University of Oulu

Malus J, Urbaczka J, Rygelova M, et al. Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine. 2023;11(7). doi:10.1177/23259671231183416

Effect of footwear type on biomechanical risk factors for knee osteoarthritis

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Author: Malus, Jan1; Urbaczka, Jan1; Rygelova, Marketa1;
Organizations: 1Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
2Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
3Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: SAGE Publications, 2023
Publish Date: 2023-08-16


Background: Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA).

Purpose: To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions.

Study Design: Controlled laboratory study.

Methods: A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used.

Results: Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [P = .015]; propulsion, ↑MF, NF, ↓BF P = .039]).

Conclusion: Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.

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Series: Orthopaedic journal of sports medicine
ISSN: 2325-9671
ISSN-E: 2325-9671
ISSN-L: 2325-9671
Volume: 11
Issue: 7
DOI: 10.1177/23259671231183416
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the University of Ostrava (grant SGS08/PDF/22) and by the European Union and Ministry of Education, Youth and Sports of the Czech Republic (grant CZ.02.1.01/0.0/0.0/16_019/0000798, Program 4 Healthy Aging in Industrial Environment). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Copyright information: © The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (