Supportive Hard Shoes Linked to Knee Loading and Arthritis

A Rush University Medical Center study has found that supportive, stable shoes increases the load on the knee joints compared with flat, flexible footwear or going barefoot.

Researchers compared gait and knee joint loading of 31 patients with osteoarthritis while walking in flip-flops, barefoot, and wearing several types of popularly prescribed shoes. Clogs and stability shoes increased loads on the knee joints up to 15 percent over flat walking shoes, flip-flops or barefoot. Knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.

Dr. Najia Shakoor, rheumatologist and lead author stated, "Stiffness is also a factor. We've shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial 'stomping' movement created by a stiff-soled shoe."

"Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less 'support,' flatter heels and more flexibility."

The article stated, "A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of osteoarthritis and its progression."



Study authors felt they had to also issue a caution that people who will trip if they wear flip flops or have poor balance not to wear them, however it seems better to do simple function to improve balance and reduce cause of the falls rather than wrap people in shoe "straight-jackets" that are not good for them.

When I was small, I remember worrying that horses had to wear iron shoes. I asked the teachers in school if it hurt the horses' feet, and was told their feet don't feel anything (a myth). I asked if the metal increased the hard impact against paved streets and why didn't horses wear sneakers instead. I was told that sneakers were bad for you because they don't "support" (another myth). I asked why you needed anything to hold your own body up and why you couldn't have healthy feet without them. I asked if cavemen wore support shoes and incredibly, the teachers said that support shoes were important and barefoot was wrong and cavemen had to wear shoes or they would not be able to walk. Later I found that arthritis, lameness, and gait changes were higher in metal shod horses, and that new horseshoes were being made in urethane and other soft composites.

When I tell patients that hard supportive shoes are known to increase pain and problems, they say they wear them because their doctor told them to, their trainer, their aerobics instructor, and their physical therapist said they must. When I remind that hard shoes may be part of their knee and foot pain, they say that they got the shoes from their podiatrist or orthopedic shoe place. Doctors used to recommend smoking cigarettes for the several benefits they gave - calming nerves, better digestion. The two bad side effects (illness and death) were left out. It may be commonly repeated that you need hard supportive shoes however, untrue stories are common.


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Labels: arthritis, feet, fix pain, injury, knee, shoes

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