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The working conditions and the prevalence of self-reported musculoskeletal symptoms among 180 Iranian hand-sewn shoe workers were evaluated in this cross-sectional study. Data were collected using both questionnaire (for assessing musculoskeletal symptoms and associated risk factors) and direct observations of posture (by the Rapid Upper Limb Assessment [RULA] method). The prevalence and severity of symptoms was very high among the study population. The mean RULA grand score of 6.2 indicates that in most cases the workers' postures at their workstations need to be investigated and some changes are required immediately. Multiple logistic regression models indicated that the job experience, daily working hours, duration of continuous work without breaks, feeling pressure due to work and working postures were significantly associated with musculoskeletal symptoms of different body regions …