{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:54:06Z","timestamp":1791309246687,"version":"4.3.1"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Rwanda National Council for Science and Technology","award":["NCST-NRIF\/AIC-CAT1\/006\/2021"],"award-info":[{"award-number":["NCST-NRIF\/AIC-CAT1\/006\/2021"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Podoconiosis is a disabling neglected tropical disease (NTD) caused by prolonged occupational exposure to alkaline red clay soil, disproportionately affecting female farmers in Rwanda. Although preventable through the consistent use of protective footwear, such as farming boots, high costs and limited availability at local markets impede rural farmers\u2019 access to appropriate footwear. Among female farmers, gender norms and cultural expectations further constrain their ability to access and wear farming boots. This qualitative community-based participatory project aimed to test a women-centered farming boot, co-designed by participants and the research team, to address previously identified barriers to protective footwear access among rural Rwandan farmers. Boots were distributed for testing, to male and female farmers, in four villages with the highest podoconiosis prevalence across Rwanda. This was paired with education campaigns and other informational materials. Sixteen audio-recorded focus group discussions were subsequently conducted to explore farmers\u2019 experiences with the boots. Farmers reported that receiving the footwear encouraged a more consistent use of farming boots, with female participants expressing feelings of pride and an emerging sense of empowerment associated with owning and wearing the boots. While community reactions to the boots varied, most female farmers noted that restrictive gender norms and expectations related to boot wearing persist but do not deter them from wearing the boots. Findings reiterate the importance of gender-sensitive, culturally tailored, and locally driven solutions in preventing podoconiosis and other skin NTDs. Future podoconiosis eradication strategies should strive to prioritize equitable access to protective footwear and address underlying social norms that limit women\u2019s access to preventive tools.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007114","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:31:20Z","timestamp":1791307880000},"page":"e0007114","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cMy feet are no longer swollen\u201d: Testing a co-designed podoconiosis protective footwear among rural female farmers in Rwanda"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9641-2509","authenticated-orcid":true,"given":"Gloria","family":"Igihozo","sequence":"first","affiliation":[{"name":"Center for One Health, University of Global Health Equity","place":["Butaro, Rwanda"]},{"name":"Celia Scott Weatherhead School of Public Health and Tropical Medicine at Tulane University","place":["New Orleans, Louisiana, United States of America"],"department":["Department of International Health and Sustainable Development"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Dusabe","sequence":"additional","affiliation":[{"name":"Center for One Health, University of Global Health Equity","place":["Butaro, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Uwizeyimana","sequence":"additional","affiliation":[{"name":"Heart and Sole Africa","place":["Musanze, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Boiles","sequence":"additional","affiliation":[{"name":"DuHope","place":["Kigali, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2893-0378","authenticated-orcid":true,"given":"Tonya","family":"Huston","sequence":"additional","affiliation":[{"name":"Heart and Sole Africa","place":["Musanze, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6122-5332","authenticated-orcid":true,"given":"Janna M.","family":"Schurer","sequence":"additional","affiliation":[{"name":"Center for One Health, University of Global Health Equity","place":["Butaro, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"pgph.0007114.ref001","doi-asserted-by":"crossref","first-page":"105918","DOI":"10.1016\/j.actatropica.2021.105918","article-title":"Podoconiosis - From known to unknown: Obstacles to tackle","volume":"219","author":"S Wanji","year":"2021","journal-title":"Acta Trop"},{"issue":"5","key":"pgph.0007114.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010057","article-title":"Podoconiosis: Clinical spectrum and microscopic presentations","volume":"16","author":"W Enbiale","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pgph.0007114.ref003","first-page":"210","article-title":"Podoconiosis, a neglected tropical disease","volume":"70","author":"DA Korevaar","year":"2012","journal-title":"Neth J Med"},{"key":"pgph.0007114.ref004","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.4269\/ajtmh.16-0932","article-title":"Risk factors for podoconiosis: Kamwenge District, Western Uganda, September 2015","volume":"96","author":"C Kihembo","year":"2017","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pgph.0007114.ref005","first-page":"53","article-title":"A human right to shoes? 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