Published February 17, 2012
If you’re attached to high heels the way your husband is to ESPN,
think twice: Studies show that your towering stature may come at the
expense of joint health. Which shoes best lower your risk of suffering
from knee osteoarthritis? And if you already suffer from arthritis,
which footwear is right for you? Read on (your knees will thank you)...
Sure we love our Jimmy Choos and Manolo Blahniks, but are those
leg-flattering heels and high wedges increasing our risk of knee
osteoarthritis – or ruining joint health?
Unfortunately, yes.
Women’s
shoes “have a substantial impact on the load on knee joints,
particularly when we walk," says Najia Shakoor, M.D., a rheumatologist
at Chicago’s Rush University Medical Center.
That’s because joint loading is a key factor in the development of knee osteoarthritis, she says.
How?
Researchers at the University of Virginia found back in 1998 that
wearing heels alters the normal function of the ankle and makes the
quadricep muscles work harder.
By compensating, we load the knee joints in ways that could lead to
degenerative changes in the kneecap and medial (inner) knee, areas where
osteoarthritis usually lurks.
So what’s the right footwear if you have knee osteoarthritis? Read on for practical tips from arthritis experts.
1. Don’t wear heels.Heeled
shoes are a no-no, whether they’re 4-inch stilettos or stacked 1-1/2
inch sandals. Whatever their height, they cause the same harmful
alterations of knee torques, according to a 2001 University of Virginia
study of wide-heeled and narrow-heeled shoes.
Even moderate high heels can contribute to the development or progression of knee osteoarthritis, according to the researchers.
“Overall,
you can’t wear a heel and not increase loads on your joints,” Shakoor
says. “They may increase your pain and the progression of arthritis – so
you shouldn't keep wearing heels if you have osteoarthritis.'
2. …Or at least limit your use of high heels.There are occasions when practical shoes just won’t cut it, and you need a high-heeled stunner to complete the look.
“I usually tell my patients to save their heels for formal functions and limited periods of time,” Shakoor says.
It's OK to wear them for a few hours – to a wedding, date night or other special evening – once in awhile, she adds.
3. Avoid the narrow toe box.
A
narrow toe box, which scrunches toes together, can cause big problems,
not in terms of knee osteoarthritis, but with toes later in life, says
David Felson, M.D., a rheumatologist and professor of medicine and
public health (epidemiology) at Boston University School of Medicine,
and principal investigator of the Framingham Osteoarthritis Study.
The risk is hallux valgus, in which the big toe suddenly bends to the side a bit.
“That's a function of shoes with a narrow toe box, some of which are high heels,” Felson says.
4. Wear flexible footwear.
Flat,
flexible footwear, such as flip-flops or sneakers, significantly
reduces the load on knee joints compared with stiff shoes that provide
foot support, according to a 2010 study by Shakoor published online in
the journal Arthritis Care & Research.
The study examined the gait of 31 patients with symptoms of
osteoarthritis in the Rush Motion Analysis Lab while they walked
barefoot and in four popular shoe types: Dansko clogs, Brooks Addiction
stability shoes, which are prescribed for foot comfort and stability;
Puma H-Street shoes, a flat athletic shoe with flexible soles; and
flip-flops.
Researchers found loads on knee joints were up to 15%
greater when wearing clogs and stability shoes than with flat walking
shoes, flip-flops or no shoes.
One explanation: Shoes with stiff
soles make us artificially stomp when we walk as opposed to the
flexible movement when we go barefoot, Shakoor says.
“I tell patients to try a flat, flexible shoe and see what it does for their arthritis,” she says.
When choosing a shoe, hold it in your hand and see if it bends, she suggests.
“If
it’s really stiff and doesn’t allow you to move it, then you’re not
going to get that barefoot movement of your foot,” Shakoor adds.
Still, she says, not everyone will be comfortable making a change from a
big bulky shoe with support to a flimsy, flat, flexible shoe.
