Bold takeaway: Your everyday shoes might not be the answer to hip osteoarthritis pain—whether they’re sturdy or ultra-flexible, the difference in relieving walking pain isn’t clear, and both options can help over time. But here’s where it gets controversial: the best choice could depend on individual preferences, comfort, and specific goals beyond pain relief.
Overview
A recent pragmatic, randomized trial from Melbourne compared two common footwear styles for people with chronic hip osteoarthritis (OA): stable supportive shoes and flat flexible (minimalist) shoes. The study followed 120 participants aged 45 and older over six months to see how each footwear type affected hip pain during walking, along with broader measures of function and quality of life.
What was done
- Design and setting: A real-world, comparative effectiveness trial in Melbourne, Australia, enrolling participants between January 2022 and November 2023.
- Participants: 120 adults (mean ages around 60) with chronic hip OA and activity-related hip pain, meeting criteria such as pain at least 4/10, ongoing for at least 3 months, and no morning stiffness longer than 30 minutes.
- Randomization and footwear: Participants were randomly assigned to either stable supportive shoes (n = 60) or flat flexible shoes (n = 60). Each person selected two pairs from available options and was instructed to wear them for at least 6 hours per day for six months.
- Primary outcome: Change in self-reported hip pain while walking at six months, measured on an 11-point scale (0 = no pain, 10 = worst pain). Data were available for 116 participants. A difference of 1.8 points was considered clinically meaningful.
- Secondary outcomes: Changes in HOOS subscales (Hip Disability and Osteoarthritis Outcome Score), pain at other sites, physical activity, adverse events, and other health indicators.
Key findings
- Pain relief on walking: Stable supportive shoes did not provide significantly greater hip pain relief than flat flexible shoes at six months (mean difference -0.5 points; P = 0.163).
- Within-group improvements: Both groups experienced reductions in hip pain from baseline to six months. On average, those wearing stable supportive shoes improved by 1.9 points, while those wearing flat flexible shoes improved by 2.5 points on the walking pain scale.
- HOOS and quality of life: Flat flexible shoes showed larger average improvements in the HOOS symptom subscale (about 6.6 points) and hip-related quality-of-life subscale (about 7.8 points), but these between-group differences did not reach the nine-point threshold typically regarded as clinically meaningful.
- Adverse events: Fewer adverse events occurred with stable supportive shoes (12%) compared with flat flexible shoes (31%), with foot and hip pain being the most commonly reported issues.
Practical implications
- The study’s authors concluded that there’s no evidence to prefer stable supportive shoes over flat flexible shoes for managing chronic hip OA symptoms. They also suggested that footwear that may help with knee OA pain might not translate to hip OA pain relief.
Source and context
- Lead author: Kade L. Paterson, PhD, University of Melbourne.
- Published online February 23, 2026, in Annals of Internal Medicine, with a Patient Summary available alongside the article.
- Limitations highlighted by the authors include potential bias from participants’ expectations, the possibility that wearing new footwear in both groups minimized differences, and limited generalizability since the study was conducted in an Australian community sample.
What this means for you—and questions to consider
- If you have hip OA and are deciding between stable or flat flexible footwear, this study suggests the choice may come down to comfort and preference rather than a guaranteed difference in walking pain relief at six months.
- Consider the broader trade-offs: while flat flexible shoes might offer slightly better HOOS-related outcomes, they were also associated with more adverse events in the trial. Do you value potential quality-of-life gains more, or a lower risk of new pain in feet or hips?
- Thought-provoking angle: Should clinicians tailor footwear recommendations to the specific joints affected (hip vs knee) and individual biomechanics rather than assuming a universal benefit from a particular style? What would a personalized footwear plan look like for you?
Bottom line
Footwear choices for hip OA can affect pain and function, but this study indicates no clear winner between stable supportive and flat flexible shoes for walking-related hip pain over six months. Your best bet may be to test both styles, monitor your pain and function, and factor in comfort, fit, and how the shoes feel during daily activities. Would you like guidance on how to evaluate footwear options for your own hip OA situation or help choosing a trial plan to compare two suited styles over several weeks?
