Gait Retraining for Osteoarthritis

Overseen By Oladipo Eddo, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: George Mason University

Disqualifiers: Obesity, Recent surgery, Neurological, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 16

51 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to assist individuals with knee osteoarthritis. By retraining participants' walking patterns (known as Gait Retraining), the study aims to determine if altering foot angles or trunk leaning can reduce knee pain and enhance movement. Participants are divided into three groups: one with no changes, one focusing on foot position, and one focusing on trunk position. The trial seeks participants who can walk for at least 20 minutes and have a knee osteoarthritis diagnosis. As an unphased study, this trial offers a unique opportunity to contribute to innovative research that could improve the quality of life for those with knee osteoarthritis.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this gait retraining is safe for osteoarthritis patients?

Research has shown that changing the way one walks, known as gait retraining, can help individuals with knee osteoarthritis. Adjusting the foot's angle upon ground contact can reduce knee pain and stress, potentially slowing osteoarthritis damage.

Another method, trunk lean gait retraining, involves altering the upper body's lean while walking. Studies indicate this can also reduce knee pressure and improve osteoarthritis symptoms.

Both treatments are non-invasive, requiring neither surgery nor medication, and are generally safe. Studies have not reported any serious side effects, and participants typically tolerate the treatments well. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about gait retraining for osteoarthritis because it offers a unique, non-invasive approach by focusing on adjusting movement patterns. Unlike traditional treatments that often rely on medication or surgery, gait retraining aims to reduce joint stress by altering how patients walk. The "Foot Progression" technique helps participants visualize and achieve an optimal foot angle, while the "Trunk Lean" technique targets the upper body's movement. These methods could provide a safer alternative with fewer side effects and potentially improve long-term joint health by promoting more sustainable movement habits.

What evidence suggests that gait retraining is effective for osteoarthritis?

This trial will compare different gait retraining methods for osteoarthritis. Research has shown that personalized walking training can help reduce knee pain and slow osteoarthritis progression. In this trial, participants in the Foot Progression arm will train to change the angle of their steps, which studies suggest can reduce stress on the knee and often lead to less pain. Meanwhile, participants in the Trunk Lean arm will adjust their trunk lean angle, a method shown to reduce forces that can worsen joint damage and improve symptoms for those with knee osteoarthritis. Both methods have shown promise in making daily activities more comfortable and reducing joint stress. These changes in walking patterns have been compared to medication for their potential to relieve pain. ^{1 2 3 5 6}

Who Is on the Research Team?

Nelson Cortes

Principal Investigator

Associate Professor

Are You a Good Fit for This Trial?

This trial is for adults aged 18-80 with knee osteoarthritis, who can walk unaided for at least 20 minutes. It's not suitable for those with a BMI over 35, recent back or leg surgery, knee treatments in the last six months, conditions affecting walking, cognitive impairments impacting motor learning, or if they use gait aids or certain orthotics.

Inclusion Criteria

I can walk by myself for at least 20 minutes.

I have been diagnosed with knee osteoarthritis by a healthcare professional.

I have been diagnosed with knee osteoarthritis by a healthcare professional.

Exclusion Criteria

Body mass index greater than 35

I have not had knee surgery or injections in the last 6 months.

I do not have any cognitive issues that affect my ability to learn new physical tasks.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants complete baseline trials to assess gait kinematic and kinetic parameters

1 week

2 visits (in-person)

Gait Retraining Intervention

Participants perform 8 gait retraining sessions using patient-specific gait modifications or normal gait

8 weeks

8 visits (in-person)

Post-Intervention Testing

Over-ground gait analysis and treadmill walking performed to track skill acquisition

1 week

2 visits (in-person)

Follow-up

Follow-up testing to measure retention of prescribed gait modifications

12 months

4 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Gait Retraining

Trial Overview The study tests how changing the way participants walk (foot progression and trunk lean) affects their knee mechanics and pain. Participants will be split into groups to either receive tailored gait retraining or continue normal walking as a control group. The training includes eight sessions with decreasing feedback on their steps.

How Is the Trial Designed?

Group I: Trunk Lean Experimental Treatment 1 Intervention

Participants will visualize a desired trunk lean angle bandwidth in real-time that they should target with their trunk lean angle

Group II: Foot Progression Experimental Treatment 1 Intervention

Participants will visualize a desired foot progression angle bandwidth in real-time that they should target with their foot angle

Group III: Control Active Control 1 Intervention

No intervention

Who Is Running the Clinical Trial?

George Mason University

Lead Sponsor

Trials

60

Recruited

50,200+

Published Research Related to This Trial

A wearable visual feedback system using inertial measurement units was developed for gait retraining in patients with knee osteoarthritis, showing high accuracy (2.4 degrees RMS) in tracking foot progression angle compared to traditional optical motion capture systems.

