If you wear flip flops into my clinic you get my ceremonial response!
I take them and throw them out onto the lawn in front of our clinic space …. Seriously I do eventually go out and retrieve them and we have a little laugh. There are however, some sound reasons I dislike the favorite summer footwear of the ladies and gentleman who come to see us.
Many of the patients we see are seeking help for foot and ankle related pain or difficulty wearing certain types of shoes. The flip flop, while being easy to slide on and off and comfortable for our poor foot who has been trapped in a hot restrictive boot all winter, does not offer what a good sandal or supportive shoe offers.
Ask yourself, why do we wear shoes? Our friends who are a part of the barefoot running trend question this all the time. But especially here in the mid-west there are reasons to wear shoes:
1) Protection of the bottom of the foot: the shoe offers an interface between our soft tissues on the bottom of the foot (some have softer than others …. hence the term “tenderfoot “from the westerns of my childhood) and the surface we are walking on. We walk and or run on hot, sharp, uneven or even toxic surfaces. So for this function the flip flop does provide a very thin layer of protection.
2) Protection of the toes and top of the foot: There is a reason folks wear steel toed work boots in industrial settings and why there is the sign in the restaurants: no shoes no shirt no service. Wearing flip flops while mowing the lawn or doing gardening for example, where your foot encounters all kinds of nasty sharp, hot or chemically irritating things is, as my father would say …. “Not real smart. “
3) Sun protection: A recent in-service to our staff by a local dermatologist pointed out that we as therapists should screen for Melanoma (skin cancer) on the toes as well as more common areas such as the ears neck and face. This reminds us to protect the exposed tops of the toes to the dangers of sun exposure, which honestly, I never thought about.
4) Shock absorption: Depending on who you read, 2-5 times your body weight is transferred from the ground through your heel and foot. A cushioned shoe along with a healthy foot and leg absorb much of this shock and dampen it. The flip flop, especially a well-worn one offers very little shock absorbing qualities.
5) Support: Our feet are a complex system of bones, muscles, tendons and the nervous system that senses as well as activates the motors that drive us through life. A proper fitting shoe helps to stabilize the foot and control excess motion by the shape of the shoe, and by controlling the heel bone which is the key that locks and unlocks the foot. The flip flop just sits under the heel; it doesn’t wrap around the heel nor does it control the heel.
6) Lastly in order to hold the flip flop on your foot so it is under the foot when your heel contacts the ground you need to pull down with your toe flexors (this is the flip sound) In a regular shoe or a sandal with heel strap, the sole remains in contact with the bottom of the foot through the swing phase due to the foot being enclosed in the shoe /sandal. This is the only time the toe flexors are on constantly instead of on and off through the gait cycle. This can create a muscle imbalance that can lead to the foot being held in a positon leading to hammer, claw or mallet toes. Also in order to be sure the sole is under the heel at heel contact (the flop sound) a person alters their stride which can impact the entire leg and lower body alignment.
So am I going to tell my patients “You are not allowed to wear flip flops ever?” If I did, I may get run right out of the clinic. Instead I suggest that much like cheesecake and my diet, limit flip flop wear in your shoe wear “diet. “
So if you must wear flip flops here are my suggestions:
1) Choose a hybrid flip flop, one that has a heel strap
2) Use flip flops only for short bouts of walking (across the beach versus hiking down the Grand Canyon)
3) Replace flip flops regularly to maximize shock absorption.
4) Never wear flip flops to do lawn mowing, household cleaning or other more dangerous tasks.
5) Sunscreen tops of toes (don’t grease the bottom of the foot however)
6) Pack a “back up “pair of shoes to switch to at the first signs of heel, arch or toe pain.
7) Limit wear time to short trips. If you are shopping, hiking, or touring; wear a sandal.
References:
Zhang, Xiuli, Max R. Paquette, and Songning Zhang. "A comparison of gait biomechanics of flip-flops, sandals, barefoot and shoes." Journal of foot and ankle research 6, no. 1 (2013): 45.
Salathé Jr, Eric P., George A. Arangio, and Eric P. Salathé. "The foot as a shock absorber." Journal of biomechanics 23, no. 7 (1990): 655-659.
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