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1. Introduction
The well-being of healthcare professionals is essential, as their physical and mental health directly affects their quality of life (QoL) and patient care. Among healthcare students, foot health is often neglected, despite its critical role in daily life and work (Mbue & Wang, 2023). This is especially relevant for nursing students, who endure prolonged standing and walking during clinical training, placing significant strain on their feet (Almhdawi et al., 2017). Poor foot health may negatively impact QoL, productivity, and overall well-being (Bernardes et al., 2022), yet awareness of foot-related disorders remains limited.
QoL is a multidimensional concept, broadly defined by the World Health Organization (1995) as an individual’s perception of their position in life in relation to their culture, goals, and expectations. It plays a crucial role in self-care and symptom relief, and self-reported QoL assessments are essential for care improvements (Haraldstad et al., 2019). Among nurses, musculoskeletal disorders (MSDs) are a major issue, particularly foot and ankle pain, which significantly affects physical health and work performance (Cordioli et al., 2020; Asuquo et al., 2021). MSDs are also linked to depression and anxiety, key components of QoL (Hohls et al., 2021).
Foot health disorders are common among nurses and students, with previous studies linking them to decreased QoL (López-López et al., 2018, 2021). Students are particularly vulnerable, as long clinical hours and stress can contribute to foot pain and other physical impairments (Abledu & Offei, 2015; Rodríguez-Sanz et al., 2018). These factors may create a downward spiral, increasing the risk of burnout and even dropout from nursing programs (Bakker et al., 2019). However, there is a notable gap in research exploring the interplay between foot health, QoL, and nursing students' knowledge of self-care. Addressing this issue is crucial for promoting health awareness and fostering effective self-care behaviors.
Additionally, nursing education plays a pivotal role in shaping students’ knowledge, skills, and attitudes toward self-care. While some studies have explored health-promoting behaviors in undergraduate nursing students, the literature on foot health remains limited (Nevins et al., 2016). Given that nursing is both physically and emotionally demanding (Alzayyat & Al-Gamal, 2014), and clinical training environments often contribute to increased stress and lower QoL (Hamaideh et al., 2017; Labrague et al., 2018), it is imperative to address these factors to improve student well-being and academic performance.
Ensuring high QoL among nursing students is essential for enhancing learning outcomes, academic success, and ultimately, patient care. However, there is a lack of research focusing on foot health’s role in QoL and self-care knowledge among nursing students. To fill this gap, this study aims to: (i) characterize nursing students' foot health and QoL in clinical settings, (ii) assess their knowledge of foot health, (iii) identify correlations among these factors, and (iv) explore students' perceptions of foot health's impact on their QoL. By addressing these gaps, this study seeks to contribute to improved health practices and nursing education
2. Methods
2.1 Design and Sample
This sequential multimethod exploratory study was conducted in a Portuguese public Nursing School in January and July 2022. The project leader described the objectives and procedures for four classes. Each student delegate was mandated to collect all interested peers and manage their participation throughout the study. We used STROBE (von Elm et al., 2007) and COREQ (Tong et al., 2007) guidelines to structure and report data.
The initial phase of the study involved two assessment points-prior to (month 0) and following (month 5) exposure to standing environments in clinical settings. During these assessments, students were required to complete two instruments: the Portuguese version of the Self-Administered Foot Health Assessment Instrument (S-FHAI; Stolt et al., 2017) to evaluate current foot health, and the EQ-5D-5L (EuroQol Group, 1990) to assess Quality of Life (QoL).
The subsequent phase took place at the midpoint of the exposure period (Month 3), during which students responded to the Portuguese version of the Nurses’ Foot Care Knowledge Test (NFKT; Stolt et al., 2015) and participated in a semi-structured interview.
