Flip-floppers: Summer favorites spark health concerns

Jimmy Buffett warned us all in “Margaritaville:”

“I blew out my flip-flop

Stepped on a pop top

Cut my heel, had to cruise on back home”

Yet every time temperatures creep up, flip-flops appear on feet across America. Flip-flop lovers say the footwear is a stylish yet comfortable, lightweight alternative to close-toed shoes in the summer heat.

However, experts point to three general issues with the traditional thong-style flip-flops: a lack of support for feet and ankles, hygiene concerns and an increased possibility of injury.

Spokane podiatrist Dr. Nicholas Tanner believes flip-flops do not provide the foot with enough support, which can cause long-term damage.

“Flip-flops that don’t have any arch support are going to allow the arch to completely collapse,” Tanner said. He warned a lack of arch support can lead to general foot pain, along with tendonitis or the ball of the foot to fall.

Tanner said flip-flops can alter how the foot is held as toes grip the shoe while the foot lifts from the ground. This habit, Tanner said can create hammer toes or bent toes that will not fit into regular shoes and can require surgery to fix if left untreated.

“When one is exclusively in the flip-flops, they are more susceptible to these problems,” Tanner said.

Others against flip-flops often point to a 2008 study (http://wireeagle.auburn.edu/news/359) at Auburn University that found flip-flops decrease stride length when compared to walking barefoot. Decreased stride-length can be a result of how the foot is held in a flip-flop due to shoe construction: a thin rubber insole with a plastic thong strap between two toes.

Luke Gordon, a Spokane Valley physical therapist and co-owner of Gordon Physical Therapy, said he does not recommend flip-flops for prolonged physical activity, but did not have a problem with wearing flip-flops for light activities such as gardening or housework.

“To be honest with you, I’m OK with flip-flops,” Gordon said. “I like to go barefoot.”

He does not see a direct link between the increase in summer patients with foot pain and flip-flops.

“If someone has foot pain or ankle pain then we’ll look into (their shoes),” Gordon said. While Gordon will consider shoes as a factor to injuries, he believes increased number of cases are caused by more activity, and that pain can be caused by a variety of shoes.

The American Podiatric Medical Association also points to high heels or nonsupportive running shoes as contributing to foot or leg pain, as they can hold the foot at an unnatural angle.

Parts of the Auburn University study support Gordon’s beliefs. The study also concluded flip-flops with increased arch support and added straps create a gait similar to walking barefoot, which does not restrict the foot or alter how it is held.

Tanner recommends flip-flops with an insole at least a half-inch thick, a wide strap over the ball of the foot. Sandals that include straps behind the heel offer even better protection, Tanner said.

“Now I have no problem with someone wearing them for a short time,” Tanner said, adding he would rather see patients in closed-toed and supportive sandals for full-day use.

For flip-flop fanatics, the APMA promotes properly sized flip-flops made of soft leather, as leather minimizes the potential for blisters and other irritations.

While flip-flops can limit exposure to plantar warts, athlete’s foot, ringworm and other infections common in public places such as pools and hotels, the APMA warns people that flip-flops can have greater health concerns aside from bone health.

Bad flip-flops construction can cause more than minor health troubles. In 2014, flip-flop related injuries caused more than 25,300 emergency room visits in the U.S., according to the Consumer Production Safety Commission.

The APMA asks consumers not to drive in flip-flops to avoid the possibility of the shoe lodging behind the gas or brake pedal.

The APMA suggests limiting flip-flop usage to short periods as most pairs leave the foot and toes unprotected. Other safety concerns include a lack of protection from glass or other dangerous material on the ground that can cut through the shoe’s thin sole.

“The problem with flip-flops is they expose the foot to dirt, to air, to the area you walk on,” Tanner said. In the summer he sees patients with cracked heels which can develop painful sores and become infected if left uncovered.

Close-toed shoes, the APMA says, best protect feet during yard work when using lawn mowers or weed trimmers. To limit twisted ankles, avoid flip-flops while playing sports. Instead, wear tennis shoes or sport-specific footwear that support the foot and ankle.

The APMA suggests examining flip-flops each year before sliding back in. Excessive break down in flip-flops can hurt the foot and overexpose the feet to the ground.

To avoid infection and extra doctor visits, thorough foot cleaning and extra care can keep feet healthy while wearing flip-flops.

“I would recommend that they wash well between the toes and use a soft brush on the bottom of their feet to remove any dirt or debris they picked up while wearing the flip-flop,” Tanner said.

Epsom salt serves as another at home remedy to reduce foot swelling or pain.

“Swelling can cause problems year-round, but it’s especially troublesome in the summer, when people wear sandals and other shoes with straps,” New York podiatrist Dr. Suzanne Levine said, in a news release. “The inflammation aggravates bunions, bursas, corns and hammer toes.”

Levine suggests mixing a half cup of Epsom salt in a gallon of lukewarm water to soak feet for 15 minutes. Creating a exfoliating paste from Epsom salt and a natural moisturizing cream to use in the shower can have the same affect. Either of those options reduce swelling and reverse flip-flop related irritations on the foot when done three times a week to daily.

While medical professionals remain split on the effects of flip-flops, recent studies in the Journal of the American Podiatric Medical Association have found improved construction can diminish the negatives of flip-flops.

“I think appropriate footwear is smart,” Gordon said, but he added his support of flip-flops. “I don’t see any problem with flip-flops or barefoot.”