RESEARCH
Eu opean Spine Jou nal
h ps://doi.o g/10.1007/s00586-025-08880-3
In oduc ion
Radicula low back pain, also known as “scia ica,” occu s
due o comp ession o he do sal oo o a spinal ne e, adi-
a ing o one o mo e de ma omes. I may be accompanied by
addi ional adicula symp oms o unc ional de ici s in he
ee and lowe ex emi ies [1]. Scia ica is a majo cause o
ch onic non-oncological pain in Eu ope, wi h a p e alence
in he gene al popula ion anging om 3 o 25% [1–3]. S ud-
ies ha e indica ed ha lumbosac al adiculopa hies con ib-
u e o 34.6% o neu opa hic pain cases [4]. This condi ion is
cha ac e ized by pain adia ing along he lowe limb, which
may also ex end o he oo .
The scia ic ne e is comp ised o he L4 h ough S3
ne e oo s [5], which me ge o o m a la ge ne e unning
om he pel is, passing along he pos e io high, and di id-
ing in o he ibial and common pe oneal ne es a he pop-
li eal ossa, con inuing o he oo . A unc ional ela ionship
Ma ía Reina-Bueno
[email p o ec ed]
Ped o V. Munue a-Ma ínez
[email p o ec ed]
Ca men Vázquez-Bau is a
[email p o ec ed]
Gab iel Domínguez-Maldonado
[email p o ec ed]
Ángel Ma ínez-Na as
[email p o ec ed]
Ma ía José Ga cía-Rod íguez
[email p o ec ed]
Inmaculada C. Palomo-Toucedo
[email p o ec ed]
1 Uni e si y o Se ille, Se ille, Spain
2 Uni e si a y Valme Hospi al, Se ille, Spain
Abs ac
Objec i e This s udy aimed o de e mine whe he he e a e di e ences in plan a p essu es du ing gai be ween pa ien s wi h
lumba disc he nia ion -induced scia ica and heal hy indi iduals.
Me hods This obse a ional case–con ol s udy included 41 pa ien s wi h scia ica due o lumba disc he nia ion and 30
heal hy con ols. Plan a p essu es we e e alua ed using he Foo Scan® pla o m in 10- oo zones du ing 3 gai phases,
de ined as ocke s. A e walking, body ad ancemen wi h he suppo ing oo depends on s ance–limb mobili y, wi h he
suppo ing oo ac ing as a pi o sys em. In a se ial ashion, he heel, ankle, and o e oo se e as ocke s ha allow he body
o ad ance smoo hly. Da a we e also collec ed on quali y o li e, low back pain, lowe limb pain, oo pain, oo pain- ela ed
disabili y, oo join ange o mo ion, and oo pos u e index. All a iables we e compa ed be ween he wo g oups.
Resul s Pa ien s wi h scia ica had a longe con ac ime and highe mean and peak p essu es in all oo zones, excep o
he i s me a a sal and oes. P essu es we e highe in he hi d o i h me a a sals, especially du ing push-o . Pa ien s wi h
scia ic a h i is expe ience no only low back pain, bu also lowe limb and oo pain, as well as highe oo pain- ela ed
disabili y. The e we e no signi ican di e ences in oo pos u e o join anges, excep o dec eased sub ala p ona ion in
pa ien s wi h scia ica.
Conclusion Al e ed plan a p essu e dis ibu ion in pa ien s wi h scia ica may be associa ed wi h neu omuscula compensa-
ion mechanisms.
Keywo ds Scia ica · Plan a p essu e · Lumba disc he nia ion · Lumba adiculopa hy.
Recei ed: 8 Oc obe 2024 / Re ised: 25 Feb ua y 2025 / Accep ed: 18 Ap il 2025
© The Au ho (s) 2025
Foo p essu e in pa ien s wi h ch onic lumba adicula pain (scia ica)
caused by lumba disc he nia ion: a case-con ol obse a ional s udy
Ped o V.Munue a-Ma ínez1· Ma íaReina-Bueno1· Ca menVázquez-Bau is a1· Gab ielDomínguez-Maldonado1·
ÁngelMa ínez-Na as2· Ma ía JoséGa cía-Rod íguez2· Inmaculada C.Palomo-Toucedo1
1 3
Eu opean Spine Jou nal
be ween he oo and lumba egion has been es ablished,
wi h one egion in luencing he de elopmen o pa hologies
in he o he . A descending ela ionship is obse ed in which
lumba pa hology, such as lumba disc he nia ion (LDH) o
lumba spinal s enosis (LSS), leads o changes in he lowe
limb and oo [6–8]. These changes can include muscle
weakness, pain, and neu ological de ici s. Con e sely, an
ascending ela ionship, in which oo suppo al e a ions
con ibu e o lumba dys unc ions, is also possible. Abno -
mal oo unc ion, al e ed oo loading, and nonspeci ic low
back pain a e equen ly associa ed wi h lumba pa hologies
[9, 10]. Al e a ions in oo unc ion du ing gai can a ec
pel ic posi ion and mobili y, inc easing he isk o lumba
pa hologies [11–16].
LDH- ela ed ne ous and muscula al e a ions can a ec
oo s eng h and mo o con ol and al e oo loading du ing
gai , esul ing in changes in plan a p essu e ha inc ease
he isk o lowe ex emi y inju ies. Lumba adiculopa hy
a ec s senso y inpu and p op iocep i e esponses in he
oo [17],, and he in ol emen o muscles inne a ed by
he S1 and L5 oo s u he con ibu es o al e ed plan a
p essu e. Assessing plan a p essu e may help e alua e lum-
ba oo dys unc ion se e i y [18]. Combining oo unc ion
assessmen s wi h neu ological ehabili a ion may help man-
age gai and pain in such pa ien s. The iden i ica ion o an
associa ion be ween speci ic plan a p essu e pa e ns and
scia ica could lead o imp o ed clinical managemen .
