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Warnings and Advice for Wearing Flip-Flops This Summer

By Tim Boyer Jul 6 2012 - 12:42pm
Flip-Flops
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Flip-flops are as much a part of summer as fireworks on the 4th and long afternoons at the beach or by a pool. However, flip-flops can also mean an afternoon spent in the ER or winding up limping painfully for several weeks. In a recent press release issued by orthopedic doctors at the Mount Sinai School of Medicine in New York City, flip-flop use poses two problems: they offer little to no support for the arches and no protection for exposed toes.

Poor Support

Flip-flops are typically nothing more than a thin layer of rubber or plastic designed for convenience and for protecting tender soles from bits of yard or beach debris—which is fine for casual, temporary foot wear. However, where most people wind up in trouble is exceeding causal use by wearing flip-flops all day long. Wearing flip-flops all day long means that your feet are not getting the normal support and cushion they need to remain healthy.

One result of lack of support is the risk of developing arch pain or plantar fasciitis—the most common cause of heel pain. The plantar fascia is a long, flat band of ligament that connects your heel to your toes and provides support for the arch. When poorly supporting flip-flops are worn for extended periods of time, the ligament becomes overly stretched, weakened and inflamed resulting in pain on the bottom of your foot. Ignoring the pain and continuing to wear flip-flops can cause tears to develop in the ligament and worsen the problem.

Another problem associated with poor support is poor absorption that not not affects the feet, but can also affect the bone-to-bone joints in the ankles, knees, hips and even the vertebrae causing severe back pain.

Poor Protection

Face it, open-toe sandals and flip-flops are an open invitation to insult and injury. Small breaks in the skin and cracks in the nails can allow bacteria and fungi easy access to your toes that in the least can lead to discoloring fungal infections under the nails that are nearly impossible to get rid of. The biggest problem with under-the-toenail fungal infections is that it takes weeks or longer of anti-fungal medications that are not only toxic to the nail fungus, but toxic to the liver as well and often contraindicated for patients on other types of medications.

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Injuries from exposed flip-flop shod feet range from simple stubbed toes to ripped-off nails. Typical injury examples seen in adults include a nail snagging on a wood patio step, impalement with a sliver under a toenail, or (my favorite) weed-whacking trauma. Children are more prone to experience scraped toes and lost nails from their flip-flops slipping off of the pedals of their bicycles.

Another concern is excessive sun exposure to the skin of the feet. Sun-related skin cancer can develop anywhere on the body that is not adequately protected from UV-ray exposure. An SPF-30 or higher sunscreen is recommended for the feet while wearing flip-flops.

However, in spite of the potential for injuries this does not mean that flip-flops should be altogether avoided—just use a little common sense and heed the following Do’s and Don’ts of flip-flops as recommended by the American Podiatric Medical Association (APMA):

• Do shop for a flip-flop made of high-quality, soft leather. Leather minimizes the potential for blisters and other types of irritation.
• Do gently bend the flip-flop from end to end, ensuring it bends at the ball of the foot. Shoes of any kind should never fold in half.
• Do ensure that your foot doesn’t hang off of the edge of the flip-flop.
• Do wear a sturdy pair of flip-flops when walking around a public pool, at the beach, in hotel rooms and in locker room areas. Walking barefoot can expose foot soles to plantar warts and athlete's foot.
• Don't re-wear flip-flops year after year. Inspect older pairs for wear. If they show signs of severe wear, discard them.
• Don't ignore irritation between toes, where the toe thong fits. This can lead to blisters and possible infections.
• Don't wear flip-flops while walking long distances. Even the sturdiest flip-flops offer little in terms of shock absorption and arch support.
• Don't do yard work while wearing flip-flops. Always wear a shoe that fully protects feet when doing outside activities such as mowing the lawn or using a weed-eater.
• Don't play sports in flip-flops. This practice can lead to twisting of the foot or ankle, as well as sprains and breaks.

The APMA also advises consumers that when shopping for a pair of flip-flops to choose only those brands that carry the APMA's Seal of Acceptance. According to the AMPA website, their Seal of Acceptance evaluates footwear, materials, insoles, hosiery, and equipment. The Seal is awarded to a product after the Committee on Podiatric Seals, a standing committee of the American Podiatric Medical Association, scientifically evaluates and determines whether the product allows normal foot function and promotes quality foot health.

