Gait, foot angle retraining slows knee osteoarthritis progression vs sham treatment

October 14, 2025

2 min read

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Key takeaways:

Personalized foot angle retraining may be an effective nonsurgical option for medial knee OA.
The program relieved pain, reduced loading and slowed cartilage degeneration vs. sham treatment.

Patients with knee osteoarthritis who received personalized gait and foot angle retraining demonstrated pain relief, reduced loading and slowed cartilage degeneration at 1 year vs. a sham intervention group, according to data.

“Unlike pain medications, gait retraining addresses a contributor to knee OA progression (joint loading), and it slowed cartilage degeneration in this study,” Scott D. Uhlrich, PhD, of the department of mechanical engineering at the University of Utah, and colleagues wrote in The Lancet Rheumatology.

Data were derived from Uhlrich SD, et al. Lancet Rheumatol. 2025;doi:10.1016/S2665-9913(25)00151-1.

To assess the biomechanical and clinical efficacy of a personalized foot angle retraining program in patients with mild or moderate medial compartment knee OA, Uhlrich and colleagues performed a single-center, parallel-group, randomized controlled trial. The researchers recruited a total of 68 patients (mean age, 64.4 years) who were assigned 1:1 to receive either six retraining visits or six sham treatment visits at a gait laboratory. Patients in both groups were instructed to walk consistently with a targeted foot progression angle.

“The intervention group’s target was the 5° or 10° change in foot progression angle that maximally reduced their knee loading, and the sham group’s target was their natural foot progression angle,” Uhlrich and colleagues wrote.

Outcomes were assessed at 1-year follow-up and included numeric rating scale (NRS) pain scores, medial knee loading — measured via knee adduction moment peak — and cartilage degeneration on MRI.

At 1 year, patients in the retraining program demonstrated greater reductions in NRS pain scores (–2.5 vs. –1.3) and knee adduction moment peak (–0.17 vs. 0.08), compared with patients in the sham program, according to the researchers. In addition, patients in the retraining program had slowed degeneration in medial knee cartilage microstructure, as measured by relaxation time on MRI, representing a between-group difference of –3.74 ms (95% CI, –6.42 to –1.05), compared with patients in the sham program.

“These results suggest that personalized gait modifications could be a promising treatment for some individuals with medial knee osteoarthritis,” Uhlrich and colleagues wrote.

“When we began this study, a gait laboratory was required to accurately measure the knee adduction moment and retrain the foot angle,” they added. “We have since shown that smartphone videos can detect how gait modifications change the knee adduction moment, enabling knee-load-based screening and personalization to be conducted in a clinic.”

Perspective

It is widely understood that osteoarthritis causes significant disability nationwide. Unfortunately, there is no established pharmacological option that has been shown to decrease its progression and surgical options focus on repair and replacement of damaged joints, which accounts for a considerable amount on the overall national health care financial burden.

Anecdotally, many of the patients I see in clinic with connective tissue diseases and inflammatory arthropathies suffer from concurrent osteoarthritis. Many of these cases are secondary to their underlying autoimmune disease, while others also possess concurrent primary severe deforming degenerative arthritis.

This study offers an excellent nonpharmacologic, nonsurgical option with the potential to not only improve pain but also decrease the progression of osteoarthritis. Further study in this area would be helpful to evaluate personalized angle modification of other weight-bearing joints, namely hips and ankles that are also similarly affected by osteoarthritis.

Many of the connective tissue disease and inflammatory arthropathy patients I see in clinic also suffer from significant upper extremity joint deformities, due to degenerative joint disease that is unaffected by rheumatologic disease modifying modalities. It is unfortunate that upper extremity joints could not benefit from this same treatment modality, but perhaps further exploration into a similar angle modification modality focused on non-weight bearing joints could also show promise.

One of the limitations I noted in this study was that only 40% of the participants were male while 60% are female. This is a disproportionately higher number of female participants than male participants, which may favor a certain outcome based on gender related physiologic differences.

Also important to note is that 79% of the patients in this study were Caucasian. The American Indian and Alaska Native populations have a disproportionately higher age-adjusted prevalence rate of osteoarthritis in United States. African Americans also have a higher prevalence rate of knee osteoarthritis and more severe radiological features, with greater pain and disability than Caucasians.

It would be important to include a more diverse population in further research studies in this area to determine if the same outcome could be achieved across other less represented ethnic groups.

Current pharmacological treatment options for osteoarthritis focus on supportive care, and surgical options focus more on repair or replacement after damage to the affected joint has already occurred. There is still no research-supported treatment option for the prevention of osteoarthritic disease progression. This study not only shows potential as a nonpharmacological/nonsurgical treatment option for osteoarthritic pain, but could also show promise in the slowing of disease progression that no treatment modality has yet to offer.

J. Nicholas Manwaring, MSN, APRN, FNP-C