A surprisingly simple way to relieve knee arthritis pain without pills or surgery

A clinical trial published in The Lancet Rheumatology suggests that a small, carefully chosen adjustment to the angle of your feet could make a meaningful difference. After one year, participants who learned to walk with a personalized foot position reported significantly less knee pain than those receiving a placebo treatment. They also showed encouraging signs of slower deterioration in their knee cartilage.

The pain relief was comparable in magnitude to benefits reported for some commonly used medications. More importantly, the approach may help address something painkillers cannot: the excessive pressure on knee joints that contributes to osteoarthritis progression.

A Simple Walking Change Could Help Fight Knee Arthritis

Osteoarthritis affects roughly 22% of adults over age 40 and is one of the leading causes of disability. The condition gradually damages cartilage, the smooth, protective tissue that cushions the ends of bones and allows joints to move with minimal friction.

As cartilage deteriorates, everyday activities such as walking, climbing stairs, and getting out of a chair can become increasingly painful. Although exercise, physical therapy, weight management, and medications can help manage symptoms, there is currently no established treatment that reliably restores cartilage lost to osteoarthritis. People with advanced disease may eventually need joint replacement surgery.

Researchers from the University of Utah, New York University, and Stanford University have investigated a different strategy called gait retraining. Rather than focusing only on relieving pain, this approach changes the mechanics of walking to reduce pressure on vulnerable parts of the knee.

The findings, published in August 2025, came from the first randomized, placebo-controlled clinical trial to demonstrate the effectiveness of personalized gait retraining for knee osteoarthritis over a full year.

The research was co-led by Scott Uhlrich, an assistant professor of mechanical engineering at the University of Utah's John and Marcia Price College of Engineering, with collaborators at Stanford and New York University. The work received support from federal research agencies, with the U.S. Department of Veterans Affairs listed as the trial's funder.

"We've known that for people with osteoarthritis, higher loads in their knee accelerate progression, and that changing the foot angle can reduce knee load," said Uhlrich, an assistant professor of mechanical engineering. "So the idea of a biomechanical intervention is not new, but there have not been randomized, placebo-controlled studies to show that they're effective."

Why the Angle of Your Feet Matters

The secret lies in how body weight moves through the knee with each step.

The knee has an inner section, called the medial compartment, and an outer section, known as the lateral compartment. During normal walking, the inner section typically carries more of the load. This helps explain why osteoarthritis affecting the inside of the knee is especially common.

For people with this type of arthritis, repeatedly placing excessive pressure on the already damaged area can accelerate deterioration.

Changing the direction in which the toes point during walking can redistribute some of that pressure. Turning the toes slightly inward or outward alters the forces acting on the knee, potentially reducing stress on the affected cartilage.

However, there is an important catch: the same adjustment does not work for everyone.

Some people benefit from turning their toes inward, while others respond better when their toes point farther outward. Making the wrong adjustment could fail to help or even increase pressure on the damaged joint.

"Previous trials prescribed the same intervention to all individuals, resulting in some individuals not reducing, or even increasing, their joint loading," Uhlrich said. "We used a personalized approach to selecting each individual's new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effect on pain and cartilage that we saw."

How Scientists Found the Right Walking Pattern

The researchers focused on people with mild to moderate osteoarthritis affecting the inner part of the knee.

At their first two laboratory visits, participants underwent MRI scans and walked on a specialized treadmill equipped with sensors that measured the forces generated during each step. Motion capture cameras recorded their movements in detail, allowing the researchers to analyze how different walking styles affected the knee.

Participants tested small changes in their foot position, turning their toes inward or outward by either 5° or 10°.

The scientists then identified which adjustment reduced pressure on the affected knee most effectively for each person.

Not everyone qualified. Some prospective participants were excluded because none of the tested adjustments successfully reduced their knee loading. Including such individuals in earlier studies may help explain why previous attempts at gait retraining produced inconsistent results.

After the initial assessments, 68 participants were randomly divided into two groups of 34.

One group received personalized instructions designed to minimize stress on the inner knee. The other received a sham treatment, meaning they went through the same training process but were instructed to maintain their natural foot angle.

This comparison allowed the researchers to separate the benefits of changing walking mechanics from improvements caused by expectations, attention from researchers, or participation in a structured walking program.

Just Six Weeks of Training Changed How They Walked

Both groups attended six weekly training sessions.

During these visits, participants walked on a treadmill while wearing a small device on their shin. The device provided biofeedback, delivering gentle vibrations whenever their foot moved outside the prescribed angle.

Biofeedback is a technique that uses immediate signals to help people recognize and gradually control movements they normally perform without thinking.

Over time, participants learned to maintain their assigned foot position without needing constant reminders.

After completing the six weeks of supervised training, they were encouraged to practice their walking technique for at least 20 minutes each day until it became a natural habit.

Follow-up assessments indicated that participants were remarkably consistent. On average, they maintained their prescribed foot angles to within approximately one degree.

That consistency is important because the potential benefits depend on continuing the altered walking pattern during ordinary daily activities, not just during laboratory sessions.

Arthritis Pain Improved, and Cartilage Showed Less Damage

One year after starting the program, participants returned for another MRI and reported how much knee pain they were experiencing.

The results showed a meaningful advantage for those who received personalized gait retraining.

On a pain scale from zero to 10, participants in the intervention group reported an average improvement of 2.5 points, compared with 1.3 points in the sham group.

In an exploratory analysis, approximately 91% of participants receiving personalized retraining experienced a clinically meaningful reduction in pain, compared with 66% in the comparison group.

