Can Your Feet Help Your Knees? What the Evidence Says About Foot Orthoses and Knee Osteoarthritis
June 2026
By Essendon Sports Medicine Team
Knee osteoarthritis (OA) is one of the most common musculoskeletal conditions we see in clinic. If you've been living with the ache, stiffness, or reduced mobility that comes with it, you've probably already heard about exercise, weight management, and anti-inflammatory medication. But there's another tool that often gets overlooked in the conversation: foot orthoses.
As podiatrists and sports medicine clinicians, we're frequently asked whether an insole or custom orthotic can actually make a difference to knee pain. The short answer is yes, for many people it can. Here's what the evidence tells us, and what you should know if you're considering this option.
The Foot-Knee Connection
To understand how orthoses help, it helps to understand the biomechanical link between your feet and your knees.
When you walk, the forces generated at foot strike travel up through your ankle and into your knee. The way your foot contacts the ground, and how it distributes load throughout the gait cycle, has a direct influence on how much stress passes through the knee joint.
In medial compartment knee OA, the inner (medial) side of the joint bears the brunt of loading. This is the most common form of the condition. During walking, this load is measured by what researchers call the knee adduction moment (KAM) — essentially, the rotational force that pushes the inner knee together. Elevated KAM is associated with greater pain, faster joint deterioration, and worse long-term outcomes.
This is where foot orthoses come in.
Lateral Wedge Insoles: The Most Studied Option
The most researched orthotic device for knee OA is the lateral wedge insole (LWI). This is a simple, wedge-shaped insert that raises the outer (lateral) edge of the foot slightly. By doing so, it shifts the centre of pressure laterally, which reduces the lever arm of the ground reaction force relative to the knee — and in turn, reduces KAM.
Research shows that lateral wedge insoles can reduce peak KAM by approximately 5 to 12% on average during walking. Systematic reviews confirm that this offloading effect is consistent across patients, and that the insoles are also associated with reductions in pain and improvements in function in many individuals.
A 2024 study published in Scientific Reports confirmed that lateral wedge insoles shift the calcaneus into a valgus position relative to the tibia, move the foot's centre of pressure laterally, and produce a more vertical ground reaction force — all of which contribute to reduced medial knee loading.
What Does the Clinical Evidence Actually Show?
The research picture is nuanced, and it's worth being honest about what we know and where the gaps remain.
On the positive side:
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Multiple systematic reviews have found that foot orthoses are effective in reducing pain, joint stiffness, and the need for pain medication in people with knee OA.
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A comparative study published in 2024 found that all three types of orthotic treatment examined (knee braces, foot orthoses, and combined use) produced significant improvements in functional scores and comfort after three months.
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There is good evidence that orthoses improve proprioception and balance — two factors that matter greatly for falls risk and daily function in people with knee OA.
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A 2018 study in Osteoarthritis and Cartilage found that when patients were pre-screened to select those most likely to respond biomechanically, lateral wedge insoles were significantly more effective at reducing knee pain compared to a neutral insole.
Where the evidence is less clear:
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Long-term effects on disease progression remain inconclusive. While orthoses can reduce loading in the short to medium term, we don't yet have strong evidence that they slow cartilage loss over years.
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Not everyone responds the same way. Some patients show what's called a paradoxical increase in KAM when wearing lateral wedges — research suggests this is related to individual ankle and foot biomechanics. This is one reason why a thorough assessment before prescribing is important.
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The optimal combination of orthoses (e.g. whether adding a foot orthosis to a knee brace provides additional benefit) remains an area of active research. A 2024 randomised crossover trial found that combined use did not substantially improve outcomes beyond a well-fitted valgus knee brace alone.
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Who Is Most Likely to Benefit?
The evidence increasingly supports a stratified, patient-specific approach to orthotic prescription for knee OA. People who tend to respond well include those who:
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Have predominantly medial compartment knee OA (inner knee pain)
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Show a favourable biomechanical response to lateral wedging on gait assessment
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Do not have significant concurrent lateral patellofemoral OA
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Are in the early to mid-range stages of the condition
This is why an individualised assessment matters. Off-the-shelf wedge insoles are a reasonable starting point for many patients, but a thorough gait analysis and clinical examination allows us to prescribe more precisely — and to identify patients who may not be good candidates.
Foot Orthoses as Part of a Broader Plan
It's important to be clear: foot orthoses are not a standalone cure for knee OA. The evidence consistently supports their use as part of a comprehensive, multi-modal management plan that includes:
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Targeted exercise and strengthening (particularly quadriceps and hip abductor strengthening)
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Weight management where appropriate
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Footwear advice (appropriate shoe stiffness, heel height, and cushioning all influence knee loading)
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Activity modification
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Manual therapy where indicated
Orthoses work best when they're one piece of a well-coordinated plan, not a passive "set and forget" solution.
What to Expect if You're Fitted for Orthoses
If you come to Essendon Sports Medicine for assessment of knee OA, our approach will typically include:
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A detailed history and physical examination of your knee, foot, and lower limb alignment
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Gait analysis to assess your current loading patterns and how your foot mechanics are influencing your knee
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A discussion of orthotic options, which may include off-the-shelf lateral wedge insoles, prefabricated orthoses with modification, or custom-made devices depending on your presentation
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A review appointment to assess response and make adjustments
Orthoses are generally well tolerated. Some people notice a difference in symptoms within the first few weeks; for others it takes a little longer as the body adapts to altered loading.
The Bottom Line
The relationship between your feet and your knees is real, and addressing foot mechanics is a legitimate and evidence-supported part of managing knee OA. Lateral wedge insoles in particular have a solid body of research behind them for reducing medial knee loading and improving pain and function in the right patients.
The key is getting the right assessment first. Not everyone with knee OA will respond the same way, and the best outcomes come from matching the right intervention to the right person.
If you'd like to find out whether foot orthoses might be a useful part of your knee OA management plan, our team at Essendon Sports Medicine is here to help. Book an appointment online or call us to speak with one of our podiatrists or sports medicine clinicians.
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