A survey of 204 people with knee osteoarthritis showed that while no clinical evidence indicates an optimal shoe, the majority of patients receive the same advice and share the same beliefs and wear habits, all of which favor sturdy, supportive shoes, shoes with built-in arch supports and athletic shoes/sneakers.
Researchers at the Centre for Health, Exercise and Sports Medicine at the University of Melbourne in Melbourne, VIC, Australia, were investigating a specially designed unloading shoe for knee osteoarthritis (OA) when they came up with the idea for the survey.
“As part of that project, we had asked participants to bring in a few pairs of their everyday walking shoes and we were surprised at the types and conditions of many of the shoes we saw,” Kade Paterson, BPod, MAPodA, PhD, post-doctoral research fellow at the University of Melbourne and sports podiatrist at Lakeside Medicine Centre in Victoria, Australia, told O&P Business News. Paterson and colleagues decided a survey was the best method to find out how people with knee OA make footwear decisions. “We wanted to know not only what shoes they were wearing, but also if they had received any advice from health professionals in particular about what were and were not good shoes or shoe features for their knee OA. We also wanted to know what they themselves felt were good footwear choices for their knee symptoms, and what footwear they mainly wore.”
Preference for comfort, support
The survey contained 14 questions divided into four sections: clinical characteristics of the participant, advice the participant had received about footwear for knee OA, the participant’s beliefs about the best footwear for knee OA and which footwear styles were most frequently worn by the participant. Surveys included 21 different categories of footwear for participants to best describe shoes. Some participants chose multiple categories for the same shoe, for example, in the case of an athletic shoe that is also cushioned and supportive.
“We chose to include multiple categories of footwear in an attempt to capture the wide variety of language used to describe shoe styles and features, and we felt that this was important to ensure participants correctly described their footwear,” Paterson said.
The results showed that a third of participants had received footwear advice from a health professional, most commonly from a podiatrist (68%). About a quarter of participants received footwear advice from a non-health professional, and significantly more females (27%) received advice than males (12%).
“Regardless of where the advice came from, most of our respondents were told that the best shoes for managing their knee OA symptoms were sturdy/supportive shoes (47%), shoes with built-in arch supports (41%) and athletic shoes (40%), whilst they were advised high heeled shoes (40%), flip flops (28%) and flexible thin soled (23%) shoes were the worst,” Paterson said. “In the third section of the survey we found that the majority of the sample (74%) thought that their knee OA symptoms were directly influenced by the shoes they wore. Participants felt that athletic (80%), cushioned (78%) and sturdy/supportive shoes (77%) were the best for their knee OA, whereas high-heeled shoes (77%), flip flops (57%) and flexible thin-soled shoes (45%) were rated the worst, matching the advice received from health professionals.” Participants also reported that the most common shoes they wore athletic shoes, sturdy/supportive shoes and cushioned shoes while they wore high heels the least.
Clinical evidence needed
Paterson said the findings show a need for high quality clinical trials that determine the effects of different types of footwear on people with knee OA because many health care professionals are not offering footwear advice and among those who are, no evidence currently supports the recommendations being offered.
“Our research highlights that the majority of people with knee OA are not receiving advice on how footwear may influence their knee symptoms and potentially the progression of their disease,” he said. “This could be partly due to the lack of clinical trials in the area … Clinicians may not be confident recommending one footwear style over another.”
“Furthermore,” he added, “Our results show a widespread belief amongst both clinicians and patients that supportive footwear is optimal for managing knee OA, and that thin and flexible footwear may be bad for their symptoms … Although quality research is lacking, there is biomechanical and pilot clinical data that potentially conflicts with this advice. It is important that clinicians discuss this openly with their patients given our results show these beliefs about supportive and flexible shoes are shared by their patients and reflected in the footwear styles they choose to wear, and the ones they avoid.”
For example, Paterson said emerging evidence is showing that arch supports and stability shoes can increase medial knee joint loading in people with media knee OA, and therefore these footwear styles could increase disease progression for these people. Additionally, in a recent pilot study people with media knee OA who wore a flexible thin-soled shoe for 6 months experienced a reduction in knee joint pain.
“Given that footwear alters knee joint pain and loading, and therefore could provide a widely available, inexpensive and self-administered treatment option for people with knee OA, we feel those findings underscore that well-designed clinical trials are needed to determine which footwear styles are truly best for managing knee OA.”
Different footwear for different problems
Paterson and colleagues hope their results will lead to further research on the effect of different types of footwear on people with knee OA.
“Greater knowledge concerning optimal footwear for knee OA is needed, and these findings need to be translated to clinical practice and ultimately, to patient wear habits,” he said.
He and his fellow researchers also would like to examine the use of lateral wedges for people with knee OA. The use of lateral wedges was not included in this study.
“Despite conflicting evidence about the clinical efficacy of these devices, there may be a subgroup of patients who respond positively. Anecdotally it would appear that many clinicians prescribe lateral wedges to people with medial knee OA,” he said. “It would be of interest to investigate whether knee OA patients are being [advised] to wear lateral wedges and other orthotic devices and whether a particular subset of patients do indeed gain clinical benefits from their use.” – by Amanda Alexander
For more information:
Paterson K. J Foot Ankle Res. 2014; doi:10.1186/s13047-014-0043-8.
Disclosure: Three of the study’s authors (Bennell, Hinman and Wrigley) receive royalties from sales of an osteoarthritis shoe (Gel Melbourne OA, Asics Pty Ltd).