Method: Five databases were searched. A full search of 258 articles was found. To be included in this study, the population should be with OA of any grade without any ambulatory aids, male and female were included with age group above 54 years. For the intervention, all the types of shoes and any kind of modification in the shoes were included. The Primary outcome of interest relating to the biomechanical risk of disease progression was the 1st and 2nd Knee Adduction Moment. Eligible studies were pooled using meta-analysis.
Result: Twenty-three studies were included with a total population of 841. Variable stiffness shoe (Mean Difference MD: -0.27; 95% CI: -0.34, -0.21) and Moleca (Mean Difference MD: -0.25; 95% CI: -0.56, 0.05) (Mean Difference MD: -0.25; 95% CI: -0.56, 0.05) have a comparably large statistically significant reduction in KAM with low heterogeneity (Ch2 = 1.49, I2 = 0%). The quality of all the studies is moderate (modified Downs and Black quality checklist) and low to moderate risk of bias (QUADAS 2).
Conclusion: Biomechanical parameters related to the medial knee load, including first peak EKAM and second peak EKAM, were reduced with the use of footwears and footwear modification, apart from the mobility shoes in first peak KAM and MBT in second peak KAM in comparison with barefoot. VSS and Moleca show significant changes in KAM. Future studies need to consider in terms of height of arch in LWI, duration of footwear usage, material, and rigidity of insole, consider the grades of OA knee for baseline for disease specific recommendation. However, based on our study, the footwear and its modifications show an immediate reduction in EKAM. VSS and Moleca have greater effect in reducing EKAM.

Key words: Footwear, OA knee, Degenerative knee, Biomechanical knee, Knee adduction moment, Joint loading, Kinematic knee joint

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