Effects of human variation on foot and ankle pain in rural Madagascar.

Journal Article (Journal Article)


Foot and ankle dysfunction in barefoot/minimally shod populations remains understudied. Although factors affecting musculoskeletal pain in Western populations are well-studied, little is known about how types of work, gender, and body shape influence bone and joint health in non-Western and minimally shod communities. This study examines the effect of human variation on locomotor disability in an agrarian community in Madagascar.

Materials and methods

Foot measurements were collected along with height, weight, age, and self-report data on daily activity and foot and ankle pain from 41 male and 48 female adults. A short form revised foot function index (FFI-R), that measures functional disability related to foot pain, was calculated. Raw and normalized foot measurements were compared by gender and used in a multiple linear regression model to determine predictors of FFI-R.


Compared to men, women reported higher FFI-R scores (p = 0.014), spent more time on their feet (p = 0.019), and had higher BMIs (p = 0.0001). For their weight, women had significantly smaller and narrower feet than men. Bimalleolar breadth (p = 0.0005) and foot length (p = 0.0223) standardized by height, time spent on feet (p = 0.0102), ankle circumference standardized by weight (p = 0.0316), and age (p = 0.0090) were significant predictors of FFI-R score.


Our findings suggest that human variation in anatomical and behavioral patterns serve as significant explanations for increased foot and ankle pain in women in this non-Western rural population. Foot and ankle pain were prevalent at similar levels to those in industrialized populations, indicating that research should continue to examine its effect on similar barefoot/minimally shod communities.

Full Text

Duke Authors

Cited Authors

  • Tasnim, N; Schmitt, D; Zeininger, A

Published Date

  • October 2021

Published In

Volume / Issue

  • 176 / 2

Start / End Page

  • 308 - 320

PubMed ID

  • 34397101

Electronic International Standard Serial Number (EISSN)

  • 1096-8644

International Standard Serial Number (ISSN)

  • 0002-9483

Digital Object Identifier (DOI)

  • 10.1002/ajpa.24392


  • eng