Better Footwear, Better Knees

January 29, 2014

Better Footwear Could Be Key to Preventing Knee Osteoarthritis, Says Associate Professor Douglas Gross

Dr. Doug GrossDepartment of Physical Therapy Associate Professor Douglas Gross, DPT, ScD, has received a grant to investigate ways to develop or improve footwear to treat and prevent knee osteoarthritis.

The Investigator Award from the Rheumatology Research Foundation, presented by the American College of Rheumatology, will allow Dr. Gross to research whether a person’s foot mechanics can contribute to their risk of developing osteoarthritis in their knees.

“We think that certain foot alignments—such as flat footedness or having high arches—may affect how load is distributed on certain parts of the knee,” said Dr. Gross.

He will analyze data from two previous studies of knee osteoarthritis that assessed participants’ foot pressure and foot alignment in order to determine the relationship of foot mechanics to knee loading and subsequent risk of knee osteoarthritis.

The Shoes and Insoles on Loading at the Knee (SILK) study measured the walking medial knee load of 70 baseline participants with medial knee osteoarthritis to evaluate the effectiveness of shoe inserts on knee osteoarthritis. The Multicenter Osteoarthritis Study (MOST) included longitudinal knee x-rays of 3,026 older adults who had or were at risk of knee osteoarthritis.

“People develop osteoarthritis or experience worsening osteoarthritis over time,” Dr. Gross said, “so we should be able to find out if flat or high-arched foot mechanics bring about increased loading of certain vulnerable parts of the knee during walking. If so, then similar foot mechanics may also increase the risk of developing osteoarthritis in those same parts of the knee as we age.”

The ultimate goal of this research is to develop footwear interventions, such as shoes or inserts, that prevent and treat knee osteoarthritis. Dr. Gross said existing footwear interventions, such as wedge inserts or insoles of variable stiffness, are not as effective as they could be.

“Both inserts and insoles have demonstrated an ability to change mechanics of loading at the knee, but neither have demonstrated an ability to reduce developing osteoarthritis or even reduce pain,” he said, “so it suggests we could do a better job if we understood better how the foot affects loading on the knee.”  

The American College of Rheumatology’s three-year grant will be awarded to the MGH Institute beginning July 2014. The grant, which will fund a portion of Dr. Gross’s salaried effort, will allow him to collaborate with biomechanist Howard Hillstrom, PhD, Director of the Leon Root, MD Motion Analysis Laboratory in New York City; and rheumatologist investigator David Felson, MD, MPH, Director of Clinical Epidemiology, and a Professor of Medicine and Public Health at Boston University School of Medicine.