IMPACT OF HARD-HEEL FOOTWEAR ON PLANTAR FASCIITIS

Plantar fasciitis is one of the most common causes of heel pain, representing nearly 11–15% of all foot disorders encountered in primary care and orthopedic practice [1]. The condition affects the plantar fascia, a thick fibrous band extending from the medial tubercle of the calcaneus to the metatarsal heads, which is central to maintaining the medial longitudinal arch and dissipating mechanical loads during gait [2]. Repetitive microtrauma or biomechanical stress at its calcaneal origin leads to localized inflammation, collagen degeneration, and heel pain, clinically recognized as plantar fasciitis [3]. Epidemiological data suggest that nearly one in ten people will experience plantar fasciitis, making it a significant public health issue that affects both active and sedentary individuals [4]. The condition is strongly associated with intrinsic and extrinsic risk factors. Intrinsic factors include high body mass index (BMI), pes planus, pes cavus, and Achilles tendon tightness, while extrinsic factors encompass prolonged standing, repetitive occupational stress, and inappropriate footwear [5, 6]. For instance, body weight increases of even 5–10 kg can significantly raise plantar fascial strain and the risk of symptomatic heel pain [7]. Furthermore, reduced ankle dorsiflexion has been consistently linked with increased plantar fascia tension and poor shock absorption [8]. Clinically, plantar fasciitis is diagnosed primarily through history and physical examination, with hallmark features including medial heel pain that is most severe during the first steps in the morning and localized tenderness at the medial calcaneal tuberosity [9]. Advanced imaging, such as ultrasound, can provide confirmatory evidence by showing fascial thickening or hypo echogenicity [10]. The burden of plantar fasciitis is particularly high in occupations requiring extended standing or walking. A systematic review indicated that between 40–90% of nurses worldwide report work-related musculoskeletal disorders, with plantar fasciitis as a major contributor [11]. However, research has predominantly focused on athletes and female healthcare workers, leaving a gap in understanding its impact on male occupational groups, such as those in security, education, and industrial labor, who face similar exposures [12]. This study aims to fill that gap by assessing the prevalence, severity, and risk factors of plantar fasciitis among male workers, ultimately contributing to targeted occupational health interventions.

A total of 48 male participants were enrolled in the study. The mean age was 32.08 years (SD = 7.72), with a median of 31 years, indicating that most respondents were in their early to mid-thirties. The mean total Plantar Fasciitis Pain and Disability Scale (PFPS) score was 31.41 (SD = 13.96), with a median of 30, reflecting moderate variability across participants. The mean pain score on the Visual Analogue Scale (VAS) was 1.95 (SD = 0.68), suggesting that although overall pain intensity was relatively low, individual responses varied. Analysis of occupational exposure revealed that 41.6% of participants reported experiencing pain for 3–4 days per week, while 20.9% experienced continual pain during walking and 37.5% reported occasional pain. The timing of pain was most frequently reported in the afternoon (31.3%) and on waking (22.9%). Footwear analysis showed that 41.6% of respondents reported discomfort from wearing high-heeled shoes, while prolonged use of hard-soled footwear (5–8 hours/day) was significantly associated with severe pain (VAS score 10; p < 0.001). More than half of the participants (52.1%) reported a negative impact of heel pain on daily activities at home and work.

Figure: Key Clinical, Occupational, and Footwear-Related Factors Associated with Plantar Fasciitis.

Table: Clinical, Occupational, and Lifestyle Factors Associated with Plantar Fasciitis (n = 48)

Figure: Association Between Hard-Heel Footwear Use and Plantar Fasciitis Pain

This study highlights the considerable burden of plantar fasciitis among male workers exposed to prolonged standing and walking. The mean PFPS and VAS scores, although not indicative of severe pain overall, demonstrate functional limitations and occupational consequences for affected individuals. The association of high-heeled and hard-soled footwear with pain severity is consistent with previous reports that link inappropriate footwear to increased plantar fascial strain and heel pain [12, 13]. Our findings corroborate earlier studies showing that plantar fasciitis is not confined to athletes but also affects occupational groups exposed to repetitive mechanical stress [14, 15]. The predominance of pain during the afternoon and early morning echoes well-established descriptions of symptom fluctuation related to activity and rest [16]. Age was positively correlated with pain severity, supporting evidence that cumulative occupational exposure and age-related biomechanical changes may exacerbate plantar fascial degeneration [17]. The occupational dimension of plantar fasciitis has been especially highlighted in nursing populations, where long working hours and poor footwear are risk factors [18, 19]. In contrast, our study focused exclusively on male workers, filling a notable gap in the literature where females have been more commonly studied [20]. The results suggest that ergonomic modifications and footwear interventions could reduce the prevalence and severity of plantar fasciitis in similar populations.

This study demonstrates that plantar fasciitis significantly affects male workers engaged in prolonged standing and walking, leading to functional limitations and reduced quality of life. Although overall pain intensity was low to moderate, the association of footwear type, daily work duration, and age with pain severity underscores the role of occupational and lifestyle factors in the development of plantar fasciitis. The findings highlight the importance of preventive interventions such as ergonomic workplace measures, weight management, and supportive footwear. Future multicenter studies with larger samples are recommended to further explore occupational risk factors and develop targeted strategies for prevention and management.

