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There's trouble afoot with flip-flops. These popular summer shoes protect arthritic knees, but for those of us who do not have arthritis, they can spell trouble.

Trouble afoot with flip-flops

Since the days of the ancient Egyptian Queen Cleopatra, people have worn soles-only shoes connected to the feet with a strap between the big toe and the second toe. Also called thongs, slip-slops, slaps, slides, and zoris, these shoes have been the traditional footwear of choice for days at the beach or days at home when it's just too hot to wear shoes. If you ask any flip-flop fan why they choose these shoes, chances are you will get a very simple answer: Comfort.

Flip-flops let your feet breathe. They don't harbor athlete's foot fungus, and they don't get smelly. It's even possible to find designer flip-flops. Gucci makes flip-flops in Italian leather that is cushy, comfy, and stylish.

Flip-flops flunk examination by podiatrists. The problem with flip-flops is that they easily sail off your feet. This means that wearers of flip-flops tend to take tiny steps, and they don't hit the ground with the full force of their feet. Flip-flops don't support the arches, and people with flat feet, especially, can experience pain in the ankles, legs, and knees.

Even people who do not have flat feet can have problems with flip-flops. The strap holding these shoes to your feet has to be grasped by the toes. This means the wearer cannot take as long a step, and the ankle has to go through a wider angle of motion. The connective fascia at the ankle can pull on muscles all the way up into the hips, causing real pain after flip-flops have been worn while walking on grass, or in athletic competition.

Flip-flops flying away. The loose and comfortable attachment of flip-flops to the feet also means it's easy to get them caught on something. If you are walking across hot pavement, you can experience a painful burn to the soles of your feet if the tar in the asphalt pulls your shoes off your feet. If you have an ankle injury, the act of slipping your foot into the shoe can make the injury worse, and if you have diabetes, you may not notice the blisters that can form at the strap between your toes until they have become infected.

When are flip-flops the healthier footwear alternative? 

Times when flip-flops are the healthier footwear alternative. There are times, however, when flip-flops are clearly the healthiest form of footwear. It's a good idea to wear flip-flops when you go to public changing rooms and showers, to avoid picking up fungal infections and the much more serious MRSA. Flip-flops are used by some branches of the US and European military services to prevent the spread of foot diseases.

People who have arthritic knees often find that flip-flops greatly reduce pain, for the same reason that people who have ankle problems may find that flip-flops increase pain. Although the ankles go through a wider angle of motion, the knees go through a narrower angle of motion, and there is less stress and less pain. Most arthritis specialists, however, do not recommend that knee pain sufferers wear flip-flops all the time.

Choosing among the summer footwear alternatives, flip-flops, sandals, and going barefoot. Flip-flops, of course, are just one of several choices for summer footwear. It's also possible to choose sandals, which are strapped to the foot, and much less likely to come off. Or one might just go completely shoeless, choosing bare feet. What are the differences in the health impacts of these summer shoe choices?

  • When you go barefoot, the middle of your foot strikes the ground as you walk or run. When you wear shoes or sandals, the back of your foot strikes the foot at you walk or run. And when you wear flip-flops, the front of your foot is more likely to contact the ground first. If you have injuries to specific parts of your feet, you may prefer one summer footwear alternative to the others, depending on where the injuries are.
  • When you go barefoot, your feet tend to turn to the sides to give you more traction. When you wear shoes of any kind, your feet tend to move forward without turning outwards. If you have a problem with your feet turning outward, don't wear flip-flops. If you have a problem with your feet turning inward, wear flip-flops when you can.
  • If you wear socks with sandals, you protect the soles of your feet from fungal infections, but fungi still penetrate your socks at the sides of your feet. If you don't wear socks at all, simply rinsing your sandals or flip-flops with cold water after extended use will remove many of the attached athlete's foot fungi--but be sure to dry your footwear before you use it again.
  • If you step on a sharp object while wearing rubber flip-flops, both the object and the rubber from your shoes may become imbedded in your feet. Both have to be removed for complete healing of your foot.
  • If you are allergic to latex, you may develop a rash where the flip-flop strap is in contact with your toes if your flip-flops are made of rubber.
  • Constant gripping of the flip-flop strap can result in the development of hammer toes.
  • A pain in your ankle may be an early warning sign of Achilles tendonitis, which can make walking difficult for weeks or months. Achilles tendonitis usually does not respond well to over-the-counter pain relievers.
  • Don't forget to put sunscreen on your feet. Exposed skin on your feet can burn, too.

Wear the right shoes for every occasion. There's no doubt that flip-flops are great for walking on the beach. They're not good for taking a mountain hike. And don't wear the same pair of flip-flops day after day. Even flip-flops can accumulate athlete's foot fungus and infectious bacteria, and once your flip-flops have softened up enough that you can roll them into a ball, they don't offer enough support to protect your feet from rocks, sharp objects, and falls.

There is one time flip-flops will always fall flat in terms of foot health. That's when you walk across any ground that may be contaminated with pesticides, herbicides, or animal or human feces or urine, or if you or your neighbor's pets have been infected by worms. The comfort you feel on your feet just is not worth the risk of parasitic infection or chemical burns. Wear regular shoes when you must walk on contaminated ground.

  • Johnson AJ. Flip-Flop Sandals. Br Med J. 1967 April 1, 2(5543): 55
  • Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan 28,463(7280):531-5.