Inclusion criteria were: (i) nursing students enrolled in a Nursing bachelor degree, at the moment of the study; (ii) nursing students that, at the moment of the recruitment phase, were not enrolled in a clinical setting. The exclusion criteria were being diagnosed with any chronic systematic diseases (e.g., rheumatoid arthritis), students that, at the moment of the recruitment phase, were also committed to a professional working activity or involved in high-competition sports, which might influence foot health (e.g., waitress, door-to-door delivery, among others), being under antipsychotics or other related drugs, and not fluent in Portuguese language.
2.2 Instruments and Outcomes
The primary outcomes were Foot Health at five months, Quality of Life at five months, and Knowledge Level.
Foot Health was assessed using the Portuguese version (IAASP; Bernardes et al., 2024) of the Self-Administered Foot Health Assessment Instrument (S-FHAI), validated for European Portuguese. This self-reported tool measures foot health across four dimensions-Skin Health (11 items), Nail Health (4), Foot Structure (5), and Foot Pain (2)-with a total score ranging from 22 to 44, where higher scores indicate better foot health.
Quality of Life was evaluated using the EQ-5D-5L Portuguese version, which includes a five-dimension descriptive measure (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and a visual analogue scale (EQ-VAS) ranging from 100 (best health) to 0 (worst health).
Knowledge Level was measured using the Portuguese version (TCE-CP) of the Nurses’ Foot Care Knowledge Test (NFKT), which covers five dimensions with 11 questions each. The final score is expressed as the percentage of correct answers.
Students’ perceptions were gathered through face-to-face semi-structured interviews, continuing until data saturation. A pilot interview with three students (excluded from the final sample) refined the guide, adjusting question sequence and incorporating prior experience inquiries.
A trained, independent researcher conducted interviews in a designated classroom under optimal conditions, ensuring privacy and minimal disruption. All participants provided explicit consent, and interviews-averaging 20 minutes-were recorded and transcribed verbatim.
2.3 Data analysis
Quantitative data was analyzed using SPSS v.26® (IBM Corp., Armonk, NY, USA), applying descriptive statistics to characterize demographics and Spearman correlation to assess variable relationships. IASSP-related variables were recoded to ensure higher values indicated better foot health.
Qualitative interview data was processed using ATLAS.ti v7, following three phases: pre-analysis, material exploration, and result interpretation. Categories were determined post hoc through an exhaustive reading process, ensuring no relevant elements were overlooked. Coding followed a structured approach-segment selection, enumeration, and categorization-conducted by two researchers. To ensure rigor, categories were validated through independent coding, team discussions, and peer review, with discrepancies resolved collaboratively. This iterative process strengthened coding accuracy and analytical reliability.
2.4 Addressing missing data and control of confounding
There was a high probability of having several students in very different clinical rotations, thus exposed to different environments. To control this, an additional exclusion criterion included only the students enrolled in acute medical-surgical wards. All students who happened to be registered in community settings or fixed clinical appointments in the hospital were not considered and the reasons were explained.
Regarding the effect of personal lifestyle behaviours, as a more sedentary lifestyle would generate different patterns of a more active lifestyle, each student was previously screened regarding their usual activities outside the Nursing School.
Of the 84 students successfully recruited, participation was entirely voluntary, and all students provided informed consent. However, 30 students did not complete the study, resulting in a 35.7% dropout rate. The primary reasons for attrition were scheduling conflicts with clinical placements (40%), voluntary withdrawal due to personal reasons (30%), and non-adherence to study requirements (30%). To assess the potential impact of dropout, we compared baseline characteristics between those who completed the study and those who withdrew, finding no significant differences in age, gender, baseline physical activity levels, or clinical rotation type (p > 0.05).
Additionally, while this study controlled for variations in clinical placements by restricting the sample to students in acute medical-surgical wards, we acknowledge that differences in specific work tasks and prior foot problems could have influenced the outcomes. Although these factors were not systematically recorded, their potential role as confounders is recognized, and future research should incorporate them into study designs to improve control over variability.
