Simple changes to walking could ease knee pain from osteoarthritis | Nation

By Stephen Beech

People with arthritic knees can ease their pain by making “subtle” changes to the way they walk, suggests new research.

Slightly adjusting the angle of the foot when walking may reduce chronic knee pain caused by osteoarthritis, say scientists.

It may also slow the progression of the common but incurable condition in which the cartilage cushion inside a joint breaks down, according to the study.

Around one in seven adults suffer some form of osteoarthritis, commonly in the inner side of the knee.

A leading cause of disability, the disease is often managed with pharmaceutical pain relievers, physical therapy, and, in the most severe cases, knee replacement surgery.

Experts believe that excess loading can, over time contribute to the condition.

A team of American scientists used gait analysis and pain measures in the new study to investigate whether changing the way patients position their feet when walking could lessen extra “loading” – stress on the joint during motion — and help treat the disease.

The team – led by researchers at New York University Langone Health, the University of Utah, and Stanford University – tested the intervention in 68 men and women with mild to moderate knee osteoarthritis, and then used advanced MRI scans to track how well it worked.

The findings suggest that those trained to angle their feet slightly inward or outward from their natural alignment experienced slower cartilage degeneration in the inner part of their knee compared with those who were encouraged to walk more frequently without changing their foot position.

Study co-lead author Dr. Valentina Mazzoli said: “Although our results will have to be confirmed in future studies, they raise the possibility that the new, non-invasive treatment could help delay surgery.”

She says that the earlier patients receive a knee replacement, the more likely they are to require additional procedures in the future.

The findings, published in The Lancet Rheumatology, also showed that those who adjusted their foot angle reduced their pain score by 2.5 points on a 10-point scale, an effect equivalent to that of over-the-counter pain medications.

By contrast, those who didn’t change their gait reduced their pain scores by little more than a point.

Dr. Mazzoli, an Assistant Professor in the Department of Radiology at NYU Grossman School of Medicine, said: “Altogether, our findings suggest that helping patients find their best foot angle to reduce stress on their knees may offer an easy and fairly inexpensive way to address early-stage osteoarthritis.”

She says earlier research has offered little evidence that changes in gait can effectively reduce knee pain caused by osteoarthritis.

Some previous trials trained participants to adopt the same foot angle and found no relief, while others didn’t compare the intervention to a control group or only followed the participants for a month.

The research team says their study is the first to show that tailoring each patient’s foot angle to their unique walking pattern can alleviate the disease’s symptoms in the long term and may slow cartilage breakdown.

Dr. Mazzoli said the simple technique may have a “significant” advantage over pharmaceutical painkillers.

She says those drugs don’t address the underlying disease and can cause liver and kidney damage, stomach ulcers, and other unwanted side effects when taken for long periods.

The researchers recorded participants walking on a treadmill at a specialized gait-assessment lab.

A computer program simulated their walking patterns and calculated the maximum loading that occurred in the inner side of their knees.

The team then generated computer models of four new foot positions – angled inward or outward by either five degrees or 10 degrees — and estimated which option reduced loading the most.

The patients were then randomly divided into two groups: half were trained in six sessions to walk with their ideal angle, while the other half were instructed to continue walking naturally.

Pain scores and MRI scans were taken at the beginning of the study period and one year after the intervention.

The findings showed those who adjusted their gait reduced the maximum loading in the knees by 4%, while those who kept their normal walking pattern increased their loading by more than 3%.

Dr. Mazzoli said: “These results highlight the importance of personalizing treatment instead of taking a one-size-fits-all approach to osteoarthritis.”

She added: “While this strategy may sound challenging, recent advances in detecting the motion of different body parts using artificial intelligence may make it easier and faster than ever before.”

The researchers now want to test whether the new technology can identify the most effective walking method for osteoarthritis patients.

They also plan to expand their study to people with obesity.