Personalized gait retraining cuts osteoarthritis knee pain by 2.5 points

Personalized gait retraining reduced knee osteoarthritis pain by 2.5 points over 12 months in a 68-person trial published in The Lancet Rheumatology in August 2025, a University of Utah release dated Oct. 10 said.

The evidence grade is Moderate (consistent observational data or small trials): the randomized, placebo-controlled trial compared personalized walking-angle training with sham training, where pain improved by 1.3 points on the same zero-to-10 scale.

Scott Uhlrich, an assistant professor of mechanical engineering at the University of Utah, said the intervention targets joint loading rather than only symptoms. "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," Uhlrich said. "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."

The trial focused on people with mild to moderate osteoarthritis in the inner, or medial, part of the knee. The release did not give participant ages, sex distribution or declared conflicts, and said the work received federal research support with the US Department of Veterans Affairs listed as trial funder.

Participants first had MRI scans and walked on a sensor-equipped treadmill while motion-capture cameras recorded movement. Researchers tested whether turning the toes inward or outward by 5° or 10° reduced pressure on the affected knee, then selected a walking pattern for each person when one lowered knee loading.

That selection mattered because the same foot angle did not help everyone. "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."

After assessment, 34 participants received personalized gait retraining and 34 received sham training, meaning they followed the training process while keeping their usual foot angle. Both groups completed six weekly treadmill sessions with a shin-worn device that used vibration feedback to signal when foot position moved outside the assigned range. Biofeedback is a real-time cue that helps people adjust movements they usually make automatically.

After supervised training, participants were encouraged to practice the walking pattern for at least 20 minutes a day. Follow-up testing showed they kept their prescribed foot angles within about one degree on average, the release said.

At one year, pain improved more in the personalized-training group than in the sham group. In an exploratory analysis, about 91% of participants in the intervention group had a clinically meaningful pain reduction, compared with 66% in the comparison group. "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.

MRI results suggested slower worsening in T1rho, a marker of cartilage composition, among participants who changed their walking pattern. A second MRI measure did not differ significantly between groups. The release said no severe adverse events were reported, although two participants in the intervention group and one in the sham group withdrew because knee pain increased.

The study cannot show that cartilage was rebuilt or that osteoarthritis progression can be stopped permanently. It also does not identify a universal toe-in or toe-out angle. Some prospective participants were excluded because none of the tested changes reduced their knee loading, so the findings apply to selected people with mild to moderate medial knee osteoarthritis, not to all knee arthritis patients.

A separate randomized trial published in Clinical Biomechanics in April 2026 studied biofeedback training in 50 people with knee osteoarthritis. All three groups, including the control group, improved in activity-related pain and physical function, but only the group receiving feedback on walking pattern had a lasting 7.6% reduction in a knee-loading measure one month later.

For readers, the main implication is not that foot angle should be changed without assessment. The reported benefit depended on measuring which walking adjustment reduced knee loading for the individual, then training that pattern over time.

Source: University of Utah press release republished by ScienceDaily Health, Oct. 10, 2026.

Atlas360 reports health research and does not provide medical advice.