2.5 Ethics
Written informed consent was required prior to the study, and students were informed that they could drop out of the study whenever they wanted. The voluntary nature of participation was reinforced. To protect the identity of the participants, when transcribing the interviews, ID codes were used to refer to the interviewee (for example, ‘student 22’ is ‘S22’).
The study was ethically approved with the code nr. P799_07_2021 and is recorded in ClinicalTrials.gov on the number NCT05197166, and a research protocol was previously published (Bernardes et al., 2022).
The study findings were reported considering the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement (von Elm et al., 2007).
3. Results
A total of 54 students were successfully screened at 5 months. Their characteristics can be found in Table 1.
Table 1 Sample Characteristics (n=54)
| n (%) | M | SD | ||
|---|---|---|---|---|
| Sex | Male | 6 (11) | ||
| Female | 48 (88.9) | |||
| Total | 54 (100) | |||
| Age | 20.79 | 2.54 | ||
| Weight at T0 | 64.00 | 11.39 | ||
| Weight at T1 | 63.59 | 11.07 | ||
| Height | 165 | 7.48 | ||
| BMI at M0 | 23.39 | 3.96 | ||
| BMI at M5 | 23.09 | 3.46 | ||
Note: M = mean; SD = standard deviation; BMI = body mass index; T0 = month 0 (baseline); T1 = month 5
3.1 Quality of Life
Both QoL dimensions “pain/discomfort” (D4) and “anxiety/depression” (D5) changed at T1 (Table 2).
Regarding D4, at baseline (T0), only five students (9.3%) reported some pain, whereas, at the end of the clinical learning period (T1), one-fourth of the sample reported having pain (13; 24.1%).
Regarding D5, 25.9% (n=14) reported being severely anxious or depressed at baseline. At T1, the same number of students reported having these symptoms. Still, the severity levels slightly decreased, with only one student reporting this same degree of anxiety, 11 (20.4%) slight levels, and 3 (5.6%) moderate levels of anxiety/depression. Of those reporting being severely anxious or depressed at baseline, five declared no anxiety at T1, five were slightly anxious, and three reported moderate anxiety. Still, six students reported being slightly anxious for the first time at T1.
A moderate positive correlation was found between D4 and D5 (0.540; p=0.000), both having a moderate negative correlation with Global Health: -0.432 (p=0.001) and -0.409 (p=0.003), respectively.
Table 2 Quality of Life - EQ-5D-5L Scores
| T0 | T1 | ||
|---|---|---|---|
| Mobility | I have no problems in walking about | 54(100) | 54(100) |
| Self-Care | I have no problems washing or dressing myself | 54(100) | 54(100) |
| Usual Activities (e.g., work, study, housework, family or leisure activities) | I have no problems doing my usual activities | 54(100) | 51(94.4) |
| I have slight problems doing my usual activities | 3(5.6) | ||
| Pain/Discomfort | I have no pain or discomfort | 49 (90.7) | 41 (75.9) |
| I have slight pain or discomfort | 12 (22.2) | ||
| I have moderate pain or discomfort | 1 (1.9) | ||
| I have severe pain or discomfort | 5 (9.3) | ||
| Anxiety/Depression | I am not anxious or depressed | 40 (71.1) | 39 (72.2) |
| I am slightly anxious or depressed | 11 (20.4) | ||
| I am moderately anxious or depressed | 3 (5.6) | ||
| I am severely anxious or depressed | 14 (25.9) | 1 (1.9) |
Note: T0 = month 0 (baseline); T1 = month 5
3.2 Foot Health
Regarding foot health (Table 3), at baseline, more than half of the students (31; 57.4%) reported cold feet, followed by dry skin (26; 48.1%), corns and calluses (16; 29.6%) and sweating feet (13; 24.1%).