Lumba in e e eb al disc p o usion o he nia ion is a
common cause o scia ica [2]. To he bes o ou knowledge,
no s udy has di ec ly es ablished he ela ionship be ween
plan a p essu e and gai p essu e. The e o e, his s udy
elucida ed plan a p essu e pa e ns in pa ien s wi h scia ica
caused by LDH and compa e hem wi h hose o heal hy
indi iduals.
Ma e ials and me hods
An obse a ional case–con ol s udy was conduc ed wi h
pa ien s diagnosed wi h scia ica due o LDH and indi iduals
o simila age, sex, and Body Mass Index (BMI) wi hou
he condi ion. The s udy was conduc ed a Valme Uni e -
si y Hospi al (Á ea de Ges ión Sani a ia Su de Se illa)
and he Clinical Podia y A ea o he Uni e si y o Se ille,
Spain, be ween Ma ch 2022 and May 2024. The s udy was
app o ed by he Clinical Resea ch E hics Commi ee o
Valme Uni e si y Hospi al (Code 2449-N-21). All pa ien s
olun a ily pa icipa ed bu we e in o med o he s udy
de ails and po en ial isks and p o ided signed in o med
consen .
The inclusion c i e ia we e a diagnosis o ch onic
( h ee mon hs minimum du a ion) adicula low back pain
(scia ica) wi h a minimum sco e o 5 using he Nume ic Pain
Ra ing Scale 11 (NPRS-11) caused by non- auma ic LDH.
Pa ien s wi h o he spinal pa hologies causing adicula
pain, condi ions a ec ing walking (e.g., neu omusculoskel-
e al, es ibula , and ca diopulmona y diseases), neu opa hic
pain ela ed o diabe es o o he condi ions, p egnancy, cog-
ni i e impai men , p io oo su ge y, in lamma o y heu-
ma ic disease, use o walking aids, o cu en oo o hoses
we e excluded.
The con ol g oup included heal hy indi iduals wi h
simila demog aphics bu wi hou scia ica, LDH, lumba
pa hology, auma, su ge y, musculoskele al o neu ologi-
cal diseases, diabe es, o oo de o mi ies. These indi iduals
we e companions o pa ien s a ending he Clinical Podia y
A ea.
Pa ien s we e ec ui ed by wo clinicians specializing in
Anes hesiology, Resusci a ion, and Pain Managemen . Eli-
gible pa ien s we e in i ed o pa icipa e and we e e e ed
o he Clinical Podia y A ea a he Uni e si y o Se ille
o da a collec ion. (Fig. 1). The examina ions we e always
conduc ed in he mo ning be ween 10:00 and 13:00 a.m.
The pha macological ea men was no al e ed so as no o
in e e e wi h he esul s. Clinical and demog aphic da a,
including age, sex, weigh , and heigh , we e collec ed. Pain
in he oo , lowe limb, o lowe back was eco ded and
quan i ied using he Nume ic Pain Ra ing Scale 11 (NPRS-
11). Disabili y was assessed using he Oswes y Disabili y
Index (ODI), Manches e Foo Pain and Disabili y Index
(MFPDI), and he SF-12 quali y o li e ques ionnai e.
The oo join ange o mo ion was measu ed, including
ankle do si lexion (knee ex ended and lexed), hind oo and
o e oo p ona ion and supina ion, i s ay do si lexion and
plan a lexion, and i s oe do si lexion. Ex insic oo mus-
cle s eng h (do si lexo s, plan a lexo s, supina o s, p ona-
o s) was e alua ed using manual muscle es ing, g aded
pe he Medical Resea ch Council classi ica ion (0–5 scale)
[19], which assigns alues be ween 0 and 5, whe e 0 ep-
esen s no muscle ac i i y and 5 ep esen s no mal muscle
s eng h. The oo pos u e was assessed using he Foo Pos-
u e Index (FPI), a clinical ool, and he oo was classi ied
as neu al, p ona ed, o supina ed.
Plan a p essu e examina ion du ing gai was pe o med
using he Foo Scan pla o m®(RSscan In e na ional, Olen,
Bélgica), which has been p o en o ha e good eliabil-
i y and epea abili y [20]. The pla o m dimensions we e
2093 × 469 × 18 mm, wi h 16,384 esis i e senso s a anged
in a 256 × 64 ma ix wi h a esolu ion o 4 senso s/cm², an
ac i e senso a ea o 1950 mm × 325 mm, da a acquisi ion
equency o 125 Hz, and p essu e ange o 1–200 N/cm².
The pla o m was embedded lush wi h he g ound on a
2-me e -wide by 10-me e -long wooden walkway o simu-
la e walking on a egula , e en su ace and o p e en he
1 3
Eu opean Spine Jou nal
a ge ing e ec . Following he manu ac u e ’s ins uc ions,
he sys em was calib a ed be o e each da a collec ion. Du -
ing calib a ion, he pa icipan ’s body weigh and oo size
we e en e ed in o he so wa e, and hen he pa icipan was
asked o walk o e he pla o m. The analysis so wa e hen
de e mined he ecalib a ion ac o o u u e measu emen s
o he same pa icipan .
The pla o m is connec ed o a compu e ha ansmi s
and p ocesses all in o ma ion using he Scien i ic Foo -
Scan® so wa e. This sys em p o ides plan a p essu e da a
by au oma ically di iding he oo image in o 10 zones:
medial heel (MH), la e al heel (LH), mid oo (MF), i s
me a a sal (M1), second me a a sal (M2), hi d me a a sal
(M3), ou h me a a sal (M4), i h me a a sal (M5), big
oe (T1), and lesse oes (T2-5). Fo s a is ical analysis, he
ollowing plan a p essu e a iables we e selec ed o each
o hese 10 zones: con ac ime (ms), mean p essu e du -
ing o al con ac ime (N/cm²), peak p essu e (N/cm²), and
ime o peak p essu e occu ence (% o he s ance phase).
