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Introduction: Low back pain (LBP) is the most common musculoskeletal disorder in adults, affecting about 39% of the adult population and nearly 570 million people globally each year. It is classified as acute (<6 weeks), subacute (6–12 weeks), or chronic (12–52 weeks). Chronic non-specific LBP (CNSLBP) can significantly affect gait, a fundamental daily activity. Lumbar hyperlordosis is a key risk factor for LBP. Additionally, footwear can influence neuromuscular control and gait mechanics. Despite numerous studies examining the effects of each factor individually, limited research exists on their combined influence. This study aimed to investigate gait kinematics in the presence of CNSLBP, hyperlordosis, and footwear.

Methods: Fifty-eight adult males (mean age: 26.03 ± 4.32 years) were divided into four groups: healthy controls (n=15), CNSLBP (n=14), hyperlordosis (n=14), and both CNSLBP with hyperlordosis (n=15). Hyperlordosis was defined as a lumbar curve >50°, and CNSLBP was diagnosed based on persistent pain without a specific cause. Pain and disability were assessed using a Visual Analog Scale and the Oswestry Disability Index [1].

Lower limb kinematics were analyzed in the sagittal plane using a 2D camera system and Kinovea software, applying the Plug-in Gait marker protocol. Each participant walked along a 12-meter path five times under barefoot and shod conditions. Data were analyzed using MATLAB and time-series statistical parametric mapping, including paired t-tests and one-way ANOVA [2].

Results: Participants with hyperlordosis showed increased ankle dorsiflexion when wearing shoes during early stance (0–5%), mid-stance (67–85%), and late swing (92–100%) phases (Figure 1 [Abb. 1]). Wearing shoes led to reduced knee flexion during parts of the swing phase across all groups. Hip flexion also decreased at various gait stages when shod.

Participants with LBP (with/without hyperlordosis) showed greater dorsiflexion compared to those without LBP in early stance under barefoot conditions and during the swing phase when wearing shoes. They also exhibited more hip flexion before heel strike and less knee hyperextension at terminal stance. Footwear amplified these differences, indicating a compensatory reliance on the ankle joint to reduce load on proximal joints. Figure 1 [Abb. 1]

Discussion and conclusion: Wearing shoes increases ankle dorsiflexion in individuals with hyperlordosis and alters knee and hip mechanics in all groups. LBP leads to greater ankle dorsiflexion and hip flexion, possibly to redistribute impact forces away from the spine. Future studies should explore lower limb muscle activation, especially in peroneal and anterior tibial muscles, under both barefoot and shod conditions.

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