At T1, more students reported the presence of corns or calluses (21; 38.9%) and sweating feet (39; 72.2%). On the contrary, there was a dramatic decrease in cold feet (2; 3.7%). Furthermore, the following foot disorders increased or were reported for the first time: oedema (11; 20.4%), leg cramps (17; 31.5%), and pain in the feet (23; 42.6%).
Table 3 Foot Health - IAASP Scores
| T0 | T1 | |||
|---|---|---|---|---|
| Yes | No | Yes | No | |
| Skin breaks or maceration between toes | 3 (5.6) | 51 (94.4) | 8 (14.8) | 46 (85.2) |
| Dry skin | 26 (48.1) | 28 (51.9) | 26 (48.1) | 27 (50) |
| Fissures in the heels | 4 (7.4) | 50 (92.6) | 8 (14.8) | 46 (85.2) |
| Corns or calluses | 16 (29.6) | 38 (70.4) | 21 (38.9) | 33 (61.1) |
| Verrucae | 54 (100) | 1 (1.9) | 53 (98.1) | |
| Blisters | 2 (3.7) | 52 (96.3) | 5 (9.3) | 49 (90.7) |
| Oedema | 3 (5.6) | 51 (94.4) | 11 (20.4) | 43 (79.6) |
| Sweating feet | 13 (24.1) | 41 (75.9) | 39 (72.2) | 15 (27.8) |
| Burning feet | 2 (3.7) | 52 (96.3) | 8 (14.8) | 46 (85.2) |
| Cold feet | 31 (57.4) | 23 (42.6) | 2 (3.7) | 52 (96.3) |
| Leg cramps | 7 (13) | 47 (87) | 17 (31.5) | 37 (68.5) |
| Ingrown toenail | 6 (11.1) | 48 (88.9) | 4 (7.4) | 50 (92.6) |
| Thickened toenail | 3 (5.6) | 51 (94.4) | 4 (7.4) | 50 (92.6) |
| Color changes in the nails | 4 (7.4) | 50 (92.6) | 5 (9.3) | 48 (88.9) |
| Fungal infection of the nails | 2 (3.7) | 52 (96.3) | 1 (1.9) | 52 (96.3) |
| Hallux valgus | 12 (22.2) | 42 (77.8) | 10 (18.5) | 44 (81.5) |
| Taylor’s bunion | 7 (13) | 47 (87) | 5 (9.3) | 49 (90.7) |
| Lesser toe deformities | 3 (5.6) | 51 (94.4) | 7 (13) | 47 (87) |
| Low foot arch | 2 (3.7) | 52 (96.3) | 2 (3.7) | 51 (94.4) |
| High foot arch | 8 (14.8) | 46 (85.2) | 4 (7.4) | 48 (88.9) |
| Pain in the last two weeks | 6 (11.1) | 48 (88.9) | 23 (42.6) | 29 (53.7) |
Note: T0 = month 0 (baseline); T1 = month 5
Regarding pain, the sole of the foot (11; 20.49%) and the heel (10; 18.5%) were the most affected, followed by the thigh (7; 13%) and the knees (6; 11.1%). The more intense pain levels were felt at the sole of the foot (7; 13%) and the heel (4; 7.4%).
3.3 Relationshiop Between Foot Health and Quality of Life
The influence of foot disorders on the quality of life of nursing students is detailed in Table 4 and Table 5.
A strong positive correlation (0.614; p<0.05) was found between the presence of blisters and D4 - Pain/Discomfort at T0. Correlation is weaker after five months but still significant (0.494; p<0.01).
Moderate positive correlations can be found between the presence of oedema and D4 - Pain/Discomfort at baseline (0.480; p<0.01) and T1 (0.495; p<0.01).
