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The purposes of this study were to assess a) the effectiveness of Masai Barefoot Technology (MBT) shoe in reducing knee pain in persons with knee osteoarthritis (OA) and (b) changes in balance, ankle and knee ROM, and ankle strength compared with a high-end walking shoe for 12 wk.The research design was a randomized controlled trial (123 subjects, knee OA). Subjects were randomized to a MBT (N = 57) or a control shoe (N = 66). A Western Ontario and McMaster Universities (WOMAC) OA index, BMI, balance, active ROM, and ankle torque were quantified at week 0, 3, 6, 9, and 12. Two-sample t-tests were done for between-group comparisons.There was no significant difference between groups in total pain score. A significant reduction over the 12-wk period was found for both shoe conditions (−42/500 or 25.6% MBT, −46.2 or 27.1% control). There was no significant group difference in pain during walking (t = −1.09, P = 0.28). Pain during walking was significantly reduced by 5.2/100 mm in the MBT and 9.7/100 mm in the control group. Total pain showed a significant reduction for the MBT −27.4/500 (−16.6%) and the control group −28.9/500 (−17.0%) between baseline and week 3. Between week 3 and 6, there was a significant reduction for the MBT group only (−27.2/500 or −20.0%). There was a significant increase in the static balance between baseline and 12 wk in the MBT group only, although the difference between groups was not significant.The results indicate that special shoe interventions can reduce pain in subjects with moderate knee OA.