Critically appraised paper: Stable supportive shoes improved knee pain more than flat flexible shoes in people with moderate to severe radiographic medial knee osteoarthritis

physical function via the Western Ontario and McMaster Universities Osteoarthritis Index function subscale (0 = no dysfunction, 68 = maximum dysfunction). Secondary outcome measures were Knee Injury and Osteoarthritis Outcome Score subscales, pain in back/hips/knees/feet/ankles, health-related quality of life, physical activity and global changes in pain and physical function. Results: In total, 161 (98%) participants completed the study. There was no evidence found at 6 months that flat flexible shoes were superior to stable supportive shoes regarding any primary or secondary outcome. There was evidence showing a between-group difference in change in pain favouring stable supportive shoes (1.1 units, 95% CI 0.5 to 1.8), but not function (2.3 units, 95% CI -0.9 to 5.5). Fewer participants reported adverse events with stable supportive shoes (n = 12, 15%) compared with flat flexible shoes (n = 26, 32%) (risk difference -0.17, 95% CI -0.30 to -0.05). Conclusion: Flat flexible shoes were not superior to stable supportive shoes. Stable supportive footwear resulted in greater reductions in walking knee pain over 6 months and may be a useful self-management strategy in this subgroup of patients with knee osteoarthritis.