These alues we e examined ac oss he 3 unc ional ock-
e s o he s ance phase: [21] heel con ac o o e oo con-
ac ( i s ocke ), o e oo con ac o heel li -o (second
ocke ), and heel li -o o oe-o ( hi d ocke ). In addi ion,
he oo -p og ession angle was also conside ed. In o al, 121
Fig. 1 Image o he s udy
labo a o y
1 3
Eu opean Spine Jou nal
du ing he gai cycle, po en ially con ounding he in e p e-
a ion o esul s.
Da a analysis
S a is ical analysis was pe o med using IBM SPSS S a-
is ics 27 (IBM, A monk, NY, USA). Fo he desc ip i e
analysis, absolu e equency (N), ela i e equency (%),
mean alues, s anda d de ia ion (SD), 25 h, 50 h, and 75 h
pe cen iles, and in e qua ile anges (IQR) we e calcula ed.
Fo he compa a i e analysis o quali a i e a iables, he
chi-squa e es was used o de e mine whe he he e was any
ela ionship (dependence) be ween he a iables h ough
c oss- abula ions. To analyze he di e ences be ween he
con ol and scia ica pa ien g oups, no mali y es s we e i s
pe o med using he Kolmogo o -Smi no es . When he
a iable alues ollowed a no mal dis ibu ion, he indepen-
den samples T- es was used o compa e he wo g oups;
when he da a did no ollow a no mal dis ibu ion, he
Mann-Whi ney U es o independen samples was used.
Fo he in e en ial analysis, a 95% con idence le el was
conside ed by compa ing he expe imen al p- alue wi h a
5% signi icance le el.
Resul s
The pe cei ed low back pain and demog aphic cha ac e -
is ics a e shown in Table 1. The e we e no s a is ically sig-
ni ican di e ences be ween he g oups in any demog aphic
cha ac e is ics. Pa icipan s wi h scia ica had a mean dis-
ease du a ion o 16.1 ± 3.4 yea s. No signi ican di e ences
we e ound in he oo pos u e o ange o mo ion (ROM)
sco es o he main oo join s be ween he con ol and sci-
a ic g oups, excep o he p ona ion o he sub ala join
(Table 2). In he scia ic g oup, lowe muscle s eng h was
obse ed in he majo ex insic muscle g oups o he oo
(do si lexo s, plan a lexo s, p ona o s, and supina o s)
(Table 3). Addi ionally, pa icipan s wi h scia ica epo ed
pa ame e s we e eco ded o each oo (4 a iables x 10
zones x 3 ocke s + oo p og ession angle).
Pa icipan s walked on he pla o m o 2 min a a com-
o able speed o acclima iza ion. Da a we e hen collec ed
o i e passages o e he pla o m. The h ee mos consis-
en oo p in s o each oo (comple e oo p in s, heel-s ike
pa e n, no adjus men s) we e selec ed by wo expe ienced
esea che s. The a e age alues o he p essu e a iables
we e used in he s a is ical analysis.
The a iable mean p essu e was aken as a e e ence, and
he sample size was calcula ed o compa e wo means. The
o mula used is as ollows:
n=
2
s
2(
zα
2
+
zβ
)2
d
2
He e, s is he es ima ed s anda d de ia ion, α is he ype I
e o , β is he ype II e o , and d is he minimum de ec able
di e ence.
Thus, he inal equa ion is as ollows:
n
=
2
s
2(
zα
2
+
zβ
)2
d2
=
2·42·(1,96 +0,84)2
2,52
=40,14 ≈41
A minimum o 41 cases pe g oup was equi ed o pe o m
a compa ison mee ing hese c i e ia.
In his s udy, he uni o analysis was he oo , a he
han he indi idual pa icipan s. In he con ol g oup, bo h
ee we e analyzed o de e mine he sample size equi ed
o s a is ical compa isons. Howe e , in he scia ica g oup,
only he a ec ed limb was conside ed. Because plan a
p essu e a iables we e he p ima y ou come measu es, he
non-a ec ed limb was excluded om he analysis o a oid
po en ial bias.This decision was based on he p emise ha
compensa o y biomechanical and an algic adap a ion could
al e he kine ics and kinema ics o he una ec ed oo
Table 1 Pa icipan s’ demog aphic cha ac e is ics and pe cei ed low back pain
Con ol
N = 30
Scia ic
N = 41
p
N%N%
Sex
Male 10 33.3 21 51.2 0.056
Female 20 66.7 20 48.8
Mean SD 95% CI Mean SD 95% CI
AGE 47.0 9.4 46.5–43.0 47.5 10.0 46.9–44.0 0.771
BMI 25.5 3.5 24.2–26.8 27.1 4.5 26.0-28.5 0.500
Pe cei ed Low Bak Pain 0.7 1.9 0.1–1.4 8.0 2.2 7.4–8.7 < 0.001
BMI: Body Mass Index. SD: S anda d Des ia ion. IQR: In e quan il ange
1 3
Eu opean Spine Jou nal
imes han con ols in all zones excep o he oes and i s
me a a sal, and hey exhibi ed highe mean and peak p es-
su es han con ols in all zones excep o he i s oe. No
signi ican be ween-g oup di e ences we e obse ed in he
iming o peak p essu e o oo p og ession angle.
wo se sco es on pain scales, disabili y ela ed o oo , and
quali y o li e (Table 4).
Table 5 p esen s he a iables ela ed o plan a p essu e
di ided in o 10 zones o he oo , along wi h he p- alues
om he compa ison be ween he con ol and scia ic g oups.
