Flip-flops and Shoes with Flexible Soles May Be Most Beneficial for Patients with Osteoarthritis

Patients with osteoarthritis may experience less knee loading by wearing flip flops and shoes with flexible soles, instead of wearing clogs or stability shoes.

Flip-flops and sneakers with flexible soles may be the best type of footwear for patients with osteoarthritis, rather than clogs or specially designed walking shoes, according to researchers at Rush University Medical Center, led by rheumatologist Dr. Najia Shakoor.

The team analyzed the gait of 31 patients with osteoarthritis symptoms while they walked barefoot and in four types of shoes: Dansko clogs, which are often worn by healthcare professionals; 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. The researchers found that the load on the knee joints “were up to 15 percent greater than with the flat walking shoes, flip-flops or barefoot walking,” while “knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.”

"Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less 'support,' flatter heels and more flexibility," Shakoor said.

The study’s lead researcher also explained that there are several aspects of footwear that affect joint loading, which may contribute to the study findings.

"Heel height is one factor, and may explain why the stability shoes and clogs in our study, both of which had higher heels, produced greater knee loads," Shakoor said. "Stiffness is also a factor. We've shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial 'stomping' movement created by a stiff-soled shoe."

Though the findings of the study were significant, Shakoor cautioned that knee loading is not the only consideration that should be taken into account when suggesting footwear for patients with osteoarthritis.

"For the elderly and infirm individuals, flip-flops could contribute to falls because of their loose-fitting design. Factors like these need to be taken into account," she said.