot has been shown to reduce this pressure, but until now, no large, controlled studies had proven its benefits.
The trial focused on people with mild-to-moderate osteoarthritis in the inner (medial) part of the knee, where the condition is most common. Unlike earlier studies, which used the same foot-angle adjustment for everyone, this study used a personalized approach.
Using a pressure-sensitive treadmill and motion-capture cameras, researchers determined which foot angle—either turning the toe inward or outward—would reduce pressure in each participant’s knee. They also measured whether a 5° or 10° adjustment would be more effective.
This careful analysis allowed the team to screen out participants who wouldn’t benefit from the change. Earlier studies didn’t do this, which may explain why results were less conclusive.
A total of 68 participants were randomly assigned to two groups. One group received a real foot-angle adjustment to reduce knee pressure. The other group received a “sham” treatment that simply matched their natural walking pattern.
Both groups came in for six weeks of training using biofeedback devices worn on the leg to guide their new walking style. Afterward, they were asked to continue the walking habit daily.
After one year, participants reported their pain levels and received follow-up MRI scans. Those in the gait retraining group reported pain relief similar to what you might expect from ibuprofen or even stronger medications.
Their MRIs also showed slower cartilage degradation—evidence that the new walking style helped protect their joints.
Participants appreciated the simplicity of the solution. One person 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.”
Dr. Uhlrich noted that this approach could be especially helpful for people in their 30s to 50s, who may spend decades managing pain before being considered for joint replacement. Gait retraining offers a way to fill that treatment gap.
To bring this treatment to the clinic, the gait retraining process needs to become easier and cheaper.
The current motion-capture technology is costly and time-consuming, but researchers are working on using mobile sensors, like smartphone cameras or “smart shoes,” to personalize and deliver the treatment in everyday settings. Future studies will be needed to make this promising therapy widely available.
If you care about pain, please read studies about Chronic morphine use for cancer pain may increase bone loss and findings of Scientists find a new hope for chronic pain.
For more about pain, please read studies about What you need to know about diabetes and joint pain and findings of Understanding the connection between liver disease and joint pain.
The study is published in The Lancet Rheumatology.
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