Pa icipan s in he scia ic g oup showed longe con ac
Table 2 Foo pos u e and ange o mo ion o he main a icula mo emen s o he pa icipan s’ ee in he con ol and scia ic g oup (This able
shows he compa ison o oo a iables; ha is why he con ol g oup consis ed o N = 60, as all a iables we e ob ained om bo h ee )
Con ol
N = 60
Scia ic
N = 41
p
Mean SD 95%CI Median IQR Mean SD 95%CI Median IQR
Foo Pos u e Index (FPI) 3.6 3.4 2.8–4.5 4 0–6 3 3.6 1.9–4.1 4 1.5–5.5 0.4372
Ankle do sal lexion (KF) 19.6 5.9 18.1–21.1 20 16–24 18.0 6.3 16–20 18 14.5–22.0 0.1922
Ankle do sal lexion (KE) 14.1 5.2 12.8–15.5 15 10.0-19.5 12.3 5.7 10.5–14.1 12 10–16 0.1482
Rea oo p ona ion 11.2 5.2 9.8–12.5 10 8–14 9.4 4.5 7.9–10.9 9 7–10 0.0352
Rea oo supina ion 27.4 9.3 25.0-29.8 28 20.0-33.8 28.1 6.4 26.0-30.2 28 22.0-32.5 0.6321
Fo e oo p ona ion 14.2 7.9 12.2–16.2 15 8.0-19.8 12.3 6.6 10.3–14.4 10 7.0-16.5 0.2042
Fo e oo supina ion 40.6 15.1 36.7–44.5 41.5 28.0-54.3 41.2 10.4 38.0-44.5 43 33.5–50.0 0.9472
Fi s ay do si lexion 6.0 1.7 5.5–6.4 6 5–7 6.3 1.7 5.7–6.8 6 5.0-7.5 0.3732
Fi s ay plan a lexion 4.5 1.0 4.2–4.8 5 4–5 4.8 1.4 4.3–5.2 5 4–6 0.5942
Hallux do si lexion 58.0 12.8 54.7–61.3 59 50.0-66.8 54.4 11.3 50.8–58.0 55 47.0-62.5 0.2582
1T es o independen samples
2 Mann-Whi ney’s U es
KF: Knee lexed; KE: Knee ex ended
Table 3 Muscula s eng h o he pa icipan s’ ee in he con ol and scia ic g oup (This able shows he compa ison o oo a iables; ha is why
he con ol g oup consis ed o N = 60, as all a iables we e ob ained om bo h ee )
Con ol
N = 60
Scia ic
N = 41
p
Mean SD 95% CI Median IQR Mean SD 95% CI Median IQR
Foo do sal lexo s#5.0 0 5–5 5 5–5 4.8 0.5 4.6-5.0 5 5–5 0.002
Foo plan a lexo s#5.0 0 5–5 5 5–5 4.9 0.3 4.8-5.0 5 5–5 0.006
Foo p ona o s#4.9 0.3 4.8-5.0 5 5–5 4.6 0.6 4.5–4.8 5 4–5 0.002
Foo supina o s#4.9 0.3 4.8-5.0 5 5–5 4.7 0.6 4.5–4.8 5 4–5 0.011
Compa isons we e made using Mann-Whi ney’s U es
# Sco es anged om 0 o 5 (muscle s eng h quan i ied wi h he manual muscle es acco ding o he Medical Resea ch Council Scale o Muscle
S eng h)
Table 4 Foo , lowe limb and low back pain, disabili y ela ed o oo pain and low back pain, and quali y o li e be ween he con ol and scia ic
g oup
Con ol
N = 30
Scia ic
N = 41
p
Mean SD 95% CI Median IQR Mean SD 95% CI Median IQR
Foo pain* 1.9 3.0 1.2–2.7 0 0–4 4.9 3.6 3.7-6.0 6 0.5-8.0 < 0.0012
Lowe limb pain* 1.3 2.3 0.7–1.9 0 0–2 7.6 2.6 6.8–8.4 8 7–10 < 0.0012
Low back pain* 0.8 2.1 0.2–1.3 0 0–0 8.0 2.4 7.3–8.8 9 7–10 < 0.0012
MFPDI 3.5 6.3 1.9–5.2 0 0–5 16.9 10.3 13.7–20.2 20 9.5–23.5 < 0.0012
ODI 3.3 10.6 0.6–6.1 0 0–0 42.9 15.2 38.1–47.7 42 28–54 < 0.0012
SF-12 (Physical) 51.6 7.8 53.6–55.0 55 47.2–57.2 28.9 5.2 27.3–30.6 27.9 25.3–32.5 < 0.0012
SF-12 (Men al) 48.8 8.4 46.6–51.0 49.8 44.6–55.1 42.8 11.2 39.2–46.3 41.4 35.2–50.0 0.0031
1T es o independen samples
2 Mann-Whi ney’s U es
*Sco es anged om 0 o 10 (pain quan i ied wi h he Nume ic Pain Ra ing Sco e 11)
MFPDI: Manches e Foo Pain and Disabili y Index; ODI: Oswes y Disabili y Index
1 3
Eu opean Spine Jou nal
Table 5 Con ac ime, mean p essu e, peak p essu e, and ime when he peak p essu e occu s in he 10 zones in o which he oo is di ided, and
oo p og ession angle. Compa ison be ween he con ol and scia ic g oups
Con ol
N = 60
Scia ic
N = 41
p
Mean SD 95% CI Median IQR Mean SD 95% CI Median IQR
Con ac ime (miliseconds)
HM 67.2 5.8 65.7–68.7 67 63.4–71.4 70.3 6.4 68.3–72.3 71.5 68.3–74.8 0.0032
HL 67.2 5.5 65.8–68.7 66.9 63.6–70.9 73.5 22.3 66.5–80.5 71.5 68.2–74.6 0.0022
MF 67.4 5.8 65.9–68.9 68.1 63.9–71.0 72.1 4.9 70.6–73.7 72.5 69.4–75.6 < 0.0011
