Slightly changing foot angle when walking reduces knee osteoarthritis pain as effectively as common medication, year-long trial finds
A year-long randomised clinical trial has opened the door to a fundamentally new approach to knee osteoarthritis: a slight change in foot angle while walking. The study, led by Professor Scott Delp at Stanford University's School of Medicine and published this week in The Lancet Rheumatology, examined 224 patients with knee osteoarthritis. With a mean age of 68, participants were randomly allocated between an intervention arm with adjusted walking angle and a sham intervention arm.
The intervention is a personalised tuning based on rotating one foot slightly inward or outward during walking. At baseline, each patient's gait was analysed with motion-capture systems to identify whether a 5-10 degree change in one direction would minimise loading at the knee joint. Patients were then taught the new gait pattern through six weekly sessions.
At the end of the year-long follow-up, WOMAC pain scores fell on average by 2.5 points in the intervention group and 0.8 points in the sham group. The difference is equivalent to the 1.5-1.8 point improvement that paracetamol and ibuprofen typically deliver in clinical trials. More importantly, the rate of cartilage damage progression, as measured by MRI, was 22 percent slower in the intervention group than in controls.
Professor Delp said in his statement: 'Knee osteoarthritis affects approximately 365 million people worldwide. Current treatment options are usually medication or surgery. For the first time, we have shown that a simple walking change can reduce pain to a level comparable to drugs while also slowing joint damage.'
Clinical roll-out remains some distance away. Walking-angle modification is currently personalised only in advanced laboratories with motion-capture systems, limiting access in ordinary clinical settings. Professor Delp and his team announced that they have developed a smartphone-based gait-analysis app and planned its clinical trial for next year.
Professor Terence O'Neill of the University of Manchester, who independently reviewed the trial, commented: 'These results are an important addition to the evidence that physical interventions can be a real alternative in managing osteoarthritis. They will, however, need to be confirmed in more diverse patient groups, particularly those with more severe osteoarthritis.'
Limitations include the fact that 78 percent of participants were white and 62 percent were women; additional studies are needed for broader ethnic representation. Furthermore, 18 percent of the intervention group dropped out over the year of follow-up, the most common reason being difficulty in sustaining the new gait pattern in daily routine. The study authors suggested a digital follow-up app could help with adherence.
Knee osteoarthritis is a major cost item in health economics. According to NHS and US Medicare data, knee replacement surgeries attributed to osteoarthritis exceed 800,000 annually, with an average cost of $30,000 per surgery. Effective conservative treatments could cut a significant portion of that cost. University of Maryland health economist Professor Linda Demer said: 'If it becomes widespread as a digital app, the annual cost per patient could be $200-300. Compared with the multi-thousand-dollar annual cost of pharmaceutical treatment and surgery, that is a significant advantage.'
The research was supported by Stanford Bioengineering and the Genentech Foundation. The development of the digital gait app additionally received a US National Institutes of Health National Institute on Aging grant. The authors disclosed no financial interest in any forthcoming app sales.
The next step toward clinical adoption is a multi-centre Phase 2 trial that will verify the method's consistency across different medical centres. Conducted with Stanford, Mayo Clinic and Brigham & Women's Hospital, the study is expected to deliver readouts in early 2027. For patients with knee osteoarthritis, this offers a promising new treatment option beyond the traditional drug-surgery paradigm.
*This article is not medical advice. Discuss your knee pain with an orthopaedic or physical therapy specialist.*