Novel Shoes May Cut Low Back Pain, Delay Knee Arthroplasty
INCHEON, South Korea — A shoe-based biomechanical intervention worn for a short time each day may achieve greater improvements in low back pain and greater reductions in the risk for total knee replacement surgery than standard physical therapy, according to two studies presented at the World Congress on Osteoarthritis (OARSI) 2025 Annual Meeting.
'If you've ever watched somebody who has pain — whether it's knee pain, hip pain, back pain — they walk a little strange,' said presenter Matthew Bartels, MD, MPH, director of Rehabilitation Medicine and professor of physical medicine and rehabilitation at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. But walking differently to compensate for pain can actually make the problem worse, directing the ground force through the affected area of the body, whether the knee or lower back.
Bartels presented data from two studies of the US Food and Drug Administration–cleared shoe-based intervention, which 'alters the foot's pressure points to reduce loads, minimize symptoms, and promote neuromuscular control training using adjustable, convex pods under the sole,' according to the researchers.
The first was a randomized controlled trial comparing the effects of the intervention and standard physical therapy on pain in 162 patients with low back pain. Participants were randomized in a 2:1 ratio either to the shoe-based intervention from AposHealth — which was individually tailored and calibrated six times over 1 year — or to standard physical therapy. In addition to being presented at OARSI, the trial was recently published in Global Spine Journal .
At 1 year after randomization, those who used the shoe-based intervention reported a significantly greater mean 3.5-point reduction in their pain scores, as measured on a 10-point numeric rating scale, compared with a mean 1.8-point reduction in those who received physical therapy.
The participants in the intervention also reported better secondary outcomes, including greater improvements in their Patient-Reported Outcomes Measurement Information System function scores, gait speed, and overall quality of life.
Bartels told Medscape Medical News that the intervention was likely to have greater compliance than physical therapy because patients could use it at home for as little as 15 minutes at a time and feel the benefits pretty quickly.
'We all know that if you have knee or back pain, physical therapy will make you better, but the problem is, people don't keep the exercises up,' he said. 'This is a treatment that you put the shoes on, and you just wear them doing normal activities for a period, so it doesn't take time out of your day.'
Bartels' own experience of his patients using the shoes was that even if patients did stop wearing them once their symptoms improved, they often started using them again if their symptoms returned, 'so they kind of self-dose,' he said.
The second study Bartels presented was a poster detailing the results of a retrospective registry review of 95 patients with knee osteoarthritis (OA) who had been prescribed the shoe intervention after exhausting other nonsurgical options to see whether it was associated with a reduction in the likelihood of total knee replacement surgery. The study was also published last year in the Journal of Musculoskeletal Research .
After an average follow-up time of 5.6 years, 12.6% of the patients using the shoe had undergone total knee replacement compared with 34.3% of a control group of patients from the same period who received traditional physical therapy.
'Increased use of biomechanical intervention to treat knee OA may help reduce some of the burden on healthcare and society associated with end-stage knee OA by delaying or avoiding surgery,' the researchers wrote.
Commenting on the two studies, physical therapist and epidemiologist Garrett Bullock, PhD, DPT, of Wake Forest University School of Medicine, Winston-Salem, North Carolina, said, 'For a specific type of patient that has tried exercise interventions, has tried medication interventions, and a combination of both, that has a decent amount of physical activity, it may be something to explore, particularly to maintain neutral balance or create a better line through the foot.'
Bullock told Medscape Medical News that there was always a risk that patients wouldn't adhere to physical therapy, so an intervention that provided education and the tools for self-efficacy could help them to manage their own symptoms.
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Acetazolamide should not be used for HAPE prevention in those with a history of the disease, although it can be considered for prevention of reentry HAPE, which affects individuals who reside at high altitudes, travel to a lower elevation, and then develop HAPE upon rapid return to their residence.[1] Proper prevention strategies for altitude sickness include gradual ascent, often achieved through staged ascent and limiting daily altitude gain. For HAPE prevention in individuals with a history of the condition, nifedipine is the preferred medication, with tadalafil as an alternative.[1-3] The patient was discharged with instructions to avoid further high-altitude exposure until fully recovered and to seek medical guidance for future expeditions. HAPE is a potentially life-threatening condition, but with prompt recognition and treatment, the prognosis is generally excellent. When treated early with interventions including immediate descent to a lower altitude, supplemental oxygen, and sometimes medications such as nifedipine, most patients recover fully, without long-term complications.[1,2] The condition is typically self-limiting once altitude exposure is reduced, and most patients do not develop chronic lung disease. However, if left untreated or reexposure occurs without proper acclimatization, the condition can be fatal or lead to complications. Patients who experience HAPE should be educated on proper acclimatization strategies to prevent recurrence in future high-altitude activities, but with appropriate treatment, full recovery is common and long-term effects are rare.