M1 80.3 5.7 78.8–81.8 80.4 77.7–83.8 81.8 4.5 80.3–83.2 82.4 79.2–85.0 0.1711
M2 84.0 4.0 82.9–85.0 84.3 81.5–86.2 86.1 3.9 84.8–87.3 86.4 83.5–88.4 0.0101
M3 86.0 3.0 85.2–86.8 86.1 83.89–87.5 87.4 4.1 86.1–88.7 87.8 85.4–89.5 0.0082
M4 84.8 2.9 84.0-85.5 86.1 83.9–87.5 86.5 4.3 85.2–87.9 87 84.8–88.7 0.0022
M5 78.7 4.7 77.5–79.9 79.1 75.4–81.6 81.2 5.1 79.6–82.8 82 78.8–84.6 0.0032
T1 68.5 11.0 65.6–71.3 68 61.6–77.4 71.7 8.5 69.0-74.3 72.5 65.3–78.0 0.1231
T2-5 66.3 13.0 62.9–69.6 67.1 57.6–76.8 69.4 12.4 65.5–73.3 73.3 60.8–77.5 0.1902
Mean p essu e (n/cm2)
HM 11.9 4.6 10.8–13.1 10.7 9.0-13.6 14.1 3.9 12.9–15.3 14 10.7–17.5 0.0022
HL 11.0 4.1 10.0-12.1 10.5 8.1–12.8 13.3 3.6 12.2–14.5 13.4 10–16 < 0.0012
MF 3.3 1.4 2.9–3.6 3 2.2–4.1 4.6 2.2 3.9–5.3 4.3 2.9–5.4 < 0.0012
M1 7.0 3.4 6.1–7.9 5.9 4.4–8.7 8.5 3.9 7.3–9.8 8.1 5.7–10.3 0.0202
M2 10.9 3.9 9.9–11.9 10 8.2–12.9 14.3 6.6 12.2–16.4 12.3 9.3–18.9 0.0132
M3 9.6 3.7 8.7–10.6 8.7 7.4–11.3 13.4 5.0 11.8–14.9 12.2 10.2–16.3 < 0.0012
M4 7.4 3.5 6.5–8.3 6.6 5.1–8.1 10.9 4.5 9.5–12.3 10 8.1–13.4 < 0.0012
M5 4.3 2.3 3.7–4.9 3.8 2.8–5.2 6.2 3.0 5.2–7.1 5.7 3.8–8.3 < 0.0012
T1 5.2 3.3 4.3-6.0 4.6 3.2–5.7 5.8 3.6 4.7–6.9 5.4 3.0-7.1 0.3282
T2-5 2.0 1.1 1.7–2.3 1.7 1.4–2.3 2.7 2.5 2.0-3.5 2.4 1.6–2.7 0.0152
Peak p essu e (n/cm2)
HM 19.3 7.5 17.3–21.2 17.4 14.8–21.6 23.3 6.4 21.3–25.3 22.4 17.5–27.4 < 0.0012
HL 18.4 7.4 16.5–20.4 17 13.8–20.5 22.6 6.6 20.5–24.7 22 16.7–27.4 < 0.0012
MF 6.0 2.5 5.3–6.6 5.7 4.1–7.2 8.7 3.7 7.5–9.8 8.4 5.9–10.5 < 0.0011
M1 15.5 6.8 13.8–17.3 13.9 10.7–18.6 17.5 6.4 15.5–19.5 16.6 12.1–21.0 0.0552
M2 23.5 8.2 21.4–25.6 22.1 18.2–26.4 29.3 13.6 25.0-33.6 24.9 18.3–38.5 0.0482
M3 20.3 7.8 18.3–22.3 18.4 15.3–23.4 27.5 10.3 24.3–30.8 25.5 20.1–35.6 < 0.0012
M4 15.0 7.0 13.2–16.8 13.3 10.4–17.5 22.6 9.2 19.7–25.5 20.4 15.8–29.2 < 0.0012
M5 9.1 4.8 7.9–10.3 7.6 6.2–11.1 13.8 6.7 11.7–15.9 12.3 9.4–17.3 < 0.0012
T1 12.0 6.9 10.2–13.7 9.7 6.8–15.8 12.5 6.6 10.4–14.6 11 7.3–15.7 0.5752
T2-5 4.8 2.4 4.1–5.4 4.2 3.2–6.2 6.5 5.7 4.7–8.3 5.1 4.3–6.6 0.0132
Peak p essu e ime (% s ance phase)
HM 30.8 6.1 29.2–32.4 31 26.5–34.0 33.1 7.9 30.6–35.6 31.8 27.8–36.9 0.2342
HL 29.8 4.5 29.8–28.7 29.4 27.5–32.6 31.0 6.5 29.0-33.1 30.8 27.4–33.1 0.5272
MF 47.7 8.5 45.5–49.9 47.5 41.2–53.5 49.8 10.2 46.6–53.1 51.1 42.4–58.3 0.2531
M1 74.9 4.9 73.6–76.1 76.1 72.8–78.0 74.1 7.7 71.7–76.6 75.9 71.4–79.4 0.7852
M2 77.5 4.0 76.5–78.5 78 76.1–78.9 78.3 3.9 77.1–79.6 78.9 76.3–80.7 0.1562
M3 75.9 4.1 74.8–77.0 76.3 74.3–79.0 77.0 3.7 75.8–78.1 77.4 75.6–79.6 0.0602
M4 71.7 5.4 70.4–73.1 71.6 69.1–75.9 73.6 5.1 71.9–75.2 74.8 71.7–77.0 0.0532
M5 67.4 8.2 65.3–69.6 69.6 63.3–73.8 68.8 8.0 66.2–71.3 71.7 63.3–74.8 0.2962
T1 83.5 6.2 81.9–85.1 85.3 82.3–86.7 81.9 9.0 79.0-84.7 84.1 77.5–88.4 0.6862
T2-5 81.5 6.7 79.7–83.2 83.7 77.8–86.0 82.1 6.4 80.1–84.1 82.9 79.1–86.2 0.7742
Foo p og ession angle 12.3 2.9 10.4–14.2 12.3 6.8–16.2 12.1 5.7 10.0–14.2 10.7 7.8–15.2 0.9141
1T es o independen samples
2 Mann-Whi ney’s U es
1 3
Eu opean Spine Jou nal
Discussion
The main objec i e o ou s udy was o analyze he di e -
ences in plan a p essu e dis ibu ion be ween pa ien s wi h
and wi hou scia ica.The esul s showed ha pa ien s wi h
scia ica exhibi ed a signi ican inc ease in p essu e du ing
gai , as well as a longe con ac ime in all zones excep
The p essu e alues o he 10 zones du ing each o
he 3 unc ional ocke s ( i s ocke = heel ocke ; second
ocke = ankle ocke ; hi d ocke = me a a sal ocke ) a e
shown in Table 6.
