Foot for Thought: Identifying Causes of Foot and Leg Pain in Rural Madagascar to Improve Musculoskeletal Health

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Incidence of musculoskeletal health disorders is increasing in Madagascar. Foot pain in the Malagasy may be related to daily occupational activities or foot shape and lack of footwear. Our study tests hypotheses concerning the cause of foot pain in male and female Malagasy populations and its effects on gait kinematics. The study was conducted in Mandena, Madagascar. We obtained 89 participants’ height, mass, and age from a related study (n male = 41, n female = 48). We collected self-report data on daily activity and foot and lower limb pain. A modified Revised Foot Function Index (FFI-R) assessed pain, difficulty, and limitation of activities because of reported foot pain (total score = 27). We quantified ten standard foot shape measures. Participants walked across a force platform at self-selected speeds while being videorecorded at 120 fps. Females reported higher FFI-R scores (p = 0.029), spending more hours on their feet (p = 0.0184), and had larger BMIs (p = 0.0001) than males. Strong linear relationships were examined between participants’ self-selected speed and force curve peaks and loading rates. No significant differences were found in force curve parameters between participants with foot/ankle/knee pain and lack thereof. Males showed higher values of force curve parameters and steeper slopes when relating velocity to the same parameters. The higher foot pain and lower force peaks in females may be related to the combination of higher BMI, small feet relative to BMI, and the amount of time they are on their feet. Results suggest that a combination of BMI, foot size, and occupational factors influence foot pain in this community leading to long term injury and limitations on work. These results will help guide future interventions that promote engagement in leisure/work activities.





Tasnim, Noor (2018). Foot for Thought: Identifying Causes of Foot and Leg Pain in Rural Madagascar to Improve Musculoskeletal Health. Honors thesis, Duke University. Retrieved from

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