Background <p>Foot switches are commonly used to record gastrointestinal lesions. However, prolonged use of foot switches can cause unstable posture, leading to musculoskeletal disorders. Therefore, this study aimed to develop and evaluate the usability of a compact foot switch for reducing musculoskeletal disorders among endoscopists.</p> Methods <p>A new endoscopic foot switch was developed to reduce musculoskeletal disorders and was compared with a previous foot switch. Between January 1 and October 1, 2024, 50 expert endoscopists from five different centers analyzed its usability, postural stability, ability to reduce pain and work fatigue, and efficiency.</p> Results <p>Compared with the conventional foot switch, the new foot switch showed favorable outcomes in terms of musculoskeletal disease-related factors, with better results in the following areas: comport endoscopic examination (6.5 [6–7] vs. 2 [1–2], p &lt; 0.001), stable posture (6 [6–6] vs. 2 [2–3], p &lt; 0.001), relief of musculoskeletal disorders (6 [5–6] vs. 3 [2–3], p &lt; 0.001), efficiency of examination (6 [6–7] vs. 3 [2–3], p &lt; 0.001), and applicability to other equipment (6 [6–7] vs. 2 [2–3], p &lt; 0.001).</p> Conclusions <p>We developed a new foot switch that can prevent musculoskeletal disorders among endoscopists. Further validation of its usefulness in various hospitals and users is required.</p>