Table 6 Mean p essu e in he 10 zones in o which he oo is di ided, in each o he 3 ocke s sepa a ely. Compa ison be ween he con ol and
scia ic g oups
Con ol
N = 60
Scia ic
N = 41
p
Mean SD 95% CI Median IQR Mean SD 95% CI Median IQR
HM
1s ocke 5.9 2.8 5.2–6.7 5.6 4.1–7.2 5.7 2.5 4.9–6.4 5.9 3.6–7.2 0.6071
2nd ocke 12.7 5.0 11.4–14.0 11.3 9.4–14.6 15.0 4.1 13.7–16.3 14.6 11.6–18.3 0.0022
3 d ocke - - - - - - - - - - -
HL
1s ocke 5.9 2.0 5.4–6.5 5.9 4.3–7.1 6.4 2.9 5.5–7.3 6.1 4.1-8.0 0.3881
2nd ocke 11.7 4.5 10.5–12.8 11.1 8.5–13.6 14.1 3.8 12.9–15.3 14.1 10.7–16.9 < 0.0012
3 d ocke - - - - - - - - - - -
M
1s ocke 0.06 0.04 0.04–0.07 0.05 0.03–0.07 0.10 0.15 0.05–0.15 0.04 0.02–0.14 0.9382
2nd ocke 3.6 1.6 3.2-4.0 3.4 2.3–4.7 5.1 2.5 4.3–5.9 4.9 3.2–6.4 0.0022
3 d ocke 0.74 0.76 0.52–0.96 0.42 0.19–1.20 1.07 1.01 0.75–1.40 0.85 0.19–1.73 0.1882
M1
1s ocke - - - - - - - - - - -
2nd ocke 5.1 3.0 4.3–5.9 3.8 2.8–6.5 7.3 3.8 6.1–8.5 6.6 4.6–9.3 < 0.0012
3 d ocke 10.6 4.6 9.4–11.8 9.5 7.7–13.0 11.2 4.9 9.7–12.8 9.7 7.8–14.1 0.5682
M2
1s ocke - - - - - - - - - - -
2nd ocke 7.8 3.2 7.0-8.6 7.3 5.4–9.3 11.4 5.4 9.7–13.1 10 7.6–14.8 < 0.0012
3 d ocke 17.2 5.8 15.7–18.7 16 13.5–19.9 21.3 10.6 17.9–24.6 18.6 13.1–28.3 0.1122
M3
1s ocke - - - - - - - - - - -
2nd ocke 7.4 2.9 6.7–8.2 7 5.2–8.7 11.0 4.4 9.6–12.4 11 7.8–13.1 < 0.0012
3 d ocke 14.1 5.7 12.6–15.5 12.5 10.3–16.6 18.8 7.6 16.4–21.2 17.7 13.0-23.7 < 0.0012
M4
1s ocke - - - - - - - - - - -
2nd ocke 6.4 2.8 5.7–7.1 5.6 4.7–7.5 9.7 4.4 8.3–11.1 8.8 6.9–11.9 < 0.0012
3 d ocke 9.4 5.1 8.1–10.7 8.3 6.1–10.8 13.5 6.1 11.6–15.4 12.6 8.8–18.1 < 0.0012
M5
1s ocke - - - - - - - - - - -
2nd ocke 4.0 2.1 3.4–4.5 3.4 2.7–4.7 5.6 3.0 4.7–6.6 4.5 3.4–7.2 0.0022
3 d ocke 5.1 3.0 4.3–5.8 4.3 2.9–6.6 7.3 4.0 6.0-8.5 6.5 4.7–9.1 0.0032
1
1s ocke - - - - - - - - - - -
2nd ocke 2.7 2.6 2.0-3.4 1.7 0.8–3.5 4.1 3.3 3.0-5.1 3.5 1.5–5.8 0.0162
3 d ocke 10.2 5.9 8.6–11.7 8.8 6.1–13.0 10.3 5.5 8.6–12.1 9.8 5.7–14.1 0.7332
2-5
1s ocke - - - - - - - - - - -
2nd ocke 1.00 0.8 0.8–1.2 0.7 0.5–1.4 1.7 2.0 1.1–2.3 1.10 0.7–1.9 0.0142
3 d ocke 3.7 1.9 3.1–4.2 3.1 2.3–4.7 4.2 1.6 3.7–4.8 4.3 3.1–4.8 0.0402
1T es o independen samples
2 Mann-Whi ney’s U es
1 3
Eu opean Spine Jou nal
no ind a cha ac e is ic gai pa e n desc ibed in he li e a-
u e o pa ien s wi h LDH, he highe load obse ed in all
oo zones excep he i s me a a sal and oes, especially
du ing he push-o phase, could ep esen he i s epo
o a cha ac e is ic gai pa e n ha helps educe symp oms
o hese pa ien s while walking. We belie e ha his di -
e ence in oo load dis ibu ion compa ed wi h no mal ee
was no due o di e ences in oo ype be ween pa ien s
wi h LDH and con ols, as nei he he FPI no he ange o
mo ion o he majo oo join s showed signi ican di e -
ences be ween he wo g oups. Al hough pa ien s wi h sci-
a ica showed lowe gene alized s eng h in all ou ex insic
oo muscle g oups compa ed wi h con ols, we belie e ha
his di e ence was no clinically ele an enough o in lu-
ence a pos u al change in he oo du ing gai (scia ica g oup
median = 5, con ol g oup median = 5, in all muscle g oups;
small e ec size o all muscle g oups: do si lexo s 0.30,
plan a lexo s 0.27, p ona o s 0.30, supina o s 0.25).
