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

## TL;DR

This study explores how footwear choices affect plantar fasciitis symptoms in Saudi women, finding that frequent high heel use is linked to increased pain.

## Contribution

The study identifies specific footwear habits, like high heel frequency, as risk factors for plantar fasciitis in Saudi women.

## Key findings

- Frequent high heel use is significantly associated with pain after standing, a key PF symptom.
- General shoe type showed no direct association with PF symptoms.
- PF is linked to greater functional limitations and lower quality of life scores.

## Abstract

Plantar fasciitis (PF) is a common foot condition in adult women, influenced by footwear choices. Although risk factors for PF have been studied, limited research has focused on the link between footwear choices and PF symptoms among Saudi women. Cultural habits, such as frequent use of high heels and sandals, may contribute to PF, highlighting the importance of understanding this relationship for effective prevention and management. This study aimed to examine the influence of footwear choices on the prevalence of PF among adult women in Saudi Arabia to inform awareness campaigns and guide appropriate footwear recommendations. This cross-sectional study examined the impact of footwear choices on PF symptoms among 401 adult women in Saudi Arabia. Data were collected over period of 8 weeks using an online questionnaire incorporating the Foot Health Status Questionnaire (FHSQ). Descriptive and inferential statistical analyses were conducted using SPSS to assess associations between footwear types and PF symptoms. PF-related symptoms were highly prevalent, with 58.4% of participants reporting pain after prolonged standing, no significant associations were found between general shoe type and PF symptoms (p > 0.05). However, significant associations emerged between pain after standing and the frequency of high heel use (p = 0.047), as well as between shoe type and the regular use of high heels or thick soles (p = 0.046). PF was also linked to significantly greater functional limitations and lower quality of life scores (Cohen’s d =  − 2.40). Frequent use of high heels was significantly linked to pain after standing, a key symptom of PF, while general shoe type showed no direct association. This emphasizes the importance of assessing specific footwear habits rather than broad categories when evaluating PF risk. Encouraging the use of supportive footwear with proper arch support and cushioning may reduce PF symptoms. Future studies should focus on culturally appropriate footwear interventions.

The online version contains supplementary material available at 10.1038/s41598-025-24122-4.