Table 4 Correlations Between Skin Health and Foot Structure with Quality of Life at T0 and T1
| T0 | T1 | |||||
|---|---|---|---|---|---|---|
| EQ-5D-5L | ||||||
| Pain/Discomfort | Anxiety/Depression | Health | Pain/Discomfort | Anxiety/Depression | Health | |
| Skin Health | ||||||
| Skin Breaks | 0.201(0.144) | 0.041(0.769) | -0.156(0.269) | 0.319*(0.019) | 0.157(0.256) | -0.234(0.089) |
| Dry Skin | 0.331*(0.014) | 0.276*(0.044) | -0.044(0.756) | 0.245(0.077) | -0.045(0.749) | -0.059(0.673) |
| Blisters | 0.614**(0.000) | 0.331*(0.014) | -0.317*(0.022) | 0.494**(0.000) | 0.109(0.434) | -0.163(0.238) |
| Oedema | 0.480**(0.000) | 0.225(0.101) | -0.317*(0.022) | 0.495**(0.000) | 0.267(0.051) | -0.119(0.392) |
| Sweating Feet | 0.119(0.391) | 0.062(0.655) | -0.025(0.862) | 0.336*(0.013) | 0.034(0.807) | -0.204(0.139) |
| Burning Feet | 0.276*(0.044) | 0.331*(0.014) | -0.213(0.129) | 0.428**(0.001) | 0.080(0.565) | -0.043(0.758) |
| Foot Structure | ||||||
| Low Foot Arch | -0.276*(0.044) | -0.108(0.438) | 0.213(0.129) | -0.335*(0.014) | 0.406**(0.003) | |
*p<0.05; **p>0.01
Foot pain in the last two weeks has a moderate negative correlation with global health (-0.432; p<0.01).
A very strong positive correlation was found between pain in the toes and D4 - Pain/Discomfort (0.926; p<0.01), and a moderate positive relationship (0.520; p<0.05) between pain in the ankle and D3 - Problems Performing Usual Activities (0.520; p<0.05) at baseline and T1.
At M5, moderate positive correlations were found between pain in the knee and D4 - Pain/Discomfort (0.499; p<0.05), D5 - Anxiety/Depression (0.446; p<0.05) and a moderate negative correlation between pain in the thigh and global health (-0.509; p<0.05).
Table 5 Correlations between Foot Pain and Quality of Life at T0 and T1
| T0 | T1 | ||||||
|---|---|---|---|---|---|---|---|
| E1-5D-5L | |||||||
| D4 | S | D3 | D4 | D5 | S | D3 | |
| Last 2 weeks | 0.294*(0.031) | -0.432**(0.001) | 0.384**(0.005) | 0.235(0.093) | -0.215(0.127) | 0.112(0.430) | |
| Toes | 0.926**(0.008) | 0.000(1.000) | -0.025(0.909) | -0.233(0.272) | -0.039(0.856) | 0.350(0.094) | |
| Ankle | -0.316(0.541) | 0.354(0.559) | 0.520*(0.011) | 0.245(0.260) | -0.238(0.274) | 0.108(0.623) | 0.520*(0.011) |
| Knee | 0.632(0.178) | -0.354(0.559) | 0.499*(0.013) | 0.446*(0.029) | -0.248(0.243) | -0.196(0.258) | |
| Thigh | -0.016(0.941) | 0.193(0.367) | -0.509*(0.011) | 0.067(0.756) | |||
*p<0.05; **p>0.01
3.4 Students’ Knowledge about Foot Health
The Nurses' Foot Care Knowledge Test (TCE-CP) was completed by 47 students (Table 6). In the "Foot Structural Deformities" dimension, 37 (78.72%) students scored below 50%, indicating a limited knowledge or ability to identify and recognize such signs and symptoms.
Interestingly, no significant correlations were observed between the knowledge scores (NFKT) and the foot health scores (IAASP). In general, positive scores in any dimension of knowledge are associated with positive scores in the remaining dimensions.
