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Shoes and arthritis

Randomised trial

Exercise and weight loss can improve pain from knee arthritis, but little attention has been paid to the design of shoes to help knee pain. When it comes training shoes, rather than ordinary shoes or slippers, we transcend the ordinary. A few moments cursory examination of the shelves of a sports shoe shop or department will reveal huge variations in design and technology.

Some of these are reputed to be particularly useful for patients with pain from knee arthritis. One such is made by a company called Masai Barefoot technology (MBT), and unstable, which means that it demands increased muscle activity in the lower legs, especially on standing. Repute is one thing, proof is another. A randomised trial of shoes for knee arthritis [1] is interesting.

Randomised trial

The trial, in Canada, recruited residents of Calgary over the age of 40 years with symptoms of knee osteoarthritis. The sample size was based on an ability to demonstrate a 10 mm difference on a visual analogue scale of pain on walking. Arthritis was documented clinically and radiologically, was at least of six months' duration, and with initial pain intensity on walking of at least 30 mm on a 100 mm scale (moderate pain). Participants had to be on their feet for two to three hours a day. There were various obvious exclusions, including changes in therapy.

Participants were randomised using a computer generated sequence to MBT shoes or high-end walking shoes (New Balance 756 WB), properly fitted. Both groups were given instructions about training, and to gradually increase the duration of use of the shoe over three or four days. Thereafter, the shoes were to be used as much as possible.

Western Ontario and McMaster Universities osteoarthritis indices were measured initially, and at three-week intervals over 12 weeks.


The 123 participants had an average age of 58 years, with slightly more women than men, and an average BMI of 30 kg/sq metre.

Both shoes improved pain, stiffness, physical functioning, and total WOMAC score by similar percentages (Figure 1). For most measures, absolute percentage benefits were of the order of 10%. Most of the benefits on pain occurred quite early on in the 12 weeks of the trial, mostly within the first three or six weeks. Both shoes also significantly increased some measures of knee strength, but by no means all of them.

Figure 1: Percentage reduction for several scores between baseline and 12 weeks in patient scores for Masai Barefoot Technology and New Balance shoes

There were differences between the shoes in their effect on balance. Performance in the static test time with eyes closed increased significantly by seven seconds between baseline and 12 weeks with MBT shoes, but not New Balance shoes, though there was no difference between groups with different shoes after 12 weeks.


In Bandolier's young days, training shoes consisted of black canvas uppers and flat rubber soles, and were called daps. Today, the profusion of sports and walking shoes is amazing. Those who have not used a good walking shoe will be amazed at the difference the right one can make, in both feel, and one's attitude to walking as an exercise.

What we have in this trial is a very good result. Perhaps not for a particular shoes, but certainly for patients with knee arthritis. The magnitude of the average reductions in pain are useful, and indicate that there were probably some very good improvements for individuals. Moreover, adverse events from shoes are unlikely.

Choosing a good shoe might be added to the other things that people with knee osteoarthritis can do for themselves, alongside exercise, losing weight, glucosamine sulphate, avocado-soybean unsaponifiables, and topical NSAIDs, (at least in Europe). All of these put off the day when they need to see a doctor, to the benefit of both doctor and patient.

The number of good clinical trials examining good quality walking shoes on pain in knee arthritis are few. This was the only randomised study Bandolier could find. This is a shame, because the implication is that using a good shoe early on might have more beneficial effects. Who, though, will fund the necessary research?


  1. BM Nigg et al. Unstable shoe construction and reduction of pain in osteoarthritis patients. Medicine & Science in Sports & Exercise 2006 Vol:1701-1708.

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