Barefoot or shock absorbing insole for knee osteoarthritis?

Craig Payne · Jul 21, 2012

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Biomechanical and clinical outcomes with shock-absorbing insoles in patients with knee osteoarthritis: immediate effects and changes after 1 month of wear.
Turpin KM, De Vincenzo A, Apps AM, Cooney T, MacKenzie MD, Chang R, Hunt MA.
Arch Phys Med Rehabil. 2012 Mar;93(3):503

OBJECTIVES:
To examine the effectiveness of shock-absorbing insoles in the immediate reduction of knee joint load, as well as reductions in knee joint load, pain, and dysfunction after 1 month of wear, in individuals with knee osteoarthritis (OA).

DESIGN:
Pre-post design with participants exposed to 2 conditions (normal footwear, shock-absorbing insoles) with a 1-month follow-up.

SETTING:
University laboratory for testing and general community for intervention.

PARTICIPANTS:
Community-dwelling individuals (N=16; 6 men, 10 women) with medial compartment knee OA.

INTERVENTION:
Participants were provided with sulcus length shock-absorbing insoles to be inserted into their everyday shoes.

MAIN OUTCOME MEASURES:
Primary outcome measures included the peak, early stance peak, and late stance peak external knee adduction moment (KAM); the KAM impulse (positive area under the KAM curve); and peak tibial vertical acceleration. Secondary outcomes included walking pain, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale and total score, and a timed stair climb task.

RESULTS:
There was a significant reduction in the late stance peak KAM with shock-absorbing insoles (P=.03) during follow-up compared with the baseline test session. No other immediate or longitudinal significant changes (P>.05) in the other KAM parameters or peak tibial acceleration after use of a shock-absorbing insole were observed. However, significant improvements in all measures of pain and function (P<.05) were observed.

CONCLUSIONS:
Shock-absorbing insoles produced significant reductions in self-reported knee joint pain and physical dysfunction with 1 month of wear in patients with knee OA despite no consistent changes in knee joint load. Further research using randomized controlled trials, with larger sample sizes and explorations into long-term use of shock-absorbing insoles and their effect on disease progression, is warranted.
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Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis.
Arthritis Rheum. 2006 Aug 31;54(9):2923-2927
Shakoor N, Block JA.

OBJECTIVE: To evaluate the effects that modern shoes have on gait and lower extremity joint loads in osteoarthritis (OA).

METHODS: Gait analyses were performed on 75 subjects with knee OA while they were wearing their everyday walking shoes and while they were walking barefoot. The trials involved optoelectronic detection of external markers during ambulation over a multicomponent force plate, and were matched for speed. Comparisons were made of gait parameters and joint loading during trials in which the subjects walked while wearing shoes and while barefoot.

RESULTS: Peak joint loads at the hips and knees significantly decreased during barefoot walking, with an 11.9% reduction noted in the knee adduction moment. Stride, cadence, and range of motion at the lower extremity joints also changed significantly, but these changes could not explain the reduction in the peak joint loads.

CONCLUSION: Shoes may detrimentally increase loads on the lower extremity joints. Once factors responsible for the differences in loads between with-shoe and barefoot walking are better delineated, modern shoes and walking practices may need to be reevaluated with regard to their effects on the prevalence and progression of OA in our society.
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(the second one was discussed [URL="http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=46569]here[/URL])

Craig Payne · Apr 28, 2012

Craig Payne said: ↑

Spot the difference:

Biomechanical and clinical outcomes with shock-absorbing insoles in patients with knee osteoarthritis: immediate effects and changes after 1 month of wear.
Turpin KM, De Vincenzo A, Apps AM, Cooney T, MacKenzie MD, Chang R, Hunt MA.
Arch Phys Med Rehabil. 2012 Mar;93(3):503

Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis.
Arthritis Rheum. 2006 Aug 31;54(9):2923-2927
Shakoor N, Block JA.

(the second one was discussed here)
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No one took the bait :bang: :bang: :bang: :bang:

One of the studies is being touted on some barefoot sites as reducing knee osteoarthritis.....

