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The biomechanical aspects of gait and the impact of alignment have been recognized as important in the development and progression of knee osteoarthritis. Improving malalignment and altering the dynamic forces on the involved compartment of the knee during gait have the potential to improve the symptoms of knee osteoarthritis. This review examines the use of foot orthoses and knee braces to change the biomechanical forces on the knee joint and to reduce pain and improve function in patients with existing symptomatic knee osteoarthritis.Malalignment has been shown to have an impact on the development and progression of knee osteoarthritis. Patients with medial compartment knee osteoarthritis who have a visible varus thrust will also progress at a more rapid rate than patients without a varus thrust. Lateral wedge foot orthoses have been shown in biomechanical studies and clinical studies to reduce the load on the medial compartment and improve the symptoms of medial compartment knee osteoarthritis. Knee braces that stabilize the knee joint and provide a valgus stress have been shown to improve pain and function in patients with medial compartment knee osteoarthritis.The development of symptomatic knee osteoarthritis and the progression of joint space loss is in part a biomechanical process. To improve patients' function and possibly reduce disease progression, a biomechanical approach should be included in the treatment plan for patients with knee osteoarthritis. Foot orthoses and knee braces have been shown in selected patients to have a role in the management of unicompartmental knee osteoarthritis.