Personalized Walking Pattern May Reduce Knee Osteoarthritis Symptoms, Delay Progression

Personalized foot angle modifications based on individual walking patterns may help improve pain, reduce knee loading, and slow cartilage breakdown in individuals with medial compartment knee osteoarthritis, according to findings from a recent study.¹

In the single-center, parallel-group, randomized controlled trial, participants underwent 6 walking retraining visits and received real-time biofeedback instructing them to walk consistently with a personalized target foot progression angle. Results showed participants in the intervention group who targeted a 5° or 10° change in foot progression angle that maximally reduced their knee loading experienced greater reductions in medial knee pain and knee adduction moment peak.¹

“Although our results will have to be confirmed in future studies, they raise the possibility that the new, noninvasive treatment could help delay surgery,” said study co-lead author Valentina Mazzoli, PhD, an assistant professor in the Department of Radiology at NYU Grossman School of Medicine.²

According to the US Centers for Disease Control and Prevention (CDC), about 33 million US adults have some form of osteoarthritis, commonly in the inner side of the knee. In the absence of a cure, treatment seeks to manage symptoms and reduce pain, often with physical activity, maintaining a healthy weight, pharmaceutical pain relievers, physical therapy, and in severe cases, knee replacement surgery.^1,3

Of note, the CDC recognizes repetitive joint stress or injury as a risk factor for osteoarthritis, posing important implications for the potential therapeutic benefits of adjusting gait to lessen extra loading.³

To explore the impact of personalized gait retraining for medial compartment knee osteoarthritis, investigators conducted a single-center, parallel-group, randomized controlled trial of individuals with symptomatic medial compartment knee osteoarthritis at the Human Performance Laboratory and Lucas Center for Imaging at Stanford University using online and print media.¹

Eligible participants ≥18 years of age underwent 6 walking retraining visits to a university gait laboratory and received real-time biofeedback instructing them to walk consistently with a personalised target foot progression angle. The intervention group’s target was the 5° or 10° change in foot progression angle that maximally reduced their knee loading, while the sham group’s target was their natural foot progression angle. Participants and staff involved in data analysis were masked to group allocation, but staff performing the gait analysis visits were not.¹

Primary outcomes were 1-year changes in medial knee pain and medial knee loading as measured by knee adduction moment peak. Secondary outcomes were 1-year changes in cartilage microstructure estimated from MRI (T1ρ and T2 relaxation times).¹

Between Aug 2016 and June 2019, 1582 individuals were screened for eligibility, 107 participants completed an initial gait analysis, and 68 were randomly assigned to either the intervention (n = 34) or the sham (n = 34) group. Among the cohort, 41 (60%) participants were female, 54 (79%) were White, and the mean age was 64.4 (standard, deviation, 7.6) years.¹

After 1 year, participants in the intervention group experienced greater reductions in medial knee pain (between-group difference, –1.2; 95% CI –1.9 to –0.5; P = .0013) and knee adduction moment peak (between-group difference, –0.26 % bodyweight × height; 95% CI, –0.39 to –0.13; P = .0001) than participants in the sham group.¹

Investigators noted the MRI-estimated change in cartilage microstructure (T1ρ) in the medial compartment was less in the intervention group than the sham group (between-group difference, –3.74 ms; 95% CI, –6.42 to –1.05) but did not observe any significant between-group differences in T2.¹

While there were no severe adverse events; 2 (6%) participants in the intervention group and 1 (3%) participant in the sham group dropped out of the study due to increased knee pain.¹

“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,” Mazzoli concluded.²

References

1. Uhlrich SD, Mazzoli V, Silder A, et al. Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial. The Lancet. doi:10.1016/S2665-9913(25)00151-1

2. NYU Langone. Study Reveals How Small Changes in Walking Technique May Help Treat Knee Osteoarthritis. August 13, 2025. Accessed August 14, 2025. https://nyulangone.org/news/study-reveals-how-small-changes-walking-technique-may-help-treat-knee-osteoarthritis

3. US Centers for Disease Control and Prevention. Osteoarthritis. January 26, 2024. Accessed August 14, 2025. https://www.cdc.gov/arthritis/osteoarthritis/index.html