Determination of Foot Disability and Pain Among Drivers of Automatic vs Manual Buses: A Cross-Sectional Study

Abstract

Background: Bus drivers represent a high-risk occupational group for work-related musculoskeletal disorders due to prolonged driving, static postures, and repetitive foot movements. The impact of vehicle transmission type on foot pain and disability remains underexplored, particularly in South Asian settings where ergonomic and workload factors differ from high-income contexts. Objective: To determine and compare the prevalence and severity of foot pain and disability among drivers of automatic versus manual buses and to examine associations with working hours. Methods: This cross-sectional observational study recruited 150 male professional bus drivers (75 automatic, 75 manual) from major terminals in Lahore, Pakistan, between December 2023 and February 2024. Eligibility required age 25–50 years, at least one year of driving experience, and minimum five-hour daily driving. Foot pain and disability were assessed using the Visual Analogue Scale (VAS) and Foot and Ankle Disability Index (FADI), respectively. Statistical analysis employed chi-square tests and independent-sample t-tests to assess associations and differences, with significance set at p<0.05. Results: Automatic bus drivers reported significantly higher mean VAS scores (4.53 vs. 1.77, p<0.001) and lower mean FADI scores (2.63 vs. 3.57, p<0.001) than manual drivers. Moderate-to-severe pain occurred in 35.3% of automatic versus 10.0% of manual drivers. No significant association was observed between working hours and disability (p=0.068). Conclusion: Automatic bus driving is associated with significantly greater foot pain and disability, independent of age and working hours, highlighting a need for ergonomic interventions and targeted occupational health strategies.