In a randomized, sham-controlled trial, adults with mild-to-moderate medial compartment knee osteoarthritis who were retrained to walk with a personalized, small change in foot progression angle reported greater pain improvement after one year than those given sham retraining. The study, conducted at Stanford University and published in The Lancet Rheumatology, also found a smaller MRI-based worsening of a cartilage microstructure measure in the intervention group.
Adults with symptomatic medial compartment knee osteoarthritis took part in a single-center, parallel-group randomized controlled trial conducted at Stanford University.
Participants were assigned either to an intervention that modified their foot progression angle (walking with a slight toe-in or toe-out) or to a sham program that targeted each person’s natural foot progression angle. During six gait-laboratory retraining visits, both groups received real-time biofeedback aimed at keeping their steps near the assigned target angle.
For those in the intervention arm, investigators selected a 5° or 10° toe-in or toe-out change—based on gait testing—to maximize reduction in a biomechanical loading measure used in osteoarthritis research. After one year, the intervention group showed a larger reduction in medial knee pain than the sham group.
On MRI, the trial reported less deterioration in a quantitative cartilage measure (T1ρ) in the medial compartment for the intervention group compared with the sham group; the study did not find a significant between-group difference for another MRI parameter (T2). No severe adverse events were reported, though a small number of participants in each group withdrew because of increased knee pain.
Researchers and the University of Utah team behind the report cautioned that the approach is not a simple universal instruction to “toe in” or “toe out,” because the benefit depended on individualized measurement and selecting the direction and magnitude that reduced knee loading for a given person.
