Prevalence of forefoot pain

among the high heel wearing

female at Savar area in
Bangladesh
Presented by Guidance by

Md. SAJJAD HOSSAIN KHAN Dr. Md. OMAR SHARIF AHMED

CHOWDHURY
Exam Roll:1520
Class Roll:05
Reg. no: G/Phy-2085/17 BPT
Batch:32nd

Department of Physiotherapy
Forefoot is the anterior portion of the foot formed by five
metatarsals, fourteen phalange bones, and soft tissues.
Forefoot pain is a general term of  pain which localized  at
the area of the metatarsophalangeal joints. Symptoms can
range from a burning sensation to a numbness, or it could
just be that it is really painful to walk.
As a biomechanical aspect, shoe wear plays a significant
role in the process of walking and standing. Heel height,
as well as the thickness of the sole, may impact the
distribution of weight and consequently affect locomotion.
High-heeled shoes place additional weight on the ball of
the foot and narrow pointed shoes squeeze the toes
together. Tight fitting shoes in the toe-box can also
aggravate forefoot pain by compressing soft tissue and
restricting blood and nerve supply.
 RESEARCH QUESTION

 WHAT IS THE PREVALENCE OF

FOREFOOT PAIN AMONG THE FEMALE
WHO ARE WEARING HIGH HEELS, LIVES
IN SAVAR?
 Study Objectives
1.General Objective
 To find out the prevalence of forefoot pain

2.Specific Objectives
 To find out the socio-demographic factors of the
respondents.
 To establish female awareness on wearing high heel
shoes.
 To determine the prevalence and impact of forefoot
pain for wearing high heels
 RESEARCH METHODOLOGY
Conceptual Framework
Independent Variables Dependent Variable

Socio Demographic Variables:

Age, Marital status, Education,
Economical status
Forefoot pain of high
heel wearing female
Factor Related Variables:
Duration of time wearing high
heels, heel height, heel type,
personal perception

Forefoot pain Related Variables:

Affected muscle, feel pain, pain
site, unable walk, pattern of pain.
 Study Design
 It was a quantitative type of Cross-sectional study

 Target Population & Sample Population

 The sample population was collected from high heels wearing female who
lives in Savar were selected for the study.

 Study Site & Area

 Savar New Market, Savar, Dhaka
 Sena Shopping Complex, Nobinagor, Savar, Dhaka
 City Centre, Savar, Dhaka

 Study Period
 This study conducted for the duration of 4 months.

 Sample Size
 Data were collected from 35 willing respondents.
 Sampling Technique
 Non randomized purposive sampling technique was applied to collect
the data.

 Data Collection Tools

 A pretested, modified, interviewer administrated, Self-generated
questionnaire were used to collect the data

 Data Management & Analysis Plan

 All the variables were defined by Statistical Package for Social Science
(SPSS) version 16.0 in accordance with the questionnaire before data
entry were done. After complication of data collection, each question
was checked thoroughly for consistency and completeness. Data entry
was done by the researcher himself. Data were cleaned and edited and
analysis plan was structured in relevance to study objectives.
Distribution of continuous variables was checked for normality.
Construction of new variables and recoding of some variables were
done as per the requirement of analysis.
 Ethical Considerations
 The research first introduced himself with the respondents. She then
gave them the assurance that the response of the respondents will be
used only for the Academic purpose. Then the research told them
that their name will be keep secret. All kind of privacy is confirmed
and rejection from the patient are first priority. They also told that
this information will only use for benefit for physiotherapy
profession and the improvement in health and decrease occupational
hazard.
 
 Limitations of the Study
 It is generally accepted that every researcher is persistent by money,
manpower and time. Despite of all positive initiative taken to
conduct this study properly, the finding of the study had a number
of limitation.

1. Forefoot pain can recorded by high heel wearing shoes.

 Inclusion Criteria
• Females
• 18-40 years of age
• Wearing high heels regularly on working days
• Heel height at least 2.5cm-5cm and above.
• Post-traumatic foot pain
• Previously operated ankle or foot
• Age >40 years
• Females not wearing high heels
 Exclusion Criteria
• Post-traumatic foot pain
• Previously operated ankle or foot
• Age >40 years
• Female not wearing high heels
 QUESTIONNAIRE
Name ID
Prevalence of the Forefoot Pain among High Heel Wearing Female at
Savar area in Bangladesh
Section A:Socio-demographic Variables
SL.NO QUESTIONS RESPONSES

01 AGE ___________YEAR

02 Wight ____________Kg

03 Height ____________Inch

04 Marital status 1.Married

2.Unmarried
3.Divorce
05 Educational Background 1.No formal education
2.Primary
3.Secondary
4.Higher Secondary

06 Economic Status 1.Very poor

2.Poor
3.Rich
4.Very rich
Section B: Factor related Variable
SL.NO QUESTIONS RESPONSES

01 Since how long are you wearing your high heels? 1.Less than 1 year
2.1-2 years
3.3-4 years
4.5 years or more
02 How many days do you wear high heels per week? 1.3 days
2.4 days
3.5 days 4.More

03 How long a day do you put your high heels on? 1.4 hours
2.5 hours
3.6 hours 4.More time

04 Height of your heels? 1.1-2 inch

2.3-4 inch
3.4-5 inch
4.5-6 inch
05 Type of high heel you wear? 1. Wedge
2.Ankle strap
3. Platform heel
4. Cone/pencil heel
06 What is your personal perception of wearing high heel 1. To look professional
shoes? 2. Due to short height
3. As a fashion
4. Any other
Section C: Forefoot Pain Related Variable

