GAIT BIOMECHANICS AND FOOTWEAR: SEX-BASED KINEMATIC AND SPATIOTEMPORAL DIFFERENCES – A CROSS-SECTIONAL STUDY

Abstract

Importance: Understanding the biomechanical impacts of common everyday footwear, in relation to sexual dimorphism, is crucial for clinical practice and therapeutic planning. Objective: To analyze and compare the kinematic and spatiotemporal gait parameters between healthy men and women during barefoot walking and while wearing flip-flops and shoes. Design: A quantitative, comparative, cross-sectional study. Setting: Kinesiology and Functional Assessment Laboratory, Universidade Federal de Pernambuco. Participants: Fifty healthy adults (25 men and 25 women). Exposures: Straight-line walking at a comfortable, self-selected speed under three conditions: barefoot, wearing flip-flops, and wearing shoes. Main Outcomes and Measures: Three-dimensional evaluation of spatiotemporal variables (walking speed, stride length, step width, and stance and swing phase durations) and lower limb joint angles (hip, knee, and ankle) captured via 3D motion capture. Results: Shoe use significantly increased mean walking speed, stride length, step width, and stance phase duration. A significant interaction between footwear and sex was identified: women required a greater hip range of motion (ROM) when wearing flip-flops, whereas men exhibited an abrupt increase in plantar flexion and total ankle ROM exclusively when wearing shoes. Conclusions and Relevance: Gait biomechanics are modulated by the interaction between footwear and sex. Men and women adopt distinctly different neuromotor strategies to overcome the instability of loose footwear or the rigidity of closed shoes. The findings demonstrate that footwear prescription in rehabilitation should not be generalized; considering sexual dimorphism is necessary to ensure the footwear acts as a biomechanical facilitator and prevents overload on specific joints.