Prevalence of Onychocryptosis and Its Association with Occupational Footwear Practices Among Urban Workers in Karachi: A Cross-Sectional Study

Abstract

Onychocryptosis, commonly known as ingrown toenail (IGTN), is a frequent podiatric condition characterized by pain, inflammation, and possible secondary infection, particularly among occupationally active individuals exposed to prolonged standing and inappropriate footwear practices. Despite its clinical importance, limited epidemiological data are available from urban populations in Pakistan. This cross-sectional study aimed to determine the prevalence of IGTN among workers in Karachi and evaluate its association with occupational footwear characteristics. A total of 200 male and female workers aged 18–60 years from multiple occupational sectors were recruited using a structured and pre-validated questionnaire that assessed demographic details, occupational variables, footwear habits, and symptomatology. Participants reporting two or more symptoms suggestive of IGTN underwent standardized clinical examination for confirmation. Data were analyzed using SPSS version 26, and Pearson’s chi-square test was applied to assess associations, with statistical significance set at p < 0.05. The prevalence of IGTN was found to be 24.0% (48/200). The most frequently reported symptoms among affected participants were pain during ambulation (79.2%) and discomfort while nail trimming (64.6%). Tight-fitting footwear was observed in 61.5% of IGTN cases, while 54.2% reported using shoes with a narrow toe-box design. Additionally, 68.8% of affected individuals wore footwear for more than eight hours daily. Statistical analysis demonstrated significant associations between IGTN and tight-fitting footwear (χ² = 9.74, p = 0.002) as well as narrow toe-box footwear design (χ² = 7.31, p = 0.007). In contrast, occupational sector and shift pattern showed no statistically significant relationship with IGTN occurrence. The study concludes that Onychocryptosis represents a substantial occupational foot health concern among urban workers in Karachi, with inappropriate footwear practices serving as major modifiable risk factors. Increased awareness regarding proper footwear selection and preventive foot care strategies is recommended to reduce disease burden and improve occupational health outcomes.