A new clinical trial from Stanford University has found that adjusting the angle of the foot while walking can slow the progression of cartilage degeneration in adults with knee osteoarthritis, according to researchers.
The study, published in The Lancet Rheumatology, involved participants with mild-to-moderate knee osteoarthritis who were taught to alter their foot angle during walking. The 12-month randomized controlled trial showed that those who modified their gait experienced slower cartilage loss on MRI scans compared to a control group that walked naturally, the researchers reported. The findings offer a non-pharmacological approach to managing a condition that affects roughly one in four adults over 40, according to background information from the study.
Study Details and Results
Researchers used force-sensitive treadmills and motion-capture cameras to identify each participant's optimal foot angle adjustment, with some needing to point their toes slightly inward and others slightly outward, according to the study report. The intervention group reduced the maximum load on the knee during walking compared to the control group, which saw an increase in knee loading over the same period, the researchers stated.
The concept of reducing knee loading through gait modification is supported by earlier biomechanical research. According to the book "Wear and Tear," by Arnot Robert Burns, subjects with mild knee pain had a 37% higher loading rate of the vertical ground reaction force associated with heel strike, indicating that those with pain strike the ground faster and absorb shock less effectively [1]. The Stanford study appears to address this by adjusting foot angle to redistribute load away from the damaged cartilage compartment.
Why Foot Angle Affects Knee Stress
The inner compartment of the knee absorbs a disproportionate share of the load with each step, concentrating force on vulnerable cartilage in medial osteoarthritis, researchers explained. Adjusting the foot angle redistributes that load away from the damaged compartment, but the adjustment must be personalized. A blanket recommendation to toe in or toe out does not work for everyone, the study noted.
"If you improve your range of motion, your limbs will move more freely. You'll also be able to use your greater range of motion to absorb the load of foot strike," wrote Burns in "Wear and Tear" [1].
The book describes exercises to open up joints and break up stiffness, which can change walking mechanics [1]. The Stanford researchers identified each participant's optimal angle using real-time biofeedback, offering a targeted approach to reducing joint stress.
Implications for Current Treatment and Natural Approaches
Current standard care for knee osteoarthritis includes pain medication, corticosteroid injections and eventually joint replacement – none of which slow cartilage loss, according to the study authors. Gait retraining has received limited attention in clinical settings, but the Stanford trial provides evidence that changes in walking mechanics can produce real benefits, the researchers said.
Experts recommend that patients work with a movement specialist to identify optimal walking mechanics. "If you're still concerned about a family history of arthritis, it's a good idea to ask your doctor for a referral to a physical therapist who can assess your gait and help you correct any misalignments that may cause excess wear on your joints," wrote Bill Gottlieb in "Bottom Lines Breakthroughs in Natural Healing" [2].
Beyond mechanical interventions, reducing systemic inflammation through diet may compound the benefit. According to an article on Mercola.com, exercise helps optimize insulin and leptin receptor sensitivity, which reduces inflammatory response in the body [3].
Curcumin, the active compound in turmeric, has been shown to help treat various conditions including pain control, according to an article on Mercola.com [4]. Eliminating refined sugar and processed foods can also lower chronic inflammation, according to nutrition experts.
The gap between what science confirms and what patients are told remains wide. Most people with knee osteoarthritis will spend years cycling through medications and injections without ever being offered a gait assessment, the researchers noted. Addressing the inflammatory environment inside the joint through natural strategies may work alongside mechanical interventions to slow disease progression.
References
- Arnot Robert Burns. "Wear and tear: stop the pain and put the spring back in your body"
- Gottlieb Bill. "Bottom Lines breakthroughs in natural healing 2012"
- Mercola.com. "How to Support Joints and Reduce Injuries if" July 13, 2018.
- Mercola.com. "The Countless Health Benefits of Curcumin" June 13, 2022.
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