07 Have you experienced any tightness in your calf/leg 1.None

muscles? 2.Mild
3.Moderate
4.Severe
08 Have you ever felt any hard skin below your big toe? 1.None
2.Mild
3.Moderate
4.Severe
09 Have you had to use soft pads in your toe box/special 1.never
shoes? 2.Sometimes
3.Most of times
4.Always
10 Have you been able to walk on uneven ground? 1.Yes easily
2. With little difficulty
3.With moderate difficulty
4. With extreme difficulty
11 Do your feet hurt in heels? 1.Yes
2.No
12 Have you been troubled by pain in foot after putting of 1.Yes
your heels? 2.No
13 What are the areas of severe pain while wearing high 1.Forefoot
heels? 2.Middle of foot
3.Heel
4.None
14 What is the intensity of your pain? 1.0(no pain)
2.2-4(mild-moderate)
3.6-8(severe pain)
4.10(worst pain)
 RESULT
Distribution of respondents by felling pain in foot after putting heels

Pain Frequency Percent Mean Std. Deviation

Yes 24 68.6    

No 11 31.4 1.3143 .47101

Total 35 100.0    

MEAN±SD 1.31±0.47

This table showed that respondents complaining of foot pain after putting off their
heels were 68.6% of the total population while 31.4% of them responded with no
pain. It means that more than half of the study population suffered from pain in foot
after putting their high heels off. Mean of the sample was 1.3143 while the standard
deviation was .47101.
 Distribution of respondents by the areas of severe pain while wearing high heels

Areas of pain Frequency Percent Mean Std. Deviation

Forefoot 20 57.1    

Middle of foot 5 14.3    

Heel 3 8.6 1.9143 1.22165

None 7 20.0    

Total 35 100.0    

MEAN±SD 1.91±1.22

This tabel showed that 57.1% of the total population complained of pain in the forefoot while
wearing high heels. 20% had no pain in any area of the foot. 14.3% complained of middle of
foot pain while only 8.6% responded to heel pain. The main concern of this study was well
represented in this frequency distribution that foot pain experienced by females wearing
high heels was most commonly located in the forefoot region with 57.1 of percentage. Mean
of the sample was 1.9143 while the standard deviation was 1.22165.
 Distribution of respondents by intensity of pain

Intensity Frequency Percent Mean Std. Deviation

0 (No pain) 5 14.3    

2-4 (Mild-moderate) 19 54.3    

6-8 (Severe) 9 25.7 2.2286 0.77024

10 (Worst pain) 2 5.7    

Total 35 100.0    

MEAN±SD 2.22±0.77

Table 15 showed the intensity of pain according to the visual analog

scale. 54.3% had mild to moderate pain. Severe pain was complained by
25.7% of respondents. 14.3% responded with no pain and only 5.7% had
the worst pain while wearing high heels. Mean of the sample was 2.2286
while the standard deviation was 0.77024.
 DISCUSSION
Few studies were available on this topic so it was a difficult task as limited literature was
available. Almost every fourth women wear high heels for at least one day in the week.
According to a study nearby 59% of females carry high-heel for 1-8 hours daily. Wearing
high heels causes changes in pressure distribution on foot. Due to high-heel shoes,
pressure, and bodyweight loading on forefoot increase and is decreased on the hind foot.
According to Cong high heels can cause increase loading on foot which in turn can lead
to forefoot pain hallux valgus deformity and soft tissue problem on the plantar side of the
foot. According to Broch stated that increasing the heel height the normal pressure
distribution on foot was changed and forefoot was subjected to more constraint as
compared to the heel of the foot. When we are wearing high heel shoes our feet assume
such a position in which our heels are raised and elevated and our bodyweight shifts more
to our footballs and toes.
After completing analysis, it came to a result with 57.10% females’ complaint of forefoot
pain, while 14.3% of females’ complaint middle of foot pain and 8.6% complaint of heel
pain. While 20% responded no pain at all. So, it was concluded that forefoot was more
common as compared to the other two regions of foot, hind foot, and heels. The reason
behind might be that as compared to normal load distribution on the whole foot, more
pressure is subjected to front of the foot. The forefoot is an anatomically delicate region
as compared to the other two regions plus the increased pressure on it causes more pain in
this region. The intensity of pain in Table  is interpreted as 5.7% female’s complaint of
worst pain, 25.7% complaint of severe pain and 54.3% complaint of mild to moderate
pain and 14.3% responded with no pain.
 CONCLUSION:
The finding of this study indicated that high heel shoes cause more
pain in the forefoot as compared to other regions of foot because
weight distribution is changed while wearing high heel shoes.
Among the female of Savar most of the female suffering from this
forefoot. The reason behind this suggests that high heel shoes
changing the normal distribution of weight on the whole foot,
forefoot region is more prone to bear pressure as compared to middle
foot and heel. Precautions to prevent forefoot pain should be a major
concern of the female who are wearing high heels. This study help to
increase their awareness about forefoot pain, such as a result they
will be follow the precaution which are helpful for avoiding this type
of pain.
RECOMMENDATION:
•This study was a short time study, it is therefore
necessary to do a long-term study to make the result
more valid.
•Sample studied was small so large population will be
recommended.
•Forefoot pain can recorded by high heel wearing shoes.
•Build up awareness among female about prevent
forefoot pain.
•Use something alternative to high heels to prevent or
reduce pain.
•Use cushion within shoe and leg to prevent injury.
THANK YOU