You��d never go for a walk wearing high heels or flip flops, right? You might be surprised to learn that wearing the wrong walking shoes could be just as bad for your knees.

“Your shoes affect the amount of impact your knee takes with every step,” says Matt Minard, DPT, a physical therapist and orthopaedic specialist with Carolinas Healthcare System. “The right shoes are the first line of defense in dealing with knee pain.”

All walking shoes aren’t the same. They can vary in how much cushioning and support they offer. The design also affects how the shoe feels and whether it creates pressure points on the foot, which can affect your walk and, in turn, worsen knee pain.

What Works?

While some shoes claim their extra cushioning and special insoles can ease knee pain, research shows these “enhanced” shoes might not be effective.

A 2016 study published in the Annals of Internal Medicine studied 164 adults with knee osteoarthritis and found that there was no difference in knee pain between those who walked in enhanced shoes and those who wore regular walking shoes.

“There is no one brand that is best,” Minard says. “It’s all about how your foot fits in a particular shoe and how it affects your stride.”

A walking shoe might not always be the best option, says Bryan Heiderscheit, PhD, professor of orthopedics and rehabilitation at the University of Wisconsin-Madison.

“Walking shoes can be more rigid and stiff, and that can interfere with your normal stride pattern and change the load on your knee, making pain worse,” Heiderscheit says. “A running shoe might offer more cushion and flexibility. If you have knee pain, you need to think beyond a stereotypical stiff leather walking shoe.”

How to Choose

Minard suggests shopping for walking shoes at a specialty retail shop where the staff will look at the structure of your foot, watch you walk, and make recommendations based on your specific needs. The right shoe for someone with flat feet is different from the right shoe for someone with high arches, for example.

In general, look for shoes that are flexible. Heiderscheit recommends that you pick up a shoe and flex the toe toward the laces. A good walking shoe should flex easily. A shoe that’s hard to bend will restrict your foot, change your stride, and worsen knee pain.

Also check the soles for changes in height from the toe to heel. The shift should be subtle.

“A shoe that is higher heel affects the bend of the knee and puts extra pressure on the joint,” Minard says.

A walking shoe designed with a thicker sole and rigid structure, known as a stability shoe, increases the load on the knee compared with walking barefoot or wearing flexible sneakers with thinner soles.

Sole width and flexibility aside, the most important thing to focus on when choosing a walking shoe is comfort.

“Buy the shoe that fits best and feels best,” says Rajwinder Deu, MD, assistant professor of orthopaedic surgery at Johns Hopkins University. “All of us have certain styles and brands that fit us better.”

You may have to try on several pairs of walking shoes to find the one that fits best.

When to Shop

To get the right fit, try on shoes in the evening. Your feet swell throughout the day and will be their largest late in the day. Wear the same socks you wear during a walk. Lace up each pair and walk around the store. Pay attention to how the shoe feels.

“The right shoe will be comfortable right away,” Minard says. “You shouldn’t have to break in a walking shoe.”

Found one that works? “Stick with it,” Deu says.

When to Replace Them

Unlike running shoes, which you should replace every 300 to 500 miles, walking shoes absorb less force and can last much longer. As a general rule, walking shoes can last up to 9 months, Heiderscheit says.

To know when it’s time to replace your walking shoes, Heiderscheit suggests that you look at the soles: When the tread pattern is worn down, the heel is worn more on one side than the other. This can cause your foot to shift, which puts extra pressure on your knees. And when there are dimples in the side or bottom of the sole because the cushioning has broken down, it’s time for new shoes.

“Shoes play an important role in the mechanics of your stride,” Heiderscheit says. “The wrong shoe can change how you walk and put more pressure on the knee, making the pain worse. It’s worth it to invest in finding the right pair of walking shoes.”

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