Investigation of the relationship of foot-ankle characteristics with postural control, psychosocial status and quality of life in chronic nonspecific low back pain

Low back pain (LBP) is a common public health problem worldwide. LBP that is not caused by specific causes such as fracture, radiculopathy or inflammation is defined as nonspecific low back pain (NSLBP). When NSLBP persists for 3 months or more, it is called chronic NSBP (CNSLBP). NSLBP can be caused by sedentary lifestyle, biomechanical malalignment, loss of activation in the muscles responsible for lumbopelvic motor control. Although the foot-ankle is a distal component, it is an important structure that provides shock absorption, creates a mobile-adaptive joint surface, creates the foot-ankle balance strategy, minimizes secondary trauma to the upper joints and helps structures such as the knee, hip and lumbopelvic region to perform their functions at optimal levels in terms of biomechanical smoothness in terms of kinetic chain. When the literature was examined, it was found that the detailed examination of foot-ankle characteristics in patients with CNSLBP was insufficient, and the existing studies were mostly concerned with the physical parameters of clinical measurements. In this context, the aim of our study was to examine the relationship between foot-ankle characteristics and postural control, psychosocial status and quality of life in patients with CNSLBP. As a result of the study, an increase in left dorsiflexion muscle strength in the eyes open position was associated with improvement in postural control in all measurements (MLSI, APSI, OSI), while an increase in right plantar flexion muscle strength in the eyes closed position was associated with improvement in anteroposterior stability. The increase in left inversion muscle strength was found to be associated with improvement in balance scores in terms of left single leg balance test. The increase in left dorsiflexion muscle strength was found to be associated with improvement in kinesiophobia scores. In the eyes open position, increase in left dorsiflexion range of motion values was associated with an increase in mediolateral stability, while increase in left eversion range of motion values was associated with improvement in postural control in terms of anteroposterior stability and overall stability. In eyes closed position, increase in left dorsiflexion range of motion values was associated with improvement in postural control in terms of anteroposterior stability and overall stability. The increase in left plantar flexion range of motion values was found to be associated with improvement in kinesiophobia scores. Increase in left plantar pressure perception was found to be associated with improvement in postural control in all directions in the eyes open position, whereas it was found to be associated with improvement in anteroposterior oscillations and overall stability index in the eyes closed position. The increase in left foot-ankle proprioception was found to be associated with improvement in the balance parameter in terms of the single leg balance test variable. It is thought that our study results will form the basis for future longitudinal studies to investigate the effectiveness of foot-ankle focused rehabilitation programmes in people with CNSLBP.