Footwear choices and their association with plantar fasciitis among adult women in Saudi Arabia: a cross-sectional study

Key points

1. 0158.4% of 401 adult women reported pain in the soles after prolonged standing, the most common plantar fasciitis symptom
2. 02Frequent high heel use was significantly associated with pain after standing (p = 0.047), but not with stabbing heel pain, heel swelling, or morning pain
3. 03General daily shoe type (sports shoes, flats, sandals, heels) showed no statistically significant association with any plantar fasciitis symptom (all p > 0.05)
4. 04Binary logistic regression found no significant footwear predictors of plantar fasciitis when adjusting for BMI and physical activity (overall model p = 0.500)
5. 05Women with plantar fasciitis reported significantly lower quality of life scores and greater functional limitations in stair use compared to those without

How it was conducted

Design

Cross-sectional survey study conducted over 8 weeks

Participants

401 adult women aged 20 and older living in Saudi Arabia, recruited via convenience sampling through online platforms

Outcome measure

Self-reported plantar fasciitis symptoms assessed via the Arabic Foot Health Status Questionnaire (FHSQ-Ar); four symptom domains: foot pain, foot function, footwear, and general foot health

Footwear assessment

Daily shoe type, frequency of high heel use, average heel height, hours of wear per day, and use of cushioned insoles or orthotics

Analysis

Chi-square tests, binary logistic regression adjusted for BMI and physical activity, independent-samples t-tests, and effect size (Cohen's d)

Exclusions

Women with prior foot surgery, systemic arthritis, neurological conditions, lumbar radiculopathy, or diabetes-related foot complications

What they found

• 58.4% of participants reported pain in the soles after prolonged standing; 16.0% reported severe morning pain; 15.7% stabbing heel pain; 8.2% heel swelling or sensitivity
• Significant association between frequency of high heel use and pain after standing: chi-square(3, N=401) = 7.94, p = 0.047
• Significant association between shoe type and regular use of thick-soled or high-heeled shoes: chi-square(5, N=401) = 11.27, p = 0.046
• No significant association between general daily shoe type and stabbing heel pain (p = 0.598), heel swelling (p = 0.851), or pain after standing (p = 0.653)
• Binary logistic regression: overall model chi-square(9, N=401) = 8.35, p = 0.500; no individual footwear predictor reached p < 0.05; use of cushioned insoles or orthotics showed OR = 1.807, p = 0.074 (non-significant)
• Functional limitation (stair use): women with plantar fasciitis scored M = 1.30 +/- 1.13 vs. M = 0.53 +/- 0.89 without plantar fasciitis; t(399) = 7.18, p < 0.001, Cohen's d = 0.78
• Quality of life: women with plantar fasciitis scored M = 6.26 (SD 3.02) vs. M = 1.97 (SD 2.19) without; t(399) = -14.903, p < 0.001, Cohen's d = 1.63

Limitations

• Cross-sectional design prevents establishing causal direction between footwear habits and plantar fasciitis symptoms
• Plantar fasciitis was diagnosed by self-reported symptom checklist without clinical examination or imaging, introducing risk of misclassification
• Convenience sampling via online platforms (WhatsApp, social media) limits representativeness; 82% of participants were aged 20-35 and 65.6% were students, limiting generalizability to older or working women
• Very few participants reported wearing sandals (1.7%) or high heels (2.7%) as primary footwear, limiting statistical power to detect associations for these culturally relevant shoe types

Why it matters

For patients

Women who frequently wear high heels may experience more foot pain after prolonged standing, and switching to supportive footwear with arch cushioning may help reduce symptoms.

For clinicians

Assessing specific footwear habits, particularly frequency of high heel use, is more informative than broad shoe category when evaluating plantar fasciitis risk; a multifactorial approach including ergonomics, load management, and body weight is warranted.

For readers

This study adds culturally specific evidence from Saudi Arabia showing that footwear type alone does not predict plantar fasciitis, and that the condition carries a large quality-of-life burden regardless of shoe choice.