Now that we have passed July the 4th, it's officially summer in Portland! That means we can look forward to more days of sun than rain for a while, and after this year's winter, I think we all deserve some warmer temperatures. The first thing that most people do in these summer months is change their wardrobe to cooler attire, which often means a change of shoes. Time to put away the snow shoes and break out the flip-flops, right? As much as I also enjoy a nice pair of "flops," there are some risk factors to these shoes that you should know about in order to prevent injuries that could sideline your summer plans. Here are a few of the more common flip-flop related injuries that I see in the summer, and this year is no exception. We are going to start at the rear of the foot and move forward and upward. Let's get started!
Heel Injuries
The Problem: Let's face it: flip-flops are lots of fun, but they really don't give a lot of cushioning support to your heels. With heavy walking on hard surfaces such as pavement, that's a lot of heel strikes on to the ground without much to lessen the blow. In some cases, the sole of the flip-flop is so thin that you may as well be barefoot for all the support it's giving you. The biggest risk factor here is irritation of the heel bone (calcaneus) and a risk for a stress fracture of the bone. Stress fractures happen as a result of constant, repetitive stress to a bone that begins to break down the outer layers of bone, eventually forming a small, incomplete fracture line to develop. This can be very painful, and usually gets worse with weight-bearing activity like walking. Treatment usually involves time off your feet and possibly a walking boot, both of which are sure ways to kill your summer fun.
The Solution: Try to wear flip-flops that have a decent amount of rubber in their soles. Inexpensive shoes are often lacking in their level of material, so drop a little extra dough at the shoe store and get a pair that are thick in the heel area. Also, if you know you're headed out for a long hike, wear your normal athletic shoes and save the flip-flops for chilling out afterwards at the pool.
Mid-foot Stress Fractures
The Problem: We already addressed stress fractures in the heel, but this can also happen in the mid-foot in the metatarsal bones. You have five of these bones, and they make up the bulk of the foot from ankle to toes. These bones are long and slender, and don't do well with repeated impact--if you want proof, ask any ballet dancer and they will tell you. The problem with flip-flops is again the issue of sole thickness. Too thin of a sole, and your foot is basically hitting the ground every time you take a step. Eventually, you could develop a stress fracture in this area of the foot. Like heel fractures, treatment usually involves time off your feet and possibly a walking boot. Bye, bye summer.
The Solution: Again, try to find some flip-flops that give good support through the entire sole of the foot. A little extra padding there will go a long way in keeping you moving.Plantar Fasciitis
The Problem: Across the bottom of your foot runs a thick band of connective tissue called the plantar fascia. It