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Cross-sectional study of podiatric health in Spain

This cross-sectional study of 2,424 Spanish adults reveals that podiatric health, assessed via the Foot Health Status Questionnaire, is significantly influenced by sex, age, and region, highlighting the need for personalized care and improved education to enhance overall well-being.

Original authors: Víctor Pozas Navarro, Esther Chicharro-Luna, Gabriel Gijón-Noguerón, Nadia Fernández-Ehrling, María Teresa García-Martínez, Javier Ferrer-Torregrosa

Published 2026-06-30

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Víctor Pozas Navarro, Esther Chicharro-Luna, Gabriel Gijón-Noguerón, Nadia Fernández-Ehrling, María Teresa García-Martínez, Javier Ferrer-Torregrosa

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your feet are the foundation of a house. If the foundation is cracked, the whole house becomes shaky, the doors stick, and the roof might even leak. That's essentially what this study is about: checking the "foundation" (foot health) of people living in Spain to see how it affects their whole "house" (their daily life and happiness).

Here is a simple breakdown of what the researchers found, using everyday comparisons:

The Big Picture: A Massive Foot Check-Up

The researchers asked 2,424 adults in Spain to fill out a "report card" for their feet. This report card, called the FHSQ, didn't just ask "Does it hurt?" It looked at four specific areas:

Pain: How much does it ache?
Function: Can you walk and run easily?
Shoes: Do your shoes fit well and feel good?
General Health: How do you feel about your feet overall?

Think of this like a car inspection. You don't just check if the engine starts; you check the tires, the brakes, and the oil. This study checked all those parts for the Spanish population.

Who Got the Best Grades? (The Gender Gap)

When they compared men and women, men generally got higher scores (meaning better foot health).

The Shoe Factor: The biggest difference was in the "Shoes" category. Men scored much higher here.
The Analogy: Imagine men are wearing sturdy, comfortable hiking boots, while many women are trying to run a marathon in high heels or tight shoes. The study suggests that women often struggle to find shoes that are both stylish and comfortable, which acts like a "tight leash" on their foot health. This mismatch causes more pain and makes daily movement harder.

The Age Factor: The "Wear and Tear" Effect

The study looked at three age groups: Young adults (18–35), Middle-aged (36–55), and Older adults (56+).

The Trend: As people got older, their foot health scores dropped.
The Analogy: Think of feet like tires on a car. A new car (young adult) has fresh, bouncy tires. An older car (older adult) has tires that have been driven for many miles; they are flatter and wear down faster. The study found that older adults reported more pain and less ability to move around freely, just like those worn-out tires.

The Location Factor: Does Where You Live Matter?

The researchers checked if people in the North, South, East, West, or Center of Spain had different foot problems.

The Result: There were some tiny differences between regions, but they were very small.
The Analogy: It's like checking the weather in five different cities. Sure, one city might be 2 degrees warmer than another, but they are all still in the same general climate. Where you live in Spain doesn't seem to be the main reason your feet hurt; other factors (like age or what shoes you wear) matter much more.

What Does This Mean?

The main takeaway is that foot health is a big deal, but it's often ignored.

For Women: The "shoe problem" is a major issue. Finding comfortable shoes is like finding a key that actually fits the lock—it's essential for walking without pain.
For Older Adults: Their feet are like the foundation of an old house that needs extra care and attention to keep the whole structure standing.

The study concludes that to keep people healthy and independent, we need to pay more attention to these "foundations." This means teaching people (especially women and the elderly) how to choose better shoes and making sure they can get help when their feet start to act up.

In short: Your feet are the wheels that move you through life. If the wheels are wobbly or the tires are flat, the ride gets bumpy. This study found that women and older people are driving with flatter tires more often than men, and it's time to fix those tires so everyone can enjoy the ride.

Technical Summary: Cross-sectional Study of Podiatric Health in Spain

Problem Statement
Podiatric health is a fundamental component of overall well-being, autonomy, and quality of life, yet it is frequently underestimated in public health discourse. Foot injuries and chronic conditions are prevalent, with incidence rates ranging from 61% to 79%, posing significant risks to mobility, balance, and fall prevention. Despite the availability of assessment tools, there is a need for comprehensive data on the foot health status of the general Spanish population across key constructs: pain, function, general health, and footwear. This study addresses the gap in understanding how demographic variables (sex, age, and geographic region) influence podiatric health outcomes in Spain.

