Proceed With Caution When Wearing Flip-flops, Pedorthists Advise

Flip-flops have been in style for more than 3,500 years, but there is no consensus on whether they are good for feet.

Pedorthic opinion varies on the flip-flop, the simple little sandal that is as synonymous with summer fun in the sun as pool parties, backyard barbecues and Fourth of July fireworks.

Flip-flops, the ancestors of which Egyptians supposedly sported as far back as 1,500 B.C.E., can be a close encounter of the worst kind for feet. But some say not all of these shoes need be eschewed.

A variety of options

“I can’t say unequivocally that flip-flops are bad for your feet,” Erick Janisse, CO, CPed., said. “For diabetic patients with insensate feet, they do not offer adequate protection. Pebbles could easily get between the foot and the footbed and cause problems. If someone needed a lot of support, then something like $5 flip-flops wouldn’t be good.”

But there is another side to the sandal, Janisse, clinical director of pedorthics with Orthotic and Prosthetic Design in St. Louis., added. “Nowadays there are so many manufacturers like Vionic (OrthaHeel), New Balance and Teva that make good flip-flops with appreciable arch support. I actually recommend these to my patients who need arch support but don’t want to wear sneakers and orthoses all summer long.

“Actually, in some cases, flip-flops are great because they help to exercise and strengthen the intrinsic muscles in the feet.”

Consider foot mechanics, support needs

Even so, Don Haynes, CPed, a past president of the Pedorthic Footcare Association, is not a flip-flip fan. When thinking of shoes as a pedorthist, I consider the last, cushioning, stability and the laces,” Haynes, from Murfreesboro, Tenn., said. “All of those components are there for the protection of the foot. Flip-flops offer none of these things.”

Mary Hollaran, CPed, owner of Sole Control in St. Louis, shows a foot-friendly flip-flop.

Mary Hollaran, CPed, owner of Sole Control in St. Louis, shows a
foot-friendly flip-flop.

Image: Craig B, O&P Business News

He concedes that the shoes are popular. “But they are damaging feet. I worked for orthopedic surgeons who saw injuries regularly, from ankle sprains to fractures. We also saw calluses and injuries from toes to heels because [flip-flips offer] no protection from objects. Flip-flops are also made from materials that have no memory — meaning, they compress with each step, that is why they are so cheap.”

He explained, “The components of the shoe work together to protect the foot from injury and even help it to perform activities better. Soles protect the foot from the environment. Leather uppers protect the foot from environmental injuries, stumping your toes. Heel counters stabilize and help the foot to maintain stability. Laces circumferentially wrap the foot securing all of the elements of the shoe and making them work to maximize the protection and comfort of the foot.”

Haynes said nobody should wear flip-flops except in a casual setting.

“I hear people talk about their feet hurting and they are wearing flip-flops. In my opinion they would be mechanically better barefooted,” he said.

David Sables, DPM, CPed, of Nashville, Tenn., said, “When one walks, there is a heel pivot, an ankle pivot and then a forefoot pivot. The body will transfer the forward motion from one pivot to another. The motion occurring in the feet as it is transferred from one pivot to another must not be inhibited. It must be one continuous uninhibited transfer of motion.”

He added, “When wearing flat flip-flops, the excess softness, lack of support, the reflexive response of the foot trying to keep the flip-flop on the foot can cause your foot to stay in one pivot too long, which causes stress and strain on the tendons, ligaments and joint structures. Over time, this can lead to injury and pain.”


Flat, run-of-the-mill flip-flops like the ones Sables warned against are too short on foot support, said Tim Powell, CPed. “This is especially true for people trying to recover from a biomechanical problem such as plantar fasciitis and past tibial tendonitis.” Powell, of Laurie’s Shoes in St. Louis, added, “People with diabetic peripheral neuropathy shouldn’t wear flip-flops because of tripping on debris which could cause a wound.”

But he conceded that “there are also several supportive flip-flops available for situations where they are appropriate like around the pool or as house slippers. Just don’t wear the cheap, flat or ill supportive flip-flops, especially for the wrong purpose such as work or a hike.”

Carol Crocker-Griggs, CPed, also of Laurie’s Shoes, does not mince words about flimsy flip-flops.

“They are horrible, absolutely no good for anyone’s feet,” she said. “If someone is diabetic, they should not wear a flip-flop at all. But if they have plantar fasciitis and they need something to wear to the pool, [they] can actually buy flip-flops that have arch supports. It all depends on [their] foot, what [they] need and if [they] are diabetic or not diabetic.”

Mary Holloran, CPed, said flip-flops were designed to slip on at the beach or at the pool for short periods, not for everyday wear everywhere.

“Diabetics should totally avoid flip-flops,” she said.

Holloran, who owns Sole Control shoes in St. Louis, said the sandals are especially dangerous for patients who with neuropathy. “They can bump into something or get a small rock between their foot and the bottom of the rubber flip-flop and puncture their foot. By the time they realize it, the infection is already on a roll.”

Study suggests moderation

A 2008 study by researchers at Auburn University researchers found that wearing thong-style flip-flops can led to discomfort in the feet, ankles and legs. Researchers at the Auburn College of Education’s Department of Kinesiology signed up 39 college-age men and women for the study. Participants, wearing thong-style flip-flops and then traditional athletic shoes, walked on a platform that measured vertical force as the walkers’ feet struck the ground. Also, a video camcorder measured stride length and limb angles, according to the story.

According to the study results, the research does not suggest that people should never wear flip-flops. Instead, they should be worn in moderation.

The study included thong-style flip-flops manufactured and sold by well-known companies and priced from $5 to $50. Athletic shoes included in the study also varied in price and style.

Redeeming features

Holloran, who is also a certified orthopedic shoe technician and a certified personal trainer, doesn’t preach flip-flop abstinence to her clients who do not have diabetes.

“There are some very supportive and stylish flip-flops for people who love flip-flops. The Vionic basic flip- flop is my house shoe. It is what I wear when I don’t wear my foot orthotics. There are flip-flops that are friendly to all populations,” she said.

Randy Brown, CPed, said cheap, flat, foam flip-flops do have one redeeming feature. “They encourage the wearer to exercise their toes in an effort to keep the foot in the sandal,” said Brown, owner of Brown’s Enterprises in Washington, Mo., “As your toes claw during toe off, the midfoot and plantar fascia are exercised.

“Other than that, flip-flops offer no contouring to cradle the foot, no support, no stability and no control. There is naturally some protection from objects on the ground. However, in most cases, the foot is better off bare than in a flip-flop.”

He said flip-flop shoppers should seek such a sandal that offers “arch support, contoured cradling, multi-density insole/midsole, better quality materials than plastic … Let comfort be your guide.”

For more information:
Shroyer JF, Weimar WH, Garner III JC, et al. Influence of sneakers versus flip-flops on attack angle and peak vertical force at heel contact. Med Sci Sports Exerc 2008;40(5):S333.

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