One of the studies is only a theoretical risk reduction and one of the studies is an actual clinical outcome study. Who you gonna believe?

Robertisaacs · Apr 29, 2012

Yeah, I personally don't get the point of the latter. Strap a seal to the sole of each foot or move to the moon and I suspect the peak loads would reduce even further. Its not practical in everyday life!

dsfeet · May 2, 2012

Interesting conclusions!
Having severe O/a knees myself , i personally find soft insoles or walking on soft surfaces like the soft sand make my knees 10x worse than a firm orthotic or the hard sand. this from a pain perpersative. But good orthotics and shoes definetly improve pain , barefoot a killer.
might read the full articles before further comment.

NewsBot · Nov 18, 2020

Is being barefoot, wearing shoes and physical activity associated with knee osteoarthritis pain flares? Data from a usually barefoot Sri Lankan cohort
Inoshi Atukorala t al
Int J Rheum Dis. 2020 Nov 16

Aim: To identify the association between hours of being barefoot/wearing footwear, physical activity (PA) and knee osteoarthritis pain flares (KOAF).

Methods: Persons with a diagnosis of knee osteoarthritis, who reported previous KOAF, were followed up in a 3 months long telephone-based case-crossover study. Exposures to risk factors were assessed every 10 days and whenever the participants experienced a KOAF. Conditional logistic regression examined associations of KOAF with following: hours of being barefoot/using footwear and PA performed (P < .05).

Results: There were 260 persons recruited, of whom 183 continued longitudinal follow up. Of them, 120 persons had at least one valid KOAF and control period. Participants were female (90%) with mean (SD) age and body mass index of 59.9 (7.0) years, 28.0 (5.0) kg/m2 respectively. Participants were barefoot for a mean duration of 12.7 hours (SD 4.6) and used footwear for 5.1 (SD 4.7) hours daily; 99% wore heel heights <2.5 cm. Duration of being barefoot, 1 and 2 days before, demonstrated reduced multivariate odds of KOAF (odds ratio [OR] = 0.85; 95% CI 0.80-0.90). Moderate PA performed 1, 2 days prior was associated with a significantly increased risk of KOAF (multivariate OR 4.29; 2.52-7.30 and OR 3.36; 2.01-5.61). Similarly, hours of using footwear 1 and 2 days before flare demonstrated increased odds of KOAF (OR 1.15; 1.07-1.23 and 1.10; 1.03-1.18).

Conclusions: Increased duration of being barefoot 1 to 2 days before is associated with reduced risk of KOAF. Performing moderate PA 1 to 2 days before was associated with an increased risk of KOAF.
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NewsBot · Jan 31, 2023

Cushioned Footwear Effect on Pain and Gait Characteristics of Individuals with Knee Osteoarthritis: A Double-Blinded 3 Month Intervention Study
Isabella Schwartz et al
Sensors 2023, 23(3), 1375; https://doi.org/10.3390/s23031375

One of the recommendations for individuals with knee osteoarthritis (OA) is the use of specific footwear, such as sturdy or cushioned shoes. However, the long-term use effects of using cushioned shoes on the pain and spatiotemporal gait parameters in individuals with knee OA are yet to be reported. We therefore aimed to compare the efficacy of cushioned sport footwear versus sham shoes on motor functions, pain and gait characteristics of individuals with knee OA who used the shoes for 3 months. In a double-blinded study, we provided 26 individuals with knee OA with cushioned sport shoes and 12 individuals with knee OA with similar sport shoes without cushioning for 3 months. The gait analysis, the timed up and go (TUG) test and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were conducted and the pain levels were measured at the baseline, 1 month, and 3 months after the baseline. We found that the cushioned shoes reduce the amount of pain (based on WOMAC) in the affected knee and increase functionality in the research group, but not in the control group. Gait velocity and cadence were increased in both groups. Gait spatiotemporal parameters and their symmetry were unaffected during the intervention. We conclude that the use of cushioned shoes should be recommended to individuals with knee OA for alleviating pain.
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