In ou s udy, he only empo al pa ame e analyzed was
oo con ac ime du ing gai , which was longe in pa ien s
wi h scia ica. This esul is consis en wi h he indings o
Bonab e al. [24] who obse ed ha pa ien s wi h LDH had
longe s ep du a ion, sho e s ep leng h, and slowe gai
speed compa ed o heal hy adul s in he con ol g oup. The
au ho s a ibu ed hese indings o a p o ec i e esponse in
pa ien s wi h LDH ha minimizes o ces ac ing on he body
ha could cause scia ic pain and o a oid wide anges o
mo ion in he spine and lowe ex emi y. These indings a e
consis en wi h he educed sub ala p ona ion obse ed in
pa ien s wi h scia ica in his s udy and in a p e ious s udy
conduc ed by he same au ho s on ano he pa ien g oup
[27]. Sub ala p ona ion is accompanied by in e nal o a-
ion o he lowe limb [13], which may al e lumbopel ic
mo emen and con ibu e o degene a ion and inc eased
isk o low back pain [12, 28, 29]. By educing p ona ion
and in e nal o a ion o he lowe ex emi y, lumbopel ic
mechanics may be no malized, which could con ibu e o
dec eased comp ession o he ne e oo s o ming he sci-
a ic ne e, he eby sligh ly educing pain du ing walking.
Fu he esea ch is equi ed o con i m his hypo hesis.
Finally, ega ding he pain epo ed by pa ien s in he
scia ica g oup, hey showed highe alues no only a he
lumba and lowe limb le els, as expec ed, bu also in he
oo acco ding o he NPRS-11 scale. Howe e , compa ed
wi h he con ol g oup, pa ien s wi h scia ica demons a ed
disabili y alues ela ed o oo pain simila o hose seen in
o he sys emic musculoskele al condi ions [27]. The e o e,
we belie e ha oo pain associa ed wi h scia ica, al hough
less in ense han low back o lowe limb pain, may also be
ela ed o he signi ican ly lowe quali y o li e epo ed by
pa ien s, a ec ing bo h physically and men ally [30].
o he i s me a a sal and oes, compa ed wi h he con ol
g oup. No di e ences we e obse ed in oo pos u e o oo
p og ession angle be ween he g oups, sugges ing ha he
obse ed changes in plan a p essu e may be mo e ela ed
o neu omuscula compensa ion mechanisms han s uc u al
oo de o mi ies. Neu omuscula compensa ion mecha-
nisms a e adap i e esponses ha he neu omuscula sys em
employs o main ain unc ionali y and mo emen e iciency
du ing lumba disc he nia ion. These compensa ion s a e-
gies educe pain and p ese e mo emen e ec i eness,
o en a he expense o ene gy and mechanical e iciency.
To he bes o he au ho s’ knowledge, his is he i s
s udy o p o ide in o ma ion on plan a p essu e du ing he
h ee unc ional ocke s o gai in pa ien s wi h ch onic lum-
ba adicula pain due o lumba disc he nia ion. Quan i a-
i e analysis o oo p essu e du ing gai is inc easingly used
in bo h esea ch and clinical p ac ice. P e ious s udies ha e
epo ed al e ed gai empo al pa ame e s in pa ien s wi h
ch onic low back pain [22, 23], including hose wi h lum-
ba disc he nia ion [24]. Howe e , he applica ion o pedo-
ba og aphy du ing gai in pa ien s wi h neu ocomp essi e
condi ions has been epo ed in only a ew s udies [18, 25,
26]. Kanna e al. [18] in es iga ed how lumba adiculopa-
hy a ec s plan a p essu e dis ibu ion and ound ha peak
and mean oo loads we e signi ican ly lowe on he a ec ed
side du ing gai . Addi ionally, he load dis ibu ion was
asymme ic, a o ing he medial a ch and he i s me a a -
sal head on he a ec ed side. Ou s udy p esen s opposing
esul s, as he a ec ed side had a highe mean oo load han
he con ol g oup.
Mo eo e , he load was dis ibu ed di e en ly, wi h pa -
icipan s in ou s udy exhibi ing highe p essu e in all oo
zones excep o he i s me a a sal and g ea e p essu e
on he lesse me a a sals, pa icula ly du ing he push-o
phase o gai . Pa icipan s in he scia ic g oup exhibi ed
highe p essu es han con ols in he second ocke , om
he heel h ough all i e me a a sals, and signi ican ly highe
p essu es in me a a sals 3 o 5 du ing he hi d ocke . This
disc epancy may be a ibu ed o di e en pos u al compen-
sa ion pa e ns.
Wei e al. [25]. analyzed plan a p essu e dis ibu ion
in pa ien s wi h LSS be o e and a e he onse o neu o-
genic in e mi en claudica ion (NIC). Thei esul s showed
a signi ican inc ease in o e oo load and con ac a ea a e
he onse o NIC, along wi h a dec ease in he heel a ea.
In ano he s udy, Wei e al. [26] epo ed ha he medial-
la e al displacemen o he cen e o p essu e p og essi ely
inc eased wi h walking dis ance in pa ien s wi h LSS,
e lec ing a balance dys unc ion. These au ho s associa ed
he asymme ic load dis ibu ion in he oo wi h a endency
owa d o wa d lumba lexion du ing gai o alle ia e he
symp oms o ne e oo comp ession [25]. Al hough we did
1 3
Eu opean Spine Jou nal
Da a a ailabili y No da ase s we e gene a ed o analysed du ing he
cu en s udy.
Decla a ions
Compe ing in e es s Funding: This esea ch was unded by he Socie-
dad Española de Biomecánica y O opodología-.
