Stable Supportive Shoes Versus Flat Flexible Shoes for Hip Osteoarthritis Pain Relief | What the Latest Trial Found

Hip osteoarthritis is a common chronic condition that causes ongoing pain and limits mobility for millions of people around the world. Because there are few reliable nonsurgical treatments available, patients and clinicians are always looking for simple ways to reduce symptoms and improve quality of life. Footwear is one area that has received increasing attention as a potential tool for self‑management. Shoes can influence how forces act on the lower limbs during walking and may change the load on hip joints.

A recent large clinic trial compared two types of readily available shoes in people with hip osteoarthritis to see whether one style was more effective in reducing hip pain. The trial evaluated stable supportive footwear against flat flexible footwear over a six‑month period. This blog explains the study findings, how the trial was designed, the implications for people with hip osteoarthritis, and what this means for future care.

Why Study Footwear for Hip Pain?

Hip osteoarthritis is a degenerative joint condition that does not have a cure. Many people eventually require hip replacement surgery because current nonsurgical treatments often have limited benefit. Clinical guidelines recommend exercise, self‑management strategies, weight loss where appropriate, and advice on activity modifications as the first line of treatment. However, research shows that these approaches often provide only modest improvements in pain, which may not always be clinically meaningful for people living with long‑term pain (Bannuru et al. 2019; Hall et al. 2025).

Because shoes influence the way the feet move and how forces travel up the legs, researchers wanted to understand if footwear could reduce hip joint stress and improve symptoms. Some previous studies suggested that features like cushioning and motion control in supportive shoes can reduce contact forces in joints and might help with pain in knee osteoarthritis and other conditions (Paterson et al. 2026).

However, until now, research specifically evaluating the effect of different shoe styles on hip osteoarthritis pain has been very limited. This trial aimed to fill that gap by comparing stable supportive shoes with flat flexible shoes in a real‑world setting.

How the Footwear Trial Was Designed

Who Participated?

The study recruited 120 adults aged 45 or older with chronic hip osteoarthritis pain from the community in Melbourne, Australia. Participants had to have ongoing hip pain for at least three months and rate their average pain when walking as 4 or higher on a scale from 0 to 10.

People were excluded if they had other major causes of hip pain, recent hip surgery, currently used custom footwear devices, or had severe other health or joint conditions that would interfere with participation.

Shoe Comparison Groups

Participants were randomly assigned to one of two groups:

• Stable Supportive Shoes (60 people): These were shoes with greater cushioning, arch support, and motion control features.
• Flat Flexible Shoes (60 people): These were shoes with lower heels, minimal cushioning, and flexible soles.

Each person chose two styles from the options available within their allocated group. They were instructed to wear their shoes for at least six hours per day for six months.

What Was Measured?

The primary outcome was the change in average hip pain when walking, measured from the start of the trial to six months later. Pain was recorded on an 11‑point scale from 0 (no pain) to 10 (worst pain possible).

Secondary outcomes included changes in:

• Hip symptoms like stiffness and clicking
• Function during daily activities and sports
• Quality of life related to the hip
• Pain at other joint sites
• Physical activity levels
• Overall global improvement
• Adverse events related to footwear use

All outcomes were self‑reported.

What Did the Trial Find?

Main Pain Results

After six months, both groups showed improvements in hip pain when walking. However, there was no statistically significant or clinically meaningful difference between the stable supportive shoe group and the flat flexible shoe group.

Although people wearing stable supportive shoes did experience a small reduction in pain (around 1.9 points on the pain scale) compared with 2.5 points for those in flat flexible shoes, this difference was not statistically significant. In other words, stable supportive shoes were not clearly better than flat flexible shoes for hip pain on walking.

Secondary Symptoms and Quality of Life

While the main pain outcome did not differ significantly between groups, there were small differences in some secondary measures:

• The flat flexible shoe group showed slightly better improvement in some symptom scores and hip‑related quality of life scores.
• The stable supportive shoe group reported slightly less pain in the feet or ankles on the opposite side of the body.

These differences were small and generally did not reach the minimum threshold that experts consider a clinically meaningful improvement.

Adverse Events

One notable difference was in the number of reported adverse events related to footwear:

• Stable Supportive Shoes: 7 out of 58 people (12%) reported adverse events.
• Flat Flexible Shoes: 18 out of 58 people (31%) reported an adverse event.

Most of the adverse events involved increased pain in the feet or hips. More participants in the flat flexible shoe group stopped wearing their shoes due to discomfort.

What Do These Results Mean for People With Hip Osteoarthritis?

Shoes Alone Are Not a Cure

This trial suggests that choosing stable supportive footwear over flat flexible footwear does not provide a clear advantage for reducing hip pain when walking for people with chronic hip osteoarthritis. Both groups experienced some improvement over six months, but this may reflect factors like:

• Regression toward the mean (natural variation in pain over time)
• The effect of wearing any new shoes versus old footwear
• Changes in activity or self‑management behaviour during the study

Therefore, footwear alone should not be relied upon as a primary treatment for hip osteoarthritis pain.

Footwear Comfort Matters

Although stable supportive shoes were not superior in reducing pain, discomfort and side effects were higher in the flat flexible shoe group. This suggests that, for some people, more supportive footwear may still be more comfortable and tolerable compared with flexible, less structured shoes.

Choosing shoes that feel comfortable and stable during daily activities may still be beneficial, even if they do not directly reduce hip joint pain.

Individual Preferences Still Count

Because there was no clear winner between shoe types, people with hip osteoarthritis may choose footwear based on their personal comfort, activity levels, and lifestyle preferences. For example:

• People who stand or walk a lot during the day may prefer supportive cushioning and arch control.
• Occasional walkers may prefer lighter, more flexible shoes.

Consulting a healthcare provider or physiotherapist for personalized advice can also help guide decisions about footwear based on individual needs.

What Are the Trial’s Limitations?

The researchers acknowledged several limitations:

• Participants knew which type of shoes they were wearing. This lack of blinding might influence how they reported their pain and other outcomes.
• Both groups received new shoes, and improvements in symptoms might be due simply to starting fresh footwear rather than the specific style.
• The trial was conducted in Australia, and results may not apply to populations with different lifestyles, climates, or footwear habits.
• The trial did not compare shoe interventions against participants’ regular everyday shoes.

Future research could explore comparisons with participants’ original footwear, different supportive shoe designs with more pronounced features, and longer‑term outcomes beyond six months.

Final Take‑Home Points

1. Stable supportive footwear was not superior to flat flexible footwear in reducing hip pain during walking after six months.
2. Both groups reported modest improvements in pain.
3. Participants in supportive shoes experienced fewer adverse events and tended to wear their shoes more consistently.
4. Footwear choice should be based on comfort and personal preference, not solely on expectations of hip pain relief.
5. Footwear may be one small part of a broader self‑management plan that includes exercise, weight management where appropriate, and ongoing clinical care.

Source

Paterson KL, Bennell KL, Metcalf BR, McManus F, Lamb KE, Pardo J, Jones S, Hinman RS. Stable Supportive Footwear for Self‑managing Hip Osteoarthritis Pain: A Randomized Clinical Trial. Annals of Internal Medicine. Published 24 February 2026.

Disclaimer

This blog post is intended for educational and informational purposes only. It is not medical advice and should not replace consultation with a qualified health professional. Always consult a doctor or health specialist before making decisions about treatment for medical conditions including hip osteoarthritis.