Exercise and Footwear in Medial Knee Osteoarthritis: a Randomized Controlled Trial Comparing Flat Flexible Footwear to Stable Supportive Shoes

Overview

Journal Rheumatol Adv Pract

Publisher Oxford University Press

Specialty Rheumatology

Date 2024 Dec 13

PMID 39669115

Authors

Paolo Dainese

Jan Stautemas

Sophie De Mits

Ruth Wittoek

Ans Van Ginckel

Wouter Huysse

Heleen Demeyer

Hanne Mahieu

Patrick Calders

Affiliations

Soon will be listed here.

Abstract

Objective: This randomized controlled trial (RCT) investigated whether adding daily use of flat flexible footwear (FFF) to a strengthening and aerobic exercise program improved short- and longer-term outcomes compared with adding stable supportive shoes (SSS) in people with medial tibiofemoral OA.

Methods: Participants ( = 97) with medial tibiofemoral OA were randomly assigned (1:1) to the FFF ( = 50) or SSS ( = 47) group. Participants in both groups received a 9-month intervention (3 months supervised followed by 6 months unsupervised exercise). The primary outcome was the change in knee pain on walking at 3 months measured using an 11-point numeric rating scale (NRS). Secondary outcomes included the change from baseline to 3 and 9 months in the severity of knee pain overall (NRS), physical function (WOMAC subscale), habitual physical activity level (Physical Activity Scale for the Elderly), quality of life (QoL) (European Quality of Life 5-Dimensions 5-Levels questionnaire) and markers of inflammation (effusion and Hoffa synovitis) and structural disease progression (bone marrow lesions).

Results: There were no significant differences between the groups in the change in pain on walking [between-group difference -0.67 (95% CI -1.62, 0.29)] at 3 months. Knee pain on walking and overall knee pain significantly decreased in both groups at 3 and 9 months. Physical function and QoL improved in both groups at 3 and 9 months. We found no between-group differences in any secondary outcome at any time.

Conclusions: FFF added to exercise therapy did not provide additional better symptom nor structure-modification benefit compared with conventional SSS and exercise in people with medial tibiofemoral OA.

Trial Registration: ClinicalTrials.gov (http://clinicaltrials.gov), NCT03796832.

References

Starkey S, Hinman R, Paterson K, Saxby D, Knox G, Hall M . Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study. PLoS One. 2022; 17(6):e0269331. PMC: 9162314. DOI: 10.1371/journal.pone.0269331. View

Trombini-Souza F, Matias A, Yokota M, Butugan M, Goldenstein-Schainberg C, Fuller R . Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial. Clin Biomech (Bristol). 2015; 30(10):1194-201. DOI: 10.1016/j.clinbiomech.2015.08.004. View

Kellgren J, Lawrence J . Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. PMC: 1006995. DOI: 10.1136/ard.16.4.494. View

Fernandes L, Hagen K, Bijlsma J, Andreassen O, Christensen P, Conaghan P . EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013; 72(7):1125-35. DOI: 10.1136/annrheumdis-2012-202745. View

Wallis J, Webster K, Levinger P, Singh P, Fong C, Taylor N . The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial. Osteoarthritis Cartilage. 2015; 23(8):1285-93. DOI: 10.1016/j.joca.2015.04.001. View

Bull F, Al-Ansari S, Biddle S, Borodulin K, Buman M, Cardon G . World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54(24):1451-1462. PMC: 7719906. DOI: 10.1136/bjsports-2020-102955. View

Bilbao A, Garcia-Perez L, Arenaza J, Garcia I, Ariza-Cardiel G, Trujillo-Martin E . Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Qual Life Res. 2018; 27(11):2897-2908. DOI: 10.1007/s11136-018-1929-x. View

Paterson K, Wrigley T, Bennell K, Hinman R . A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis. J Foot Ankle Res. 2014; 7(1):43. PMC: 4210582. DOI: 10.1186/s13047-014-0043-8. View

Hinman R, Wrigley T, Metcalf B, Campbell P, Paterson K, Hunter D . Unloading Shoes for Self-management of Knee Osteoarthritis: A Randomized Trial. Ann Intern Med. 2016; 165(6):381-9. DOI: 10.7326/M16-0453. View

10.

Paterson K, Bennell K, Campbell P, Metcalf B, Wrigley T, Kasza J . The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms : A Randomized Trial. Ann Intern Med. 2021; 174(4):462-471. DOI: 10.7326/M20-6321. View

11.

Shakoor N, Lidtke R, Sengupta M, Fogg L, Block J . Effects of specialized footwear on joint loads in osteoarthritis of the knee. Arthritis Rheum. 2008; 59(9):1214-20. PMC: 3653288. DOI: 10.1002/art.24017. View

12.

Paterson K, Bennell K, Wrigley T, Metcalf B, Kasza J, Hinman R . Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes. Osteoarthritis Cartilage. 2016; 25(2):234-241. DOI: 10.1016/j.joca.2016.10.001. View

13.

Shakoor N, Block J . Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis Rheum. 2006; 54(9):2923-7. DOI: 10.1002/art.22123. View

14.

Henriksen M, Klokker L, Graven-Nielsen T, Bartholdy C, Jorgensen T, Bandak E . Association of exercise therapy and reduction of pain sensitivity in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014; 66(12):1836-43. DOI: 10.1002/acr.22375. View

15.

Trost S, McIver K, Pate R . Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005; 37(11 Suppl):S531-43. DOI: 10.1249/01.mss.0000185657.86065.98. View

16.

Washburn R, Smith K, Jette A, Janney C . The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993; 46(2):153-62. DOI: 10.1016/0895-4356(93)90053-4. View

17.

Dainese P, De Mits S, Wittoek R, Van Ginckel A, Huysse W, Mahieu H . Neuropathic-like pain in knee osteoarthritis: exploring differences in knee loading and inflammation. A cross-sectional study. Eur J Phys Rehabil Med. 2023; 60(1):62-73. PMC: 10938037. DOI: 10.23736/S1973-9087.23.07877-2. View

18.

Bouckaert N, Cleemput I, Devriese S, Gerkens S . An EQ-5D-5L Value Set for Belgium. Pharmacoecon Open. 2022; 6(6):823-836. PMC: 9362639. DOI: 10.1007/s41669-022-00353-3. View

19.

Roemer F, Jansen M, Marijnissen A, Guermazi A, Heiss R, Maschek S . Structural tissue damage and 24-month progression of semi-quantitative MRI biomarkers of knee osteoarthritis in the IMI-APPROACH cohort. BMC Musculoskelet Disord. 2022; 23(1):988. PMC: 9670371. DOI: 10.1186/s12891-022-05926-1. View

20.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View