The study evaluated the effect of radial extracorporeal shock wave therapy (rESWT) in 50 patients with early-to-moderate unilateral osteoarthritis of the knee who were treated at a single clinic between January 2 and (year incomplete in text)2025. Pain VAS, Lequesne score, WOMAC, Lysholm score and plantar (foot) pressure scores were collected before and after treatment. VAS scores were significantly reduced after treatment at all evaluated time points compared with pretreatment values (all P < 0.05). After treatment, the percentage of heel force (HFW) decreased, while the high pressure point (HPP), average pressure (AP), percentage of foot body weight (FBW), contact area (CA), and percentage of forefoot force weight (FFW) were significantly increased from the previous values (all P < 0.05). Dynamic plantar pressure increased significantly after treatment in areas 3–4. metatarsal (M34), 5th metatarsal (M5), arch (FM) and heel (FH) (all P < 0.05). The Lysholm score increased after treatment and the WOMAC score decreased significantly (all P < 0.05). The authors conclude that ESWT can significantly reduce knee joint pain and improve knee function in patients with KOA, while reducing abnormalities in plantar pressure distribution.