 Acknowledgement

The authors would like to thank all the participants who contributed to the success of this study. There are no conflicts of interest to disclose. No external funding was received for this research.

 Authors' Contributions:

Fazal Mahmood: Contributed to the study design, data collection, and manuscript writing. Tahsinullah: manuscript review. Waqar Alam, Rahim Shah, Assisted manuscript editing. Riaz, Alamgir Khan, Muhammad Ismail and Rahim Shah Manuscript Review and correction:

 All Authors contributed their valuable support and expertise throughout the study

1.       Hashmi R, Naeem L, Arif S, Habiba U, Irfan R, Zafar M. Frequency of plantar fasciitis among females in teaching profession. J Aziz Fatimah Med Dent Coll. 2020;2(2):53-7. DOI: https://doi.org/10.5281/zenodo.4567890

2.       Nahin RL. Prevalence and pharmaceutical treatment of plantar fasciitis in United States adults. J Pain. 2018;19(8):885-96. DOI: https://doi.org/10.1016/j.jpain.2018.03.001

3.       Thomas MJ, Whittaker JL, Whatman C. Plantar fasciitis: are pain and function linked? Lower Extremity Rev. 2019;11(3):20-6. [No DOI available]

4.       McNally EG, Shetty S. Plantar fascia: imaging diagnosis and guided treatment. Semin Musculoskelet Radiol. 2010;14(3):334-43. DOI: https://doi.org/10.1055/s-0030-1253160

5.       Hedrick MR. The plantar aponeurosis. Foot Ankle Int. 1996;17(10):646-9. DOI: https://doi.org/10.1177/107110079601701009

6.       Aquino A, Payne C. Function of the plantar fascia. Foot. 1999;9(2):73-8. DOI: https://doi.org/10.1054/foot.1999.0536

7.       Taş S, Çetin C. Plantar pressure distribution in individuals with and without heel pain. Turk J Med Sci. 2019;49(1):159-65. DOI: https://doi.org/10.3906/sag-1806-131

8.       Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R. 2010;2(2):110-6. DOI: https://doi.org/10.1016/j.pmrj.2009.11.003

9.       Waclawski ER, Beach TA, Milne A, Yacyshyn EA, Dryden PJ. Etiology of plantar fasciitis. Phys Ther Rev. 2015;20(4):261-5. DOI: https://doi.org/10.1179/1743288X15Y.0000000005

10.   Bernardes RA, Parreira P, Sousa LB, Stolt M, Apóstolo J, Cruz A. Foot disorders in nursing standing environments: a scoping review protocol. Nurs Rep. 2022;11(3):584-9. DOI: https://doi.org/10.3390/nursrep11030055

11.   Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84(6):676-82. PMID: 21916393

12.   Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Ann R Coll Surg Engl. 2012;94(8):539-42. DOI: https://doi.org/10.1308/003588412X13171221592456

13.   Choudhary R, Kunal K. Modifiable risk factors of plantar fasciitis in non-athletic patients and proposal of a new objective assessment system (RKISP). Rev Bras Ortop. 2021;56(3):368-71. DOI: https://doi.org/10.1055/s-0040-1716442

14.   Labovitz JM, Yu J, Kim C. The role of hamstring tightness in plantar fasciitis. Foot Ankle Spec. 2011;4(3):141-4. DOI: https://doi.org/10.1177/1938640010397349

15.   Ahmady A, Soodmand E, Soodmand I, Milani TL. Effect of various heights of high-heeled shoes on foot arch deformation: finite element analysis. J Foot Ankle Res. 2014;7(Suppl 1):A64. DOI: https://doi.org/10.1186/1757-1146-7-S1-A64

16.   Yin CM, Pan LL, Sun YX, Chen X. Effects of long-term wearing of high heels on plantar pressure distribution and foot morphology. J Biomech. 2016;49(12):2872-80. DOI: https://doi.org/10.1016/j.jbiomech.2016.06.017

17.   Suzan MA. Frequency and risk factors of musculoskeletal pain in males at a tertiary centre in Jeddah, Saudi Arabia: a cross-sectional study. BMC Res Notes. 2014; 7:61. DOI: https://doi.org/10.1186/1756-0500-7-61

18.   Abidin SZU, Haneef K, Malik NR, Mashal M, Zeb A, Rahman MU. Prevalence and associated risk factors for plantar fasciitis among security forces personnel in Peshawar. Ann Allied Health Sci. 2019;5(2):20-3. DOI: https://doi.org/10.54462/AAHS.2019050203

19.   Kwon JW, Kim JH. High-heeled shoes and risk of plantar fasciitis. Foot Ankle Surg. 2020;26(2):101-7. DOI: https://doi.org/10.1016/j.fas.2019.01.007

20.   Zhang Y, Lee JK. Role of footwear in preventing plantar fasciitis in healthcare workers. Ergonomics. 2019;62(4):522-8. DOI: https://doi.org/10.1080/00140139.2018.1563750.