Table 6 Students’ Knowledge about Foot Health
| IAASP Scores | ||||||
|---|---|---|---|---|---|---|
| IAASP Domain | Students Scoring below 50% | Skin | Nails | Foot Structural Deformities | Disease Specific Foot Problems | Footwear |
| Skin | 6 (12.77%) | 1 | 0.543**(0.000) | 0.425**(0.003) | 0.319*(0.029) | 0.161(0.280) |
| Nails | 10 (21.28%) | 0.543**(0.000) | 1 | 0.489**(0.000) | 0.378**(0.009) | 0.445**(0.002) |
| Foot Structural Deformities | 37 (78.72%) | 0.425**(0.003) | 0.489**(0.000) | 1 | 0.428**(0.003) | 0.553**(0.000) |
| Disease Specific Foot Problems | 16 (34.04%) | 0.319*(0.029) | 0.378**(0.009) | 0.428**(0.003) | 1 | 0.516**(0.000) |
| Footwear | 9 (19.15%) | 0.161(0.280) | 0.445**(0.002) | 0.552**(0.000) | 0.516**(0.000) | 1 |
*p<0.05; **p>0.01
A total of 22 interviews were conducted, revealing four main categories-risk factors, foot self-care, transition to clinical settings, and footwear characteristics-along with 17 subcategories.
Of the 22 students interviewed, only two lacked awareness of how clinical settings contribute to musculoskeletal disorders (MSDs). One participant admitted underestimating the impact of prolonged standing:
“I had that notion, but I didn’t realize how exposed we are in these settings. I didn’t think it would be as harsh as it was” (S49).
All students identified body regions affected by prolonged standing, with the lower back being the most frequently mentioned (19 students, 86.4%), followed by the feet (18 students). The knees and ankles were each cited by four students, while only one mentioned the hip and upper limbs. When asked which region most affects their quality of life, no student selected the feet, with 14 instead identifying the lower back:
“I think the lower back since it affects my daily life and work the most” (S76).
Despite reporting increased foot discomfort during and after clinical shifts, few students changed their foot self-care routines. However, many criticized the footwear provided by the Nursing School, citing issues with rigidity, poor insoles, and lack of ventilation:
“There must be ventilation. Our clogs are closed, and at the end of the day, my feet feel baked” (S08).
“The heel at the back isn’t good. It keeps the foot rigid, and you can’t move it” (S41).
One student highlighted how footwear affected their entire body:
“The heel area is terrible-too hard. The back squeezes, making it uncomfortable. The hallux overlaps the other toes, and a higher heel increases pressure in the front” (S90).
Finally, students' awareness of foot health issues fell into two categories: those who were always aware and those who only became aware after clinical exposure.
4. Discussion
This study explored the relationship between foot health, knowledge, and quality of life among undergraduate nursing students.
The observed increase in pain/discomfort and anxiety/depression highlights the complex challenges faced during academic and clinical training. Long hours of study, demanding clinical rotations, and high-stress situations likely contribute to both physical and psychological distress (Wedgeworth et al., 2020). The prevalence of anxiety and depression aligns with previous studies (Ahmed et al., 2023) but suggests that these conditions are not solely due to physically demanding environments. Personal predispositions and external pressures may also play a role, warranting further investigation (Sousa et al., 2022).
Encouragingly, anxiety levels decreased over time, possibly due to growing familiarity with the clinical environment, better coping mechanisms, and increased self-confidence (Savitsky et al., 2020). However, the emergence of six new anxiety and depression cases underscores the fluctuating nature of mental health in nursing students. Identifying early triggers and warning signs is crucial for timely interventions.
Regarding foot health, new disorders such as corns, calluses, excessive sweating, and pain highlight the physical strain of clinical practice. Foot pain increased 3.8-fold from baseline, exceeding previous reports of a 1.7-fold rise (Anderson et al., 2018). Many students prioritized lower back pain over foot health, which may contribute to a lack of preventive care. Addressing these issues through ergonomic interventions and education is essential.
