New findings suggest that improving a person’s footwear could help to lower their risk for knee replacement surgery.
The findings were recently presented at the World Congress on Osteoarthritis 2025 Annual Meeting, and the crux of the argument was that an issue like back or knee pain inherently affected how a person walks. A person will try to protect this area from normal or additional stress, but this compensation can end up channeling more pressure to different areas of the body, leading to even more issues.
“If you’ve ever watched somebody who has pain – whether it’s knee pain, hip pain, back pain – they walk a little strange,” said presenter Matthew Bartels, MD, MPH, director of Rehabilitation Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.
Bartels presented data from two studies of US Food and Drug Administration-cleared shoe-based intervention, which he noted “alters the foot’s pressure points to reduce loads, minimize symptoms and promote neuromuscular control training using adjustable, convex pods under the sole.” In other words, highly individualized shoe-based treatments like an orthotic insert were used to see how it affected someone dealing with back pain and related issues.
Shoes And Their Impact On Knee Health
The first study explored how the shoe-based intervention compared to physical therapy for back pain in terms of efficacy. Researchers uncovered that patients in the shoe-based intervention reported a significantly greater reduction in pain scores (3.5 point reduction on a 10-point scale) than those who received physical therapy. Patients in the shoe-based treatment also reported better secondary outcomes, like gait speed and overall quality of life.
Bartels said part of the success of the shoe-based intervention is because people need only walk around wearing the shoes to reap the benefits, while physical therapy is a much more involved treatment.
“We all know that if you have knee or back pain, physical therapy will make you better, but the problem is, people don’t keep the exercises up,” said Bartels. “This is a treatment that you put the shoes on, and you just wear them doing normal activities for a period, so it doesn’t take time out of your day.”
However, it was the second study that really focused on the impact footwear can have on a person’s knee replacement risk. That study reviewed 95 patients with knee osteoarthritis (OA) who had been prescribed shoe intervention after exhausting other nonsurgical options. After an average follow-up time of 5.6 years, 12.6% of patients using the shoe had undergone total knee replacement compared to 34.3% in the control group who had received traditional physical therapy treatment.
“Increased use of biomechanical intervention to treat knee osteoarthritis may help reduce some of the burden of healthcare and society associated with end-stage knee OA by delaying or avoiding surgery,” researchers wrote.
While the findings are interesting, it still seems like physical therapy is the best way to mitigate your risk of needing knee replacement, but you need to make sure that you stick with it for the long haul and really give your best effort during your sessions. If PT is the only thing you’re doing to care for your knee, and you’re not really giving it your all, it should come as no surprise that knee pain persists or worsens. In the future, carefully curated shoes may help reduce your risk of needing a knee replacement, or they could help alongside a PT program, but for now, follow your doctor’s instructions and really commit to their care plan.
For help overcoming a knee issue that you’re dealing with, or to learn more about your knee replacement options, reach out to Dr. Botero and his team today at (865) 558-4444.
