CLAIM:
The viral reel claims that wearing flat slippers without arch support puts excessive pressure on the knees, making them a major cause of knee pain, especially in women. It further claims that switching to cushioned footwear with a slight heel and proper arch support can help prevent joint damage and reduce the risk of knee surgery.
FACT:
False. Available evidence suggests that while footwear can influence walking biomechanics and the distribution of forces across the knee, there is no robust clinical evidence that wearing flat slippers causes knee pain in healthy individuals. Experts say knee pain is influenced by multiple factors, and current research does not support the claim that cushioned footwear with arch support can prevent joint damage or eliminate the need for knee surgery.
In a recent Instagram reel posted by orthopaedic surgeon Dr Anil B Patil, he claims that wearing flat slippers is one of the major reasons behind knee pain, particularly among women. The reel, which has received over 15,200 views, suggests that a lack of arch support in flat footwear places excessive stress on the knees and may eventually lead to joint pain.
In the reel, Dr Patil says, "In India, every other woman's knees hurt. You will be shocked to hear the reason." He argues that many people wear flat slippers at home because they believe "no one comes to see at home," but claims that this habit "slowly destroys your knees."
According to him, flat footwear lacks proper arch support, causing the impact of "6,000 steps a day" to be transmitted directly to the knees over several years. He advises people to wear footwear with soft cushioning, a slight heel and adequate arch support, and recommends replacing footwear every year. "It is better to stay away from surgery than saving money on footwear," he says.
Do flat slippers increase joint pain? What does the research say?
Available evidence suggests that footwear can influence the way forces are distributed across the knee during walking. However, there is no robust clinical evidence that wearing flat slippers causes knee pain in otherwise healthy individuals, or that cushioned footwear with arch support prevents joint damage or reduces the likelihood of needing knee surgery. Researchers consistently call for larger, long-term clinical trials before making definitive recommendations.
A 2015 randomised trial involving people with medial knee osteoarthritis examined how different footwear and lateral wedge insoles affected knee loading, pain and comfort while walking. The researchers found that lateral wedge insoles reduced loading on the inner part of the knee, while mobility shoes improved immediate pain and comfort. However, they noted that these changes did not establish that footwear alone prevents knee pain. Importantly, the authors stated that "while lateral wedge inserts have not been shown to decrease knee pain in knee osteoarthritis, they do reduce medial loading," adding that "further exploration of their possible effects is desirable."
Subsequent research has reported similar findings. A 2017 systematic review and meta-analysis of nine studies evaluating lateral wedge insoles with arch support found that although these insoles reduced certain biomechanical measures of knee loading, the benefits were inconsistent across comparison groups. The researchers concluded that their findings "do not support the use of lateral wedge arch support insoles for reducing knee load," and recommended further research to identify the most effective footwear design.
Another 2017 study compared flat flexible shoes with stable supportive shoes in older adults with medial knee osteoarthritis. The researchers observed that flat flexible shoes produced lower knee loading than stable supportive footwear. However, they found no immediate differences in knee pain between the two groups. The authors emphasised that it remains "unclear whether the reductions in knee loading observed with flat flexible shoes will translate to clinical benefits," adding that there is "no evidence that cushioning in shoes reduces loads across lower extremity joints."
Another 2018 randomised controlled study compared flat flexible shoes with stable supportive shoes in people with knee osteoarthritis over six months. In outlining the rationale for the trial, the authors noted that although some clinical guidelines recommend supportive footwear, these recommendations are "based solely on expert opinion." They added that high-quality clinical trials were needed to determine which type of footwear, if any, offers meaningful benefits.
More recently, a 2021 systematic review and meta-analysis of 13 randomised controlled trials involving 1,086 participants evaluated whether orthopaedic insoles improve symptoms of knee osteoarthritis. After pooling the available evidence, the researchers concluded that orthopaedic insoles "do not provide relief of pain or improve functionality in patients with knee osteoarthritis."
What experts say?
Dr J.V. Srinivas, Lead Senior Consultant – Orthopaedics & Joint Replacement, Aster RV Hospital, said the claim that flat slippers are responsible for causing knee pain is not supported by scientific evidence.
"Knee pain, especially in women, is a multifactorial condition," he said. "While footwear can influence gait, it is far less significant than factors such as body mass index, weak quadriceps muscles, genetic predisposition, previous injuries and anatomical differences, including the wider Q-angle of the pelvis in women."
According to Dr Srinivas, there is no evidence that simply wearing flat slippers damages the knees. He pointed out that many populations around the world spend their lives walking barefoot or in minimal footwear without experiencing higher rates of knee osteoarthritis. "It would be incorrect to single out one lifestyle factor, such as wearing slippers, as the primary cause of knee pain," he said.
Addressing the claim that the absence of arch support causes the impact of every step to be transmitted directly to the knees, Dr Srinivas said the statement is an oversimplification. "The human foot has a natural shock-absorbing system comprising the plantar fascia, muscles and medial longitudinal arch. During walking, these structures help dissipate ground reaction forces before they reach the knee and other joints."
However, he noted that footwear may become more important for people with certain structural foot abnormalities. "Individuals with conditions such as overpronation or severe flat feet (pes planus) may lack adequate natural arch support. This can alter the alignment of the foot and lower limb, increasing stress on the inner compartment of the knee," he explained.
Dr Srinivas also said current clinical evidence does not support the claim that cushioned footwear with arch support can prevent knee osteoarthritis or eliminate the need for surgery. He noted that biomechanical studies have shown that highly cushioned, stable shoes may actually increase the knee adduction moment compared with barefoot walking or flexible footwear, although these findings do not necessarily translate into better or worse clinical outcomes.
At the same time, he emphasised that footwear recommendations differ once a person develops knee osteoarthritis. "Supportive shoes may improve walking comfort and reduce pain in some patients with established knee osteoarthritis by improving gait mechanics," he said. "However, there is no clinical evidence that they prevent the development of osteoarthritis or remove the need for surgery in the future."
Dr Srinivas stressed that footwear advice should always be individualised. "Healthy individuals with normal foot alignment can safely wear flat slippers if they are comfortable," he said. "For people with knee pain or medial knee osteoarthritis, supportive footwear with good cushioning, a firm heel counter and appropriate arch support may be beneficial. Ultimately, the right footwear depends on an individual's foot structure, alignment and underlying medical condition."
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