The high prevalence of pain in the sole and heel highlights the impact of prolonged standing and walking during clinical rotations on students’ foot health. Pain, strongly linked to long working hours (Mbue & Wang, 2023), is often identified as plantar fasciitis, a common chronic condition among nurses (Sung et al., 2020). This discomfort can reduce mobility and overall quality of life, underscoring the need for ergonomic improvements in clinical settings and better footwear options.
Our study also found a strong correlation between blisters, foot oedema, and pain/discomfort, reinforcing the connection between foot health and overall well-being. Previous research linked poor quality of life to inadequate foot self-care (Rodríguez-Sanz et al., 2018), highlighting the importance of proactive foot care strategies. Additionally, ankle pain was negatively associated with performing daily activities, mirroring findings in professional nurses (Stolt et al., 2017). This suggests that nursing students experience early signs of conditions they may face later in their careers, emphasizing the need for preventive education.
Interestingly, increasing thigh pain was associated with lower global health scores, suggesting that students may adjust their posture or gait to compensate for foot discomfort. While this adaptation provides temporary relief, it may contribute to musculoskeletal issues. Gait deviations in individuals with plantar heel pain (Phillips & McClinton, 2017) and hallux rigidus (Stevens et al., 2022) suggest the need for a holistic approach to foot health, including educational programs on strategic posture and self-care interventions.
While some students lacked awareness of foot and ankle disorders, most recognized the importance of proper footwear. Suggestions such as improved cushioning and ventilation align with previous findings on comfort in standing environments (Anderson et al., 2017). Implementing these features in institutional footwear policies could enhance foot health during clinical training.
The study also revealed inconsistencies between students’ health knowledge and foot health scores, suggesting that awareness does not always translate into effective self-care practices (Ross et al., 2017). Addressing this gap through targeted education and preventive strategies is essential to improving foot health and overall well-being among nursing students.
Although it is an exploratory study of a poorly focused topic, some limitations are worth mentioning. The small and localised sample size prevents an adequate extrapolation to other realities, as educational cultures can vary. The short follow-up period of five months might have contributed to a decrease in the richness of the study. Furthermore, although preventive measures to control bias were taken, we could not be sure of some extracurricular activities that could influence foot health. Hence, a direct and sole causality between clinical rotations and decreased foot health cannot be stated, but the correlation is still a reliable conclusion in this context. Moreover, certain inherent biases remained uncontrollable in the context of diverse clinical settings, encompassing varied activities, interventions, and distances traversed. Future studies should increase the follow-up time, provide a more controlled environment of influencing factors and increase sample size to allow for a robust causality inference on the findings, also designing experimental studies.
Conclusion
This study aimed to highlight the often-overlooked importance of foot health among nursing students and emphasize proactive foot care as a vital component of holistic healthcare education. By examining the prevalence of foot-related issues, their impact on academic and clinical performance, and potential prevention strategies, we provide valuable insights into student well-being and healthcare education.
The findings underscore the complex relationship between foot health and quality of life, stressing the need for a comprehensive approach that integrates both physical and mental well-being. Nursing schools, educators, healthcare institutions, and policymakers should implement targeted interventions, raise awareness, and introduce ergonomic improvements in clinical settings and footwear to better support students. Further research is essential to develop evidence-based strategies that enhance student well-being and, ultimately, the quality of care they provide.
Authors' contribution
Conceptualization, R.B., S.C. and A.C.; data curation, R.B. and A.C.; formal analysis, R.B., M.S., N.C. and A.C.; funding acquisition, R.B. and A.C.; investigation, R.B., S.C., M.S., N.C. and A.C.; methodology, R.B., S.C. and A.C.; project administration, R.B. and A.C.; resources, R.B, S.C. and A.C.; software, R.B.; supervision, S.C., M.S. and A.C.; validation, S.C. and A.C.; visualization, S.C. and M.S.; writing-original draft, R.B., M.S. and N.C.; writing-review and editing, R.B., S.C., M.S. and A.C.