The effectiveness of the wearable system in providing biofeedback was comparable to laboratory methods, achieving about 50% success in guiding participants to maintain the target foot progression angle, suggesting it could simplify and enhance clinical adoption of gait retraining interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validation of wearable visual feedback for retraining foot progression angle using inertial sensors and an augmented reality headset. Karatsidis, A., Richards, RE., Konrath, JM., et al.[2019]

A custom haptic ankle bracelet successfully retrained 9 out of 10 healthy subjects to adjust their gait parameters, specifically foot progression angle and step width, with 80% accuracy during a short training session.

The study demonstrated that both feedback schemes used in the device were equally effective, as there was no significant difference in the number of steps required to complete the retraining task, suggesting the device's potential for future use in patients with knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Wearable lower limb haptic feedback device for retraining Foot Progression Angle and Step Width. Chen, DKY., Haller, M., Besier, TF.[2018]

Gait retraining significantly reduced the knee adduction moment (KAM) in patients with early knee osteoarthritis, with improvements maintained for up to 6 months after training, indicating its effectiveness as a therapeutic intervention.

Patients who underwent gait retraining also showed significant improvements in their symptoms as measured by the WOMAC osteoarthritis index, while those in the walking exercise group did not experience similar benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate and short-term effects of gait retraining on the knee joint moments and symptoms in patients with early tibiofemoral joint osteoarthritis: a randomized controlled trial. Cheung, RTH., Ho, KKW., Au, IPH., et al.[2019]

This feasibility study involves 40 individuals with knee osteoarthritis and aims to assess the effectiveness of a gait retraining program compared to a traditional walking program, focusing on reducing knee pain and impact loading.

The study will evaluate treatment effects through established measures of knee pain and motion analysis, providing essential data to support a larger randomized controlled trial in the future.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing knee pain and loading with a gait retraining program for individuals with knee osteoarthritis: Protocol for a randomized feasibility trial. Corrigan, P., Davis, IS., James, KA., et al.[2022]

A gait retraining program using mobile biofeedback effectively reduced peak and impulse tibiofemoral contact forces during running by 7.6% and 10.6%, respectively, in a study of 30 runners over 8 sessions.

These reductions in tibiofemoral contact forces were maintained even one month after the retraining, suggesting a lasting impact on knee load management without altering the knee adduction moment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in tibiofemoral contact forces during running in response to in-field gait retraining. Willy, RW., Meardon, SA., Schmidt, A., et al.[2022]

The study demonstrated that it is feasible for individuals to reduce the peak knee adduction moment (pKAM) by at least 10% without increasing the peak knee flexion moment (pKFM) through personalized gait modifications, including foot progression angle (FPA), step width (SW), and stride length (SL).

Modifying stride length (SL) was particularly effective, with seven out of eleven participants achieving the desired dual kinetic change, highlighting the importance of SL in gait retraining for knee osteoarthritis management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Decreasing the ambulatory knee adduction moment without increasing the knee flexion moment individually through modifications in footprint parameters: A feasibility study for a dual kinetic change in healthy subjects. Ulrich, B., Cosendey, K., Jolles, BM., et al.[2021]

This study will evaluate the effectiveness of a six-week toe-in and toe-out gait retraining program on reducing knee joint load and varus thrust in 90 participants with medial knee osteoarthritis, comparing these interventions to a placebo.

The trial aims to assess not only the biomechanical outcomes but also improvements in pain, physical function, and quality of life, with follow-up assessments at three months to determine the sustainability of any benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toe-in and toe-out gait retraining interventions to reduce proxy measures of medial knee joint load in people with medial knee osteoarthritis: Protocol for a randomised placebo-controlled trial. Hutchison, L., D'Souza, N., Grayson, J., et al.[2023]

A gait retraining program for 30 healthy runners successfully increased their step rate by 8.6%, leading to significant reductions in impact forces and peak hip adduction, which are important for preventing injuries.

The retraining also decreased eccentric knee joint work by 26.9% during running, indicating that the program not only improved running mechanics but did so without adverse effects on knee joint function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Willy, RW., Buchenic, L., Rogacki, K., et al.[2022]

Citations

1. news.stanford.edu news.stanford.edu/stories/2025/08/gait-retraining-knee-osteoarthritis-cartilage-damage-treatment-walking

Study reveals gait retraining could help treat knee osteoarthritis New research demonstrates how personalized walking patterns can slow cartilage degradation and deliver pain relief comparable to medication.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40816302/

Personalised gait retraining for medial compartment knee ... Interpretation: Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0268003324002080

Toe-in and toe-out gait retraining interventions for ... Toe-in and toe-out gait retraining is feasible and improves pain in people with knee osteoarthritis. A full-scale randomised clinical trial is warranted.

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03663790

Effects of Gait Retraining on Lower Extremity Biomechanics ... Following baseline, each participant will perform six conditions of the foot progression gait or three conditions of the trunk lean gait modifications to ...

5. thelancet.com thelancet.com/journals/lanrhe/article/PIIS2665-9913(25)00151-1/abstract

Personalised gait retraining for medial compartment knee ... Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them a promising non- ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8402273/

Sensor-Based Gait Retraining Lowers Knee Adduction ... Sensor-based gait retraining lowers knee adduction moment and improves symptoms in patients with knee osteoarthritis: a randomized controlled trial.