The researchers also found that the intervention reduced a mechanical measure associated with pressure on the inner knee, confirming that the altered walking pattern had effects beyond participants' perceptions of pain.

"The reported decrease in pain over the placebo group was somewhere between what you'd expect from an over-the-counter medication, like ibuprofen, and a narcotic, like OxyContin," Uhlrich said. "With the MRIs, we also saw slower degradation of a marker of cartilage health in the intervention group, which was quite exciting."

The MRI findings may be especially important.

Researchers used advanced imaging techniques capable of detecting subtle changes in cartilage composition before major structural damage becomes visible on conventional scans.

One measurement, known as T1rho, suggested that cartilage in the inner knee deteriorated more slowly among participants who changed their walking pattern. A second MRI measurement did not show a significant difference between the groups.

These findings do not establish that damaged cartilage was rebuilt or that arthritis progression can be permanently stopped. However, they raise the possibility that reducing mechanical stress could help preserve cartilage health over time.

The treatment also appeared generally well tolerated. No severe adverse events were reported, although two participants in the intervention group and one in the sham group withdrew because of increased knee pain.

More Recent Research Adds to the Evidence

Research published since the 2025 trial has provided further insight into how walking modifications might help people with knee osteoarthritis.

In a separate randomized trial published in Clinical Biomechanics in April 2026, researchers at the University of Bath investigated different types of biofeedback training in 50 people with knee osteoarthritis.

Participants completed a six-week program using different feedback strategies intended to improve walking mechanics.

All three groups, including the control group, experienced improvements in activity-related knee pain and physical function. However, only the group receiving feedback about its walking pattern achieved a lasting reduction in a key measure of knee loading.

That group's knee loading measure fell by 7.6%, with the improvement maintained at a follow-up assessment one month later.

Interestingly, the investigators did not detect significant changes in foot angle in any of the groups. This suggests that other adjustments to walking mechanics can also influence the forces acting on the knee.

The findings reinforce an important lesson from the 2025 trial: simply encouraging people to walk differently is not necessarily enough. The type of movement being taught, and whether it successfully reduces harmful joint loading, appears to matter.

The 2026 study did not examine long-term cartilage deterioration, so it cannot establish whether these additional walking strategies slow osteoarthritis progression.

Could This Help People Avoid Knee Replacement?

For people living with knee osteoarthritis, the appeal of this approach extends beyond its measurable effects in the laboratory.

One trial participant described the freedom of adopting a treatment that did not require medication or an assistive device:

"I don't have to take a drug or wear a device…it's just a part of my body now that will be with me for the rest of my days, so that I'm thrilled with."

Once a person learns the technique, it can potentially become part of ordinary daily movement without requiring continued use of specialized equipment.

That could be particularly valuable for people who develop arthritis relatively early in adulthood.

"Especially for people in their 30s, 40s, or 50s, osteoarthritis could mean decades of pain management before they're recommended for a joint replacement," Uhlrich said. "This intervention could help fill that large treatment gap."

Whether gait retraining can actually delay or prevent knee replacement remains unknown. Longer studies would need to demonstrate that its benefits persist and translate into better joint health and fewer surgical procedures.

Still, the prospect of relieving pain while potentially slowing cartilage deterioration makes personalized walking adjustments an intriguing addition to the available treatment options.

Smart Shoes and Smartphone Cameras Could Make Treatment Easier

One major obstacle remains: delivering personalized gait retraining outside a specialized research laboratory.

The original trial relied on sophisticated motion capture equipment, pressure-sensitive treadmill measurements, MRI scans, and repeated in-person visits. Those resources are expensive and difficult to provide in ordinary physical therapy clinics.

Researchers are exploring ways to make the technology much simpler.

"We and others have developed technology that could be used to both personalize and deliver this intervention in a clinical setting using mobile sensors, like smartphone video and a 'smart shoe'," Uhlrich said.

Smartphone cameras could help analyze walking mechanics and estimate how different movements influence knee loading. Meanwhile, shoes fitted with motion sensors could provide feedback as patients practice walking at home or around their neighborhoods.

Work published in Machine Learning with Applications in September 2026 explored another possibility: using artificial intelligence to estimate knee loading from acceleration measurements collected at the foot.

In that proof of concept study, researchers analyzed walking data from 10 healthy adults and demonstrated that a machine learning system could track changes in estimated knee forces across different walking patterns.

The technology remains experimental and has not yet been validated as a treatment tool for people with knee osteoarthritis. Nevertheless, it illustrates how future rehabilitation systems might provide personalized guidance without requiring a room full of cameras and laboratory equipment.

A Promising Treatment, but Not a Do-It-Yourself Fix

Despite the encouraging results, researchers caution that personalized gait retraining is not yet ready for widespread clinical use.

The original study included only 68 participants, all of whom had mild to moderate osteoarthritis affecting the inner knee and demonstrated that at least one tested walking adjustment could reduce their joint loading. Its findings may not apply to people with advanced arthritis, other patterns of joint damage, or those whose knees respond differently.

Importantly, turning the toes inward or outward without professional assessment is not the same as receiving personalized gait retraining. An adjustment that helps one person might increase stress on another person's knee.

Larger trials, longer follow-up periods, and practical methods for delivering the treatment will be needed before clinicians can routinely prescribe it.

For now, the research points to an intriguing possibility: the way people walk may influence not only how much their knees hurt today, but potentially how well their cartilage holds up in the years ahead.