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Re e ences
1. Van Boxem K, Cheng J, Pa ijn J e al (2010) 11. Lumbosac al
adicula pain. Pain P ac 10:339–358. h p s : / / d o i . o g / 1 0 . 1 1 1 1 / j . 1
5 3 3 - 2 5 0 0 . 2 0 1 0 . 0 0 3 7 0 . x
2. Dowe A, Da ies MA, Ghah eman A (2019) Pa hologic basis o
lumba adicula pain. Wo ld Neu osu g 128:114–121. h p s : / / d o i
. o g / 1 0 . 1 0 1 6 / j . w n e u . 2 0 1 9 . 0 4 . 1 4 7
3. Eu ope PA (2017) Su ey on ch onic pain 2017. Diagnosis, T ea -
men and Impac o Pain. B ussels
4. Rod íguez MJ, Ga cía AJ (2007) Cos es Del Dolo neu opá ico
Según e iología En Las unidades Del Dolo En España. Re Soc
Esp Dolo 14:404–415
5. Da is D, Maini K, Taqi M, Vasude an A (2024) Scia ica. S a -
Pea ls [In e ne ]. S a Pea ls Publishing, T easu e Island (FL)
6. Abdalla M, Mos o i A, Sh aya A, Johns on FG (2022) Acu e oo
d op seconda y o lumba disc p olapse a e seizu e. B J Neu-
osu g 36:524–526. h p s : / / d o i . o g / 1 0 . 1 0 8 0 / 0 2 6 8 8 6 9 7 . 2 0 2 0 . 1 8 3 9
6 3 2
7. Ma J, He Y, Wang A e al (2018) Risk ac o s analysis o oo
d op associa ed wi h lumba disc he nia ion: an analysis o 236
pa ien s. Wo ld Neu osu g 110:e1017–e1024. h p s : / / d o i . o g / 1 0 . 1
0 1 6 / j . w n e u . 2 0 1 7 . 1 1 . 1 5 4
8. Ma chesini N, Ricci UM, Soda C, Teli M (2023) Acu e bila e al
oo d op due o lumba disc he nia ion ea ed by bila e al in e -
lamina app oach: case epo and li e a u e e iew. B J Neu o-
su g 37:899–901. h p s : / / d o i . o g / 1 0 . 1 0 8 0 / 0 2 6 8 8 6 9 7 . 2 0 2 0 . 1 7 1 3 9
9 2
9. Deyo RA, Weins ein JN (2001) Low back pain. N Engl J Med
344:363–370. h p s : / / d o i . o g / 1 0 . 1 0 5 6 / N E J M 2 0 0 1 0 2 0 1 3 4 4 0 5 0 8
10. Yazdani F, Razeghi M, Ka imi MT e al (2018) The in luence o
oo hype p ona ion on pel ic biomechanics du ing s ance phase
o he gai : A Biomechanical simula ion s udy. P oc Ins Mech
Eng [H] 232:708–717. h p s : / / d o i . o g / 1 0 . 1 1 7 7 / 0 9 5 4 4 1 1 9 1 8 7 7 8 0
7 7
11. Camb on JA, Dua e M, Dexheime J, Solecki T (2011) Shoe
o ho ics o he ea men o ch onic low back pain: a andom-
ized con olled pilo s udy. J Manipula i e Physiol The 34:254–
260. h p s : / / d o i . o g / 1 0 . 1 0 1 6 / j . j m p . 2 0 1 1 . 0 4 . 0 0 4
12. Chou MC, Huang JY, Hung YM e al (2021) Fla oo and spinal
degene a ion: e idence om na ionwide popula ion-based coho
This s udy has some limi a ions. A po en ial limi a ion
o his s udy is ha he uni o analysis was he oo , a he
han he indi idual pa icipan s; in he scia ica g oup, only
he a ec ed limb was analyzed, while he non-a ec ed limb
was excluded o a oid po en ial bias due o compensa o y
biomechanical and an algic adap a ions. In addi ion, we did
no in es iga e limb p edominance. Al hough his app oach
was in ended o ensu e ha plan a p essu e measu emen s
e lec ed he di ec impac o scia ic in ol emen , u u e
s udies should conside compa ing bo h limbs o u he
explo e in e limb compensa o y mechanisms and hei clini-
cal implica ions. Ano he limi a ion is he s udy’s unique-
ness, meaning ha plan a p essu e was no compa ed wi h
ha o pa ien s wi h o he neu ocomp essi e pa hologies,
which would ha e con ibu ed o es ing he hypo hesis o
a po en ial speci ic oo load pa e n in pa ien s wi h LDH.
The al e a ions ound in he oo load dis ibu ion in
pa ien s wi h adiculopa hy, as well as he ela ed oo pain,
a e abno mali ies ha a e no obse ed in a isual clini-
cal examina ion o he pa ien . The e o e, we belie e i is
impo an o include he s udy o plan a p essu es and oo
pain in he e alua ion o hese pa ien s. These measu emen s
can be use ul o assessing neu omuscula unc ion in neu-
ocomp essi e diso de s ela ed o LDH and may suppo a
b oade and mo e a ied he apeu ic app oach ha bene i s
pa ien s. In addi ion, inco po a ing his ype o assessmen
could help iden i y speci ic gai adap a ions, allowing o
a ge ed in e en ions o imp o e unc ional ou comes and
pa ien com o .
Conclusions
Pa ien s wi h scia ica caused by LDH who pa icipa ed in
his s udy exhibi ed al e a ions in plan a p essu e compa ed
wi h heal hy indi iduals. O e all, inc eased con ac ime
and highe - han-no mal mean p essu e we e obse ed in all
oo a eas excep o he i s oe, along wi h highe peak
p essu e in all oo zones excep o he big oe and i s
me a a sal. P essu e was concen a ed in he hi d, ou h,
and i h me a a salsand in he lesse oes du ing push-o
phase o gai .
Au ho con ibu ions Concep ualiza ion, P.V.M.-M. and Á.V.-M;
me hodology, P.V.M.-M; so wa e, C.V.-B; alida ion, I.C.P.-T.; o -
mal analysis, P.V.M.-M.; in es iga ion, M.R.-B. and C.V.-B. esou ces,
P.V.M-M; da a cu a ion, M.JG.-R; w i ing—o iginal d a p epa a ion,
P.V.M.-M; w i ing— e iew and edi ing, M.R.-B and M.J.G-R.;; su-
pe ision, P.V.M.-M; p ojec adminis a ion, I.C.P.-T.; unding acqui-
si ion, G.D.-M.
Funding Funding o open access publishing: Uni e sidad de Se illa/
CBUA
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