Occupational footwear, musculoskeletal pain and agency among professional women in Cape Coast and Sekondi Takoradi

Abstract

Workplace footwear expectations can place professional women in a difficult position, particularly where a polished appearance is linked to heeled shoes despite growing evidence of musculoskeletal harm. In Ghana, little empirical attention has been given to how such expectations affect women’s health, agency and use of workplace protection mechanisms. This study examined occupational footwear expectations, musculoskeletal pain, perceived choice, legal awareness and entrepreneurial responses among women in the legal, banking, education and entrepreneurial sectors in Cape Coast and Sekondi Takoradi, Ghana. This study is anchored in three complementary perspectives, Social Role Theory, Cognitive Dissonance Theory and intersectional feminist thought, which together explain the structural, psychological and positional dimensions of occupational footwear practice. A convergent parallel mixed methods design was used. Quantitative data were collected from 400 women across the four sectors (91 legal, 138 banking, 101 education and 70 entrepreneurial), and semi-structured interviews were conducted with 40 participants to explore lived experiences, coping strategies and perceptions of workplace expectations. Survey data were analysed using descriptive statistics, chi-square tests and logistic regression, and interview data were analysed using thematic analysis. Overall, 323 respondents (80.8 percent) reported at least one form of musculoskeletal pain, with the highest prevalence among banking (90.6 percent) and legal (86.8 percent) workers and the lowest among education workers (65.3 percent). Ankle and foot pain was the most common complaint (56.8 percent), and 202 respondents (50.5 percent) considered their pain definitely or probably related to footwear, rising to 313 (78.2 percent) when possible attribution was included. Mean pain scores differed significantly across sectors (F = 5.77, p = .001), being highest in banking (6.01) and legal work (5.80). Although only 141 respondents (35.2 percent) were aware of the Labour Act 2003 (Act 651), 189 (47.2 percent) had discussed footwear discomfort with an employer or human resource officer and 213 (53.2 percent) had requested some form of accommodation, indicating that women addressed discomfort mainly through informal rather than legal channels. The interviews showed that footwear expectations were enforced through both formal dress codes and informal professional judgement, that women rationalised discomfort as a cost of professionalism, and that entrepreneurs perceived a growing but under-served demand for comfortable professional footwear. The study concludes that occupational footwear expectations represent a preventable workplace health concern shaped by organisational norms, gendered professional identity, limited legal mobilisation and unequal access to ergonomic footwear. The study recommends that employers and professional bodies, especially in the banking and legal sectors, revise dress codes to accept safe flat or low-heeled footwear, establish confidential channels through which women can request footwear-related accommodation, reframe such discomfort as a legitimate occupational health and safety concern under the Labour Act 2003 (Act 651), and support local entrepreneurs to supply affordable ergonomic professional footwear.