“Our feet may not like it,” Shakoor says. “You may have to work it in gradually.”
“If
we’re used to wearing a big bulky supportive shoe and now we’re wearing
a flimsy, flat, flexible shoe, our feet may not like it," she says,
adding you can let your feet be the guide, starting with an hour or two a
day and working your way up.
Plus, Shakoor says she wouldn't recommend flip-flops as practical wear, because their loose fit could contribute to falls.
5. Go barefoot more often.
Traditional doctors and rheumatologists once recommended that patients wear supportive, cushioned shoes, Shakoor says.
“The idea was these shoes would provide some shock absorption and be better for your joints overall,” she says.
Now
doctors are finding that barefoot is best. Studies at Rush University
have found that walking barefoot is associated with lower knee loads
than walking in conventional footwear, Shakoor says.
So you may want to try going barefoot, at least around the house. For
the brave, Vibram makes its popular FiveFingers men's shoe glove for
women now too. It cushions and separates each toe and has a rubber sole
to protect feet from rough terrain like asphalt. It hasn't been studied
for joint wear and tear.
The Rush lab has created its own shoe
that mimics the natural flexibility of going barefoot so that the
lab can study it more – and see if wearing such a shoe can lead to
delayed progression of knee osteoarthritis over time. (The shoe is not
yet being commercially produced, though a manufacturer has shown
interest).
“Amazingly, we don’t really have much information to
guide us,” Shakoor says. “We’ve been going based on common sense and
what feels comfortable.”
"We're in very early research stages of finding the right shoe for long-term wear.”
6. Try wedged inserts.
Many
doctors suggest wedged orthotic shoe inserts to relieve pressure on
knee joints for patients with osteoarthritis. But do they work?
A 2009 study by University of Melbourne researchers looked at “Advances
of Insoles and Shoes for Knee Osteoarthritis,” and found that lateral
wedge insoles appear to reduce load on the knee, in people with medial
(inner) knee osteoarthritis (the most common type of OA). The insoles do
not appear to slow progression, however.
The Australian
researchers gave clinical recommendations on the basis of current
research: that the wedge should be the full length of the foot, not just
the heel; should tilt around 5°; should be worn for 5-10 hours a day;
and should only be worn in fitted shoes with a flat heel.
Inserts appear to work best in younger patients with less severe knee osteoarthritis who aren’t obese, the researchers said.
7. Try an ‘unstable’ shoe.
You’ve
probably seen ads for “unbalanced” shoes. They're designed to mimic
barefoot movement, tricking your foot into feeling like it's walking on
sand or grass and not a hard surface. Brands include MBT (Masai Barefoot
Technology), Reebok Easy Tone and Nike Free. Do these help relieve pain
on knee joints?
Canadian researchers tested the effectiveness of the MBT shoe in
reducing knee pain in people with osteoarthritis (among other things)
and found they “can reduce pain in subjects with moderate knee
osteoarthritis.”
Specifically, the study said pain was reduced
after three weeks and remained after 12 weeks. But a caveat – the study
also looked at a regular New Balance walking shoe and found similar
results in terms of pain reduction.
8. Go with a cheap flat shoe.A Brazilian study published this past May in the journal
Gait & Posture
looked at whether inexpensive, flexible and off-the-shelf footwear
would decrease joint loading in women ages 60-70 with knee
osteoarthritis. They tested 45 women and compared Moleca flat shoes with
modern heeled shoes and walking barefoot.
The conclusion: The
cheap footwear reduced joint loading the same as going barefoot, while
still providing external foot protection – in other words, an
improvement.
For more information, visit our Osteoarthritis Health Center.
My Thoughts
How sensible can that be? Beautiful shoes that are flat and cheap. However, I think I find it sensible now because I've taken to wearing down. It has become, for me, an issue of comfort. And now, it seems it's an issue of health, too.
When I was younger the only beautiful shoes for me were stilettos. Now I look forward, with dread, to those special occasions where flats seem to be out of place. But then, why not?
