OBJECTIVE: Increased medial knee loading is associated with a much higher risk of disease progression in knee osteoarthritis (OA). Interventions that can reduce medial knee joint load have the potential to slow disease progression over time. We evaluated the effects of shoes and a cane on knee load in people with knee OA. METHODS: Forty people with medial knee OA underwent 3-dimensional gait analysis to measure their peak knee adduction moment, an indicator of medial knee joint load. Results when walking in bare feet were compared with those obtained when walking in their own usual shoes. Twenty participants also underwent testing using a cane, and results were compared with walking unaided. RESULTS: Compared with barefoot, walking in shoes was associated with a significant increase in the peak knee adduction moment (mean +/- SD N x m/BW x H% 3.49 +/- 0.84 versus 3.77 +/- 0.90; P < 0.001), although there was considerable individual variation. The use of a cane resulted in a 10% decrease in the knee adduction moment (mean +/- SD N x m/BW x H% 3.76 +/- 0.95 versus 3.38 +/- 0.68; P = 0.001). CONCLUSION: Wearing shoes increases medial knee joint load compared with walking barefoot. Given the variable response to shoes observed, further research is required to ascertain which shoe types might be optimal for those with knee OA. The use of a cane significantly reduces medial knee loading and has the potential to reduce the risk of disease progression in knee OA.