Are Your Shoes Giving You Knee Osteoarthritis? Heels Stack the Deck Against Knee Joints

If you’re attached to high heels the way your husband is to ESPN, think twice: Studies show that your towering stature may come at the expense of joint health. Which shoes best lower your risk of suffering from knee osteoarthritis? And if you already suffer from arthritis, which footwear is right for you? Read on (your knees will thank you)... Sure we love our Jimmy Choos and Manolo Blahniks, but are those leg-flattering heels and high wedges increasing our risk of knee osteoarthritis – or ruining joint health? Unfortunately, yes. Women’s shoes “have a substantial impact on the load on knee joints, particularly when we walk," says Najia Shakoor, M.D., a rheumatologist at Chicago’s Rush University Medical Center. That’s because joint loading is a key factor in the development of knee osteoarthritis, she says. How? Researchers at the University of Virginia found back in 1998 that wearing heels alters the normal function of the ankle and makes the quadricep muscles work harder. By compensating, we load the knee joints in ways that could lead to degenerative changes in the kneecap and medial (inner) knee, areas where osteoarthritis usually lurks. So what’s the right footwear if you have knee osteoarthritis? Read on for practical tips from arthritis experts. 1. Don’t wear heels. Heeled shoes are a no-no, whether they’re 4-inch stilettos or stacked 1-1/2 inch sandals. Whatever their height, they cause the same harmful alterations of knee torques, according to a 2001 University of Virginia study of wide-heeled and narrow-heeled shoes. Even moderate high heels can contribute to the development or progression of knee osteoarthritis, according to the researchers. “Overall, you can’t wear a heel and not increase loads on your joints,” Shakoor says. “They may increase your pain and the progression of arthritis – so you shouldn't keep wearing heels if you have osteoarthritis.' 2. …Or at least limit your use of high heels. There are occasions when practical shoes just won’t cut it, and you need a high-heeled stunner to complete the look. “I usually tell my patients to save their heels for formal functions and limited periods of time,” Shakoor says. It's OK to wear them for a few hours – to a wedding, date night or other special evening – once in awhile, she adds. 3. Avoid the narrow toe box. A narrow toe box, which scrunches toes together, can cause big problems, not in terms of knee osteoarthritis, but with toes later in life, says David Felson, M.D., a rheumatologist and professor of medicine and public health (epidemiology) at Boston University School of Medicine, and principal investigator of the Framingham Osteoarthritis Study. The risk is hallux valgus, in which the big toe suddenly bends to the side a bit. “That's a function of shoes with a narrow toe box, some of which are high heels,” Felson says. 4. Wear flexible footwear. Flat, flexible footwear, such as flip-flops or sneakers, significantly reduces the load on knee joints compared with stiff shoes that provide foot support, according to a 2010 study by Shakoor published online in the journal Arthritis Care & Research. The study examined the gait of 31 patients with symptoms of osteoarthritis in the Rush Motion Analysis Lab while they walked barefoot and in four popular shoe types: Dansko clogs, Brooks Addiction stability shoes, which are prescribed for foot comfort and stability; Puma H-Street shoes, a flat athletic shoe with flexible soles; and flip-flops. Researchers found loads on knee joints were up to 15% greater when wearing clogs and stability shoes than with flat walking shoes, flip-flops or no shoes. One explanation: Shoes with stiff soles make us artificially stomp when we walk as opposed to the flexible movement when we go barefoot, Shakoor says. “I tell patients to try a flat, flexible shoe and see what it does for their arthritis,” she says. When choosing a shoe, hold it in your hand and see if it bends, she suggests. “If it’s really stiff and doesn’t allow you to move it, then you’re not going to get that barefoot movement of your foot,” Shakoor adds. Still, she says, not everyone will be comfortable making a change from a big bulky shoe with support to a flimsy, flat, flexible shoe. “Our feet may not like it,” Shakoor says. “You may have to work it in gradually.” “If we’re used to wearing a big bulky supportive shoe and now we’re wearing a flimsy, flat, flexible shoe, our feet may not like it," she says, adding you can let your feet be the guide, starting with an hour or two a day and working your way up. Plus, Shakoor says she wouldn't recommend flip-flops as practical wear, because their loose fit could contribute to falls. 5. Go barefoot more often. Traditional doctors and rheumatologists once recommended that patients wear supportive, cushioned shoes, Shakoor says. “The idea was these shoes would provide some shock absorption and be better for your joints overall,” she says. Now doctors are finding that barefoot is best. Studies at Rush University have found that walking barefoot is associated with lower knee loads than walking in conventional footwear, Shakoor says. So you may want to try going barefoot, at least around the house. For the brave, Vibram makes its popular FiveFingers men's shoe glove for women now too. It cushions and separates each toe and has a rubber sole to protect feet from rough terrain like asphalt. It hasn't been studied for joint wear and tear. The Rush lab has created its own shoe that mimics the natural flexibility of going barefoot so that the lab can study it more – and see if wearing such a shoe can lead to delayed progression of knee osteoarthritis over time. (The shoe is not yet being commercially produced, though a manufacturer has shown interest). “Amazingly, we don’t really have much information to guide us,” Shakoor says. “We’ve been going based on common sense and what feels comfortable.” "We're in very early research stages of finding the right shoe for long-term wear.” 6. Try wedged inserts. Many doctors suggest wedged orthotic shoe inserts to relieve pressure on knee joints for patients with osteoarthritis. But do they work? A 2009 study by University of Melbourne researchers looked at “Advances of Insoles and Shoes for Knee Osteoarthritis,” and found that lateral wedge insoles appear to reduce load on the knee, in people with medial (inner) knee osteoarthritis (the most common type of OA). The insoles do not appear to slow progression, however. The Australian researchers gave clinical recommendations on the basis of current research: that the wedge should be the full length of the foot, not just the heel; should tilt around 5°; should be worn for 5-10 hours a day; and should only be worn in fitted shoes with a flat heel. Inserts appear to work best in younger patients with less severe knee osteoarthritis who aren’t obese, the researchers said. 7. Try an ‘unstable’ shoe. You’ve probably seen ads for “unbalanced” shoes. They're designed to mimic barefoot movement, tricking your foot into feeling like it's walking on sand or grass and not a hard surface. Brands include MBT (Masai Barefoot Technology), Reebok Easy Tone and Nike Free. Do these help relieve pain on knee joints? Canadian researchers tested the effectiveness of the MBT shoe in reducing knee pain in people with osteoarthritis (among other things) and found they “can reduce pain in subjects with moderate knee osteoarthritis.” Specifically, the study said pain was reduced after three weeks and remained after 12 weeks. But a caveat – the study also looked at a regular New Balance walking shoe and found similar results in terms of pain reduction. 8. Go with a cheap flat shoe. A Brazilian study published this past May in the journal Gait & Posture looked at whether inexpensive, flexible and off-the-shelf footwear would decrease joint loading in women ages 60-70 with knee osteoarthritis. They tested 45 women and compared Moleca flat shoes with modern heeled shoes and walking barefoot. The conclusion: The cheap footwear reduced joint loading the same as going barefoot, while still providing external foot protection – in other words, an improvement. For more information, visit our Osteoarthritis Health Center. How Much Do You Know About the Types of Arthritis? About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030. Do you or someone close to you have arthritis?