Scientists Discover a Simple Way to Relieve Osteoarthritis Pain Without Medication or Surgery

Nearly one in four adults over the age of 40 suffers from painful osteoarthritis, a condition that can make everyday movements difficult and is one of the leading causes of disability in adults. The disease leads to the gradual wear and tear of the cartilage that cushions the joints. Once this damage has occurred, doctors are currently unable to reverse it. Treatment typically focuses on pain relief, with joint replacement considered when symptoms become severe. A clinical study by researchers at the University of Utah, New York University, and Stanford University points to another possibility: changing the way a person walks.

An Individual Adjustment of the Foot Angle

In the one-year randomized controlled trial, people with knee osteoarthritis were trained to make a small, individually tailored adjustment to their foot angle while walking. The result was impressive. Participants who received the actual gait training reported pain relief comparable to that achieved with medication, and MRI scans suggested they had less cartilage wear in the knee than those in the placebo group.

The study, published in The Lancet Rheumatology, was co-led by Scott Uhlrich of the John and Marcia Price College of Engineering at the University of Utah. According to the researchers, it was the first placebo-controlled study to show that a biomechanical intervention could help treat osteoarthritis symptoms and potentially slow joint damage. “We know that in people with osteoarthritis, higher knee loading accelerates the progression of the disease and that changing the foot angle can reduce knee loading,” said Uhlrich, an assistant professor of mechanical engineering. “So the idea of a biomechanical intervention isn’t new, but there haven’t been any randomized, placebo-controlled studies to date that demonstrate its effectiveness.”

Why the Treatment Had to be Individually Tailored

The study focused on people with mild to moderate osteoarthritis in the medial compartment of the knee, i.e., the inner side of the joint. This area typically bears more weight than the outer side, making it a common site for knee osteoarthritis. But there is a key challenge: the optimal gait adjustment is not the same for everyone. Some people reduce knee stress by turning their toes slightly inward. Others benefit more from pointing them outward. For some, the wrong adjustment may not provide relief or may even increase stress on the painful part of the knee.

“In previous studies, the same intervention was prescribed for everyone, which meant that for some people, joint stress was not reduced or was even increased,” explained Uhlrich. “We used a personalized approach to select the new gait pattern for each person, which improved the unloading of the knee and likely contributed to the positive effect on pain and cartilage that we observed.”

This point has become even more significant as relevant research findings continue to show that changes in foot angle can affect knee forces differently depending on the individual, joint, and gait pattern. For example, a study from 2024 in Bioengineering found that inward and outward rotation of the foot resulted in different peak knee loads, while the moments in the ankle joint were not significantly increased in the group studied. Other studies have also shown that the foot motion angle can be measured outside the lab using wearable sensors, supporting the assumption that future versions of this approach could be more easily implemented in everyday life.

Here’s How the Study Was Conducted

During their first two visits, participants underwent an MRI scan to assess their baseline condition and walked on a pressure-sensitive treadmill while motion-capture cameras recorded their gait mechanics. Using this data, the researchers determined whether an inward or outward rotation of the toes would be more beneficial for each individual and whether an adjustment of 5° or 10° would be most appropriate.

This screening also identified individuals who were unlikely to benefit, as none of the tested foot angle changes reduced the load on their knees. These participants were excluded from the study. The researchers noted that the inclusion of such individuals in earlier studies may have helped explain why previous findings regarding pain were less clear-cut. Of the 68 enrolled participants, half were assigned to the group receiving actual gait training. The other half received a sham treatment, which served to control for the placebo effect. In the sham treatment group, participants were assigned foot angles that matched their natural gait pattern. In the intervention group, each participant received the foot angle adjustment that resulted in the greatest reduction in knee load.

Training the New Gait Pattern

Both groups returned to the lab for six weekly training sessions. During these sessions, participants walked on a treadmill while wearing a device on their shin that provided vibration feedback. The vibrations helped them maintain the assigned foot angle while walking.

After the six-week training phase, participants were encouraged to practice the gait pattern for at least 20 minutes daily. The goal was for the movement to become automatic. Follow-up examinations showed that, on average, participants remained within one degree of their prescribed foot angle. After one year, the participants reported their knee pain levels and underwent a second MRI scan so that the researchers could measure changes in the condition of the cartilage.

“The reported pain relief was somewhere between what you would expect from an over-the-counter medication like ibuprofen and a narcotic like OxyContin, compared to the placebo group,” said Uhlrich. “Based on the MRI scans, we also observed a slower decline in a marker of cartilage health in the intervention group, which was very encouraging.”

A Drug-Free Option for a Long Treatment Gap

For some participants, one of the most appealing aspects of the approach was that it required neither pills nor surgery, splints, or a device to be worn all day. One participant said: “I don’t have to take medication or wear a device … it’s just a part of my body now that will be with me for the rest of my life, and I’m thrilled about that. “

This long-term adherence could be one of the intervention’s greatest strengths. For many people, osteoarthritis develops decades before they become eligible for joint replacement. During this time, they may rely heavily on painkillers and other strategies for symptom relief. “Especially for people in their thirties, forties, or fifties, osteoarthritis could mean decades of pain management before a joint replacement is recommended. This intervention could help bridge that significant treatment gap.

A 2026 conference abstract in *Osteoarthritis and Cartilage* also highlighted the ongoing interest in placebo-controlled studies on retraining the foot progression angle and emphasized that researchers are still trying to determine which gait strategies work best and for whom. However, this area remains an active area of research, and the 2025 study in “Lancet Rheumatology” remains one of the strongest pieces of clinical evidence for a personalized approach.

Why Patients Should Not Try This on Their Own

Although these results are promising for osteoarthritis, the researchers emphasized that this is not a simple recommendation like “turn your toes inward” or “turn your toes outward.” The benefits depend on careful measurements and individual adjustment. For some people, an incorrect setting could increase the load on the knee rather than reduce it.

Therefore, the process must be simplified before it can be widely implemented in clinics. The motion-capture system used to prescribe individual gait adjustments is expensive and time-consuming. The research team envisions a future version that could be used in physical therapy settings, with training taking place during normal walks rather than just in the lab.

“We and others have developed technologies that could allow this intervention to be both individually tailored and implemented in a clinical setting using mobile sensors, such as smartphone videos and a ‘smart shoe,’” said Uhlrich. Future studies on this approach are needed before the intervention can be made widely available to the public. Anyone interested in participating in future studies can contact Uhlrich’s Movement Bioengineering Lab via this web form.