Ask A Doc - Flip Flops

May 22, 2017

StaskoPeterQ: Summer is approaching and I'm looking for help selecting footware. Are flip flops okay on my feet? 

A: Dear Reader:

The summer months present a very active time for most individuals as we exit out of a long New York winter.  In doing so, it is important to remember that shoe gear will prove important for those who perform activities ranging from competitive running to those who walk for exercise or enjoy going to festivals.  Proper shoes will decrease the potential for pain in certain areas of the foot and can prevent injuries that may lead to chronic conditions.  The use of flip flops in the summer can lead to conditions that may cut summer activities short and can lead to further foot and ankle conditions down the road.  In this article I will outline some conditions that flip flops may cause and also give guidance to shoe gear that is comfortable and functional for the summer months.

Flip flops tend to flex and bend causing increased movement to the foot.  This increase movement in the foot will cause an imbalance in the pull of tendons and ligaments.  A very common condition involved with increased flexing and bending is plantar fasciitis which is inflammation of a ligament on the bottom of the foot. The plantar fascia will have increased motion and bowing with too little support. Over long periods of ambulating with the flip flops the ligament will become aggravated.  Even standing for long periods of time will hurt the foot near the heel.  This can become a problem that can be difficult to remedy and may become something that even lasts until after the flip flops have stopped being worn.

The lack of arch support is another key factor in why flip flops can lead to pain.  Without the arch being supported, the tendon that helps support the arch can become irritated and even damaged.  The posterior tibial tendon, which runs along the inside of the foot and ankle, is a very strong tendon.  Once this tendon is irritated it can lead to pain during all activities, even while walking.  Split tears can even occur to this tendon which will need immobilization and the possibility of surgery.  If pain is noted while wearing flip flops along the inside of the foot, immediately get into a good fitting sneaker and even seek out a foot doctor to provide an arch support.

Cushioning is imperative in ambulation, and this is not provided by flip flops.  Imprints can be often be detected in flip flops from the bottom of the foot.  This causes increased pressure on important areas of the foot, especially in the front of the foot.  The metatarsals can take up much of the weight and pressure, leading to capsulitis which is an inflammation of the joint.  The capsule can be damaged due to the inflammation and the amount of pressure.  Irritation of the nerves to the front of the foot, known as neuromas, can occur.  This common problem will lead to tingling, burning, and the feeling of walking on a pebble.  This again, can be a long recovery and may prevent pain free walking for many months.

Important things to look for in proper shoes gear is the flexibility in the bottom of the shoe.  A shoe that is easy to flex does not have proper support.  A shoe where less twisting is noted is preferable.  A good way to test for this by placing one hand at the tip of the shoe and the other at the heel.  Push your fingers up in the attempts to bend the shoe.  If a lot of pressure is need to bend the shoe, this is a good sign and will provide support.  This thickness of the bottom of the shoe, or the midsole, is important for both athletes and daily walkers. The toe box of the shoe should also not be too narrow. This is located at the front of the shoe.  When purchasing the shoes, make sure that you can wiggle your toes comfortably.

I hope that this information was helpful and that the summer months are enjoyable!

Peter Stasko, DPM, FACFAS
Foot and Ankle