Methodology
The research employed an observational, analytical, cross-sectional, and prospective design involving the Spanish population.

Participants: The study included 2,424 individuals over 18 years of age residing in Spain. The final sample consisted of 1,998 women and 426 men, with a mean age of 37.86 years. Inclusion criteria required participants to be over 18, residents of Spain, and capable of reading, understanding, and completing the questionnaire in Spanish. Exclusion criteria included minors, individuals with cognitive difficulties, and those unable to comprehend Spanish.
Instrument: The primary tool was the Foot Health Status Questionnaire (FHSQ), a validated self-report instrument. The study utilized Section 1 of the questionnaire, which evaluates four domains: Foot Pain (4 items), Foot Function (4 items), Footwear (3 items), and General Foot Health (2 items). Responses were scored on a scale of 0 to 100, where higher scores indicate better health status.
Data Collection: Data were collected via online and in-person surveys across autonomous communities, starting with the Valencian Community. Dissemination involved local authorities and social media influencers.
Statistical Analysis: Variables were analyzed using mean and standard deviation. Normality was assessed via the Kolmogorov-Smirnov test. Independent t-tests were used to compare sex groups, while ANOVA was applied to analyze differences across geographic regions (North, South, East, West, Central) and age groups (Young adult: 18–35; Middle-aged: 36–55; Older adult: 56+). Effect sizes were calculated using Cohen's d and omega-squared ( $\omega^2$ ). Statistical significance was set at p < 0.05.

Key Results
The study identified statistically significant differences in podiatric health across sex, age, and geographic regions, though the magnitude of these differences varied.

Sex Differences: Men reported significantly better outcomes than women across all four domains (Pain, Function, General Health, and Footwear). The most pronounced difference was observed in the Footwear domain (Men: 63.17 ± 27.37 vs. Women: 44.52 ± 28.27; p < 0.001), with a moderate effect size (Cohen's d = -0.66). Other domains showed small effect sizes.
Geographic Differences: Significant variations were found in Foot Function, General Foot Health, and Footwear across the five geographic regions (p < 0.05). However, the effect sizes for these geographic differences were small ( $\omega^2$ ranging from 0.003 to 0.005), indicating that while regional differences exist, they explain a small proportion of the total variance. No significant differences were found for Foot Pain across regions.
Age Differences: Older adults (56+) demonstrated significantly worse outcomes in all four domains compared to younger and middle-aged adults (p < 0.001). Specifically, Foot Function scores dropped from 87.29 (Young) to 75.77 (Older), and General Foot Health scores decreased from 74.38 to 69.03. Effect sizes were small to moderate ( $\omega^2$ ≈ 0.010).

Significance and Claims
The authors claim that this study provides a foundational assessment of podiatric health in Spain, highlighting that foot health is a critical determinant of quality of life. The primary significance lies in identifying specific demographic vulnerabilities:

Gender Disparities: The data suggests that women face greater challenges, particularly regarding footwear suitability, which may be linked to higher rates of foot pain and functional limitations.
Aging Impact: The study confirms a clear correlation between aging and deteriorating foot health, underscoring the need for targeted interventions for the elderly population to maintain mobility and independence.
Regional Nuance: While geographic differences exist, the small effect sizes suggest that factors such as access to healthcare and education may be more influential than location alone.

The paper concludes that promoting podiatric health should be a public health priority. It advocates for personalized approaches to podiatric care that address the specific needs of women and older adults, emphasizing education on proper footwear and improved access to podiatric services. The authors note that while the FHSQ is a robust tool, continuous validation and cultural adaptation are necessary for diverse populations.

Limitations
The authors acknowledge several limitations, including a potential selection bias due to the exclusion of non-Spanish speakers and individuals with cognitive difficulties. The sample exhibited a significant gender imbalance (predominantly female), which may skew results. Additionally, the broad categorization of age groups and potential underrepresentation of certain geographic regions may limit the granularity of the findings. The study calls for further research to explore underlying factors contributing to these disparities and to ensure broader population representation.