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Can Flip-Flops Ease Knee Pain?

ArthritisColleges and UniversitiesMedicineRush University Medical Center

If you have arthritis in the knees, Dr. Najia Shakoor may have the shoe for you.

Shakoor, a rheumatologist at Rush University Medical Center, discovered that flat, flexible shoes, like sneakers and flip-flops, may be easier on the knees than the kinds of shoes arthritis sufferers usually wear.

"In our world, we are starting to become aware that what we do in one area can affect another," she said. "What we put into our shoes can affect how the knees work."

The idea is a lot of force is bad for the knees. "So, if we reduce the loads, we think arthritis will progress less and people will have less pain," said Shakoor, an associate professor at Rush Medical College. "For someone is at high risk of arthritis, reducing stress on the knee might be one way to prevent it."

But that doesn't mean you should go out and ask your doctor to prescribe a pair of flip-flops, Shakoor said. What may be good for the knees may not be good for the feet. And flip-flops put people at risk for falls and all sorts of foot problems, she said. Shakoor is slightly worried about what people may take away from the study results and says she does not want to create an open season for flip-flops.

Shakoor worked on a study a few years ago that found when people walk barefoot, the load is lowest on the knee. "People were doing so well barefoot, I wondered what are shoes doing to them."

Shakoor said she became interested in seeing how different types of shoes affects the "load," or force put on the knees, when people walk. The amount of force relates to how fast the arthritis will progress and how much pain there will be, she said.

Shakoor and her team at Rush measured the stress on the knees of 31 osteoarthritis patients while they were wearing four different kinds of shoes — flexible-soled sneakers, flip-flops, clogs and a stability shoe — as well as while they were barefoot. The force on the knees was 15 percent higher with the clogs and stability shoes, she found. There was no real difference between the sneakers, flip-flops and bare feet. The results of her study were published online in the journal Arthritis Care & Research. Shakoor is now working on a long-term study that is looking at the impact of a shoe she designed on knee loads.

Shakoor admitted that her theory is counterintuitive. "We intuitively think that supportive, cushioned shoes are great, like shock absorbers for the feet," she said. But when people put on supportive thick-soled shoes, they lose the natural movement of the feet. "You're stomping instead of naturally and gracefully putting your feet on the ground."

Dr. Patience White, the chief health officer for the Arthritis Foundation, said Shakoor's theory is interesting, but said it's still too early to say that everyone with arthritis of the knees should wear soft-soled shoes. She called the study a takeoff point for more work on the effect of shoes on arthritis. It makes a certain amount of sense, she said.

"The closer you are to the ground and the softer the sole is is closer to what nature meant you to be," said White, a professor of medicine and pediatrics at George Washington School of Medicine and Health Sciences. "But it's a leap of faith to say that the particular loading force measured affects arthritis."

White said that people with arthritis should speak to their doctor before changing their footwear.

A longtime volleyball player and coach, Beatrice Jirasek said she used to take painkillers before games to enable her to play through her pain from her arthritis. "Sometimes it would get so bad my knees would collapse underneath me," said Jirasek, a 57-year-old Oak Park resident who is participating in Shakoor's shoe study. Wearing flexible-soled shoes has reduced her pain and given her mobility, she said.

"My arthritis hasn't all of a sudden disappeared," Jirasek said. "But the shoes allow me to do more."

Copyright © 2014, The Baltimore Sun
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