So, for a safe footloose and fancy-free summer this year with your feet, buy a good quality pair of flip-flops, limit the time spent wearing them to only a couple of hours per day, avoid all activities where exposed toes are at risk of injury and enjoy the feel of summer on your feet.

References:
Mount Sinai School of Medicine, news release July 2012
American Podiatric Medical Association

This page is updated on May 3, 2013.

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Comments

A Crazy Individual wrote on July 13, 2012 - 12:16am
I just don't wear them-it's a lot easier than having to deal with foot injuries and other flip flop related injuries. I also have ugly feet and prefer to keep them covered at all times.
Trane Francks wrote on September 6, 2012 - 5:15am
This article, while looking reasonable on the surface, is chock full of misinformation. The first, glaring fault comes with this: "flip-flop use poses two problems: they offer little to no support for the arches and no protection for exposed toes." It behooves me to state that humans did not evolve with footwear affixed to our lower appendages. We evolved as barefooted bipeds, which meant that our feet had NO support for the arches and NO protection for exposed toes beyond our awareness of where we placed our feet while walking. Our arches cannot develop adequate strength without walking barefoot. In cultures where barefoot walking is rare, e.g., Japan, flat-footedness is a common affliction. The real problem with flip-flops is that their loose fitment causes the wearer to constrict the toes so as to hold the footwear in place. This is an unnatural flexion of the digits that causes undo stress and can affect the mechanical gate of walking. "Wearing flip-flops all day long means that your feet are not getting the normal support and cushion they need to remain healthy." What a ridiculous statement. It's as if the author presumes that everything natural about our evolutionary path is somehow wrong. The author should reassess his understanding of the human body and its evolution. We do not need "cushion" in order to thrive!
Tim Boyer wrote on September 6, 2012 - 9:39am
Sorry to have to tell you this, but your logic is seriously flawed and you really need to take a remedial course in evolutionary theory. Evolutionary development is not about perfection--which is what I gather you are indicating by using the word "natural"-- but the gradual selection and elimination of genes that provides a reproductive advantage for a species under a particular ecological niche. Physiological problems such as joint and foot pain typically develop well after a person has developed the ability to reproduce--so where's the selective pressure to evolve feet "naturally" that would not necessitate the need for protective and supportive footwear as we age? As for your argument regarding "arch strength" and flat feet, there is a whole medical association of dedicated and educated practitioners who are experts on foot care and I seriously doubt that they share your views on causes and conditions.
Trane Francks wrote on September 6, 2012 - 7:31pm
Thanks for the snotty comment, Timothy, but I suspect I'm actually not at all in need of remedial classes. Keep working on that bedside manner. I never even hinted that evolution was about perfection. (Maybe some remedial reading is in order? *grin*) Evolution is about successful accidents; oopsies that just happen to work in an organism's favour. As that pertains to footwear? I reiterate that nobody came out of the womb with Nikes attached. That happens after the fact. The need for cushion and support in footwear is a byproduct of a modified walking gate. The mechanics of our gate changes to heel-first placement when wearing footwear. The stress on the frame can be significant. Cushion and support is an allopathic approach that deals with the symptoms rather than the cause. A better solution is to fix the gate. That's easily done by walking barefoot. Yes, there is plenty of research that backs that up, done by your aforementioned medical association of dedicated and educated practitioners. While fallen arches can be hereditary, the vast majority of fallen arches cases are developed. Weakened foot muscles and excessive heel height are definite causes. The lack of "proper" arch support in shoes merely creates an environment for which our feet have not yet adequately adapted. Those proper arch supports promote atrophy in the foot. Again, this supposes otherwise healthy feet without other issues. Check out some sites dedicated to barefoot running, walking and hiking for anecdotal tales of people regaining their arch health after adopting a lifestyle that avoids excessive use of footwear. I understand that there is a whole medical association dedicated to understanding feet. It was after reading some of said association's research that I learned about the benefits of forgoing shoes. It made my feet much happier. It was also from that same research that I learned of _why_ flip flops are bad for your feet. Cheers to you, sir!
Healthman wrote on September 7, 2012 - 1:15pm
