Cushioned Running Shoes and Osteo Knee Pain: From Correlation to Causation

Seemingly small mistakes, such as wearing cushioned running shoes when walking and running leads to osteo knee pain.

A study by Shakoor and Block found that walking in the standard running shoe significantly increased dynamic loads at the knee by increasing stride length, peak knee adduction moment, peak knee extension moment, and reduced cadence compared to barefoot walking. Ouch!

Cushioned Running Shoes Linked to Osteo Knee Pain

Cushioned Running Shoes and Osteo Knee Pain: From Correlation to Causation

The study investigated the effects of barefoot vs cushioned running shoes on walking biomechanics and joint kinematics in patients with knee osteoarthritis and found that barefoot walking was more effective at reducing excessive joint-loads associated with the debilitating condition. What was the explanation for this?

The body uses information from the plantar surface to construct our perceptions of surfaces during walking and running whereby walking/running barefoot is the fundamental fabric of our motor reality.

Even the slightest amount of shoe cushioning leads to a very distorted perception of foot-ground interactions, which in turn increases loads at the knee.

  • Our internal representation of the plantar surface fails in cushioned running shoes and our brain’s ability to accurately perceive footfall intensity and foot strike precision no longer functions.

Deceivingly, cushioned running shoes feel good, but the local effect of comfortable shoes intrinsically predisposes patients with knee osteoarthritis to excessive loading on the lower legs, according to the researchers.

Moreover, walking in cushioned running shoes increased peak hip internal and external rotations which increases knee torques compared to walking barefoot. Kerrigan et al. also found that running shoes with under-heel cushioning generated more torque at the knee.

The Power of Barefootedness

The study reported that patients with knee osteoarthritis had a 12% reduction in knee-joint load, 12% reduction in peak knee adduction, higher cadence and shortened strides when walking barefoot.

One particularly appealing angle of using barefoot walking as a therapeutic approach is that it results in a more resilient knee-joint that can flourish, rather than degenerate as it would with wearing the standard running shoe.

Sadly, it’s popular for many patients with knee osteoarthritis to blame the condition on “always having bad knees…”, this popular idea confirms our negative biases about the lower extremity being inherently weak. However, cushioned running shoes impairs foot function, pushing walkers and runners more towards knee-joint dysfunction.

  • The barefoot condition is the most meaningful action because it always seems to be associated with the strongest outcome with respect to strengthening the lower extremities.

Because barefoot walking bares no perceptual distortions of the plantar surface, it comes as no surprise that walking barefoot accentuates biomechanical alterations that reduce loads on the knee, helping patients with knee osteoarthritis walk better, with less discomfort.

More From Run Forefoot:


Kerrigan DC, Johansson JL, Bryant MG, Boxer JA, Della Croce U, Riley PO. Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis. Arch Phys Med Rehabil 2005;86:871–5.

Shakoor N and Block JA. Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis & Rheumatism, 2006; 54(9):2923-2927.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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