Flip Flops are no walk in the park

Is the use of this popular summer footwear causing foot, ankle or even knee pain?

By Dr. Chad M. Pens

Now that summer is officially here, many of you will be wearing your sandals more frequently. When it comes to simplicity, style, and allowing the feet to be cool, the “flip flop” is usually a popular choice. Although flip flops may look good, they are not very good for your feet. There are a number of orthopedic overuse issues that can arise due to frequent use of this type of footwear. The problems flip flops present are the lack of support to the arches of the foot, they lack of proper cushioning, and they change the way people walk..

A recent study out of the University of Auburn Department of Kinesiology, and presented at the annual American College of Sports Medicine meeting in 2008, revealed that individuals wearing flip flop sandals demonstrated a decreased stride length, an inefficient gait (walking) pattern, and a decrease in vertical force at heel strike. These lower forces noted at heel strike are directly associated with a shorter stride length.

The actions of the foot during the normal gait, or walking cycle, start with the foot first contacting the ground on the outside edge of the heel in what is called supination. As the front of the foot descends to the ground the foot needs to pronate, or relatively flatten, in order to absorb shock and accommodate to uneven ground. This normally is followed by supination once again to provide for a rigid foot for the muscles of the lower leg to push off from before the foot leaves the ground. If the pronation portion of this cycle occurs in excess, occurs too fast, or the foot fails to come out of the pronated position, a number of issues come into play. The entire lower extremity can become turned inward and thus place undue stress on not only the foot and ankle, but the knee and hip as well. By wearing a flip flop, or something similar, the arches are unsupported and allowed to collapse. By wearing appropriate footwear that provides the necessary support to the arches of the foot, these orthopedic issues can be prevented.

Anatomically there are three arches of the foot. Two arches run from the heel to the toesone along the inside of the foot (medial longitudinal arch) and one along the outside of the foot (lateral longitudinal arch). The third arch runs across the front of the foot (transverse metatarsal arch). All three of these arches serve a purpose and are important. A gross indication of the arches of your foot can be seen in the impression your wet foot leaves on the ground. The parts that do not leave a wet impression on the ground are where your arches lie. These are the areas that need support from proper footwear.

Some of the overuse injuries that wearing inappropriate footwear can lead to are:

• Plantar fasciitis
• Heel spurs
• Metatarsalgia
• Bunions or hallux valgus
• Tarsal tunnel tendonitis
• Knee tendonitis, strains, arthritis, and bursitis
• Hip tendonitis, strains, arthritis, and bursitis
• Stress fractures of the tibia and metatarsals and sesamoids

Individuals that have flat feet as well as those with high arches need arch support but for different reasons. High arch individuals do not pronate well, and therefore do not shock absorb well. They need the cushion and arch support to dissipate forces across the bottom of the entire foot. Those that overpronate need the arch support to prevent or at least limit the amount of pronation so that the lower extremity does not get placed in positions of stress.

Flip flops are no walk in the park. This does not mean that all flip flop sandals are made the same and can be problematic. If you chose to wear this type of footwear, make sure to purchase well made sandals as well as looking for a contoured foot bed (one with arches built in). Also, be sure to replace this type of footwear every 4-6 months, which equates to a new pair ever year, given the period of time we are able to wear this type of footwear in Central New York. Remember that running shoes are made for running, and flip flops are made for lounging at the beach. They are not designed to support the foot for prolonged walking at the mall, around town, and across college campuses. When you set out for this type of walking, be sure you are in the proper shoes that give your foot the appropriate support.

If you are having issues that may have arisen from the use of this type of footwear, the first recommendation is to stop their use. If the pain still do not resolve, do not hesitate to contact the specialists at COAST Physical Therapy, P.C.