Sounds like your feelings got bruised. The way I read it is that your "nobody came out of womb with Nikes attached" and reference to "the evolution of barefooted bipeds" is your way of trying to equate what is "natural" as to what is best for man, i.e. going barefooted. What nonsense! Should we forego clothing, vaccinations, etc. because they are not "natural"? Not to mention how impractical it is to adopt a barefoot lifestyle. I have to side with the writer on this one, your misuse of defining what evolution is about is wrong. I've never heard an expert explain evolution as "...oopsies that just happen to work." Find a text and do some reading. Also, "anecdotal tales" are just that--anecdotal. Where's the science? By the way, wasn't this article about health and flip flops and not about barefoot walking?
Trane Francks wrote on September 7, 2012 - 6:24pm
No bruised feelings here; I just had an issue with the snotty tone of the author in that one comment. Intelligent discourse has no room for such an aggressive/defensive posture. If you wish to side with the author, I have no problem with that. It's always important for people to think critically and come to their own decisions. That said, I have trouble understanding where I have misused an understanding of evolution. Evolution is EXACTLY a process in which imperfections in DNA replication creates the potential for failure or success in an organism. In most cases, significant deviations from the norm create failure in the organism, i.e., an evolutionary dead end. In rare circumstances, these replication hiccoughs create an advantage for the organism. These become new variations in the line. In cases where the differences are significant enough, it will mark the beginning of a new species. Yeah, you're not going to call that misuse. However, I see that I'm dealing with at least two people who don't grasp the issue: On an evolutionary timescale, the span of our reliance on extremely padded and/or misshapen footwear is but a mere blip compared to the vast amount of time we've spent evolving as obligate bipeds. Does that need clarification? This tendency we have to automatically assume that we know better in the last hundred years than what we evolved over millennia to prefer/require often happens to be shockingly off the mark. It pushes us into a period by which we need to adapt or fail. As an example, uur culture now gets the vast majority of its daily caloric intake from High Fructose Corn Syrup (HFCS). To use your "what nonsense" approach, should we forgo what is natural and just assume that what is newly invented and pushed as being Good is so? A lot of people in business and medicine (which IS business in North America) would certainly want you to believe so. Be wary there. We wonder why we're suddenly obese and HFCS being our main energy provider should be a clue. Physical anthropologists suggest that foot distress is a relatively new disorder; why would we not look at the technological evolution of our footwear and try to determine a correlation? So, where's the science? That's a good question. Science is only done where money is to be made. It's a striking and sad fact of life. You're not going to have the Bayers and Pfizers of the world paying for large-scale evaluations of the benefit of going barefoot. With Big Pharma paying for the world's medical research, you're not going to see anything looked at that doesn't bring the potential of profit. That's a simple fact of life in a for-profit world. Just as the tobacco companies spent 30 years "proving" with science that smoking was safe, other industries play the same game. So, rather than just offhand skeptically blowing off anything that isn't "science", you'd be far better off looking at science (which I dearly love) and following the money. If the money's dirty, the science will be, too. Yes, this article is about flip flops and I said it was offering misinformation. I stand by that. If you're a flip flop wearer, watch your feet through the course of a step. Your toes will being doing a complete reverse of what they'd do in a barefoot (i.e., natural) step: The distal part of the toe flexes down (planter flex) to hold the flip-flop on, while the other part of the toe (middle) tries to bridge up (dorsi flex). The result is a mechanically awkward, shortened stride. It disallows the natural "locking" of the foot and leaves it vulnerable to injury. It creates additional stress on the hip and leg musculature due to the unnatural gate. Some muscles are overworked and others are shut down altogether. So, to reiterate: I side with the author that flip flops are best avoided, but his reasoning is demonstrably flawed. You're absolutely right that it's impractical for the vast majority of us (including me) to adopt a barefoot lifestyle. I do try to get out for at least a few minutes daily, however, and I enjoy hiking barefoot in the mountains when time permits. I can certainly accept your skepticism about why being barefoot is healthier than wearing footwear, but why not try? Go to a park and take of your shoes and walk barefoot in the grass. I'd be extremely surprised if you didn't find pleasure at how good it feels. That "how good it it feels" is a clear signal that it's worth exploring further. The best footwear, in my opinion, would probably be moccasins that have no cushion whatsoever. They offer protection from abrasion, but encourage a natural mechanical gate that supports the healthful development and maintenance of the structure of the feet and frame. That also allows for an exchange of free electrons with the Earth (thereby acting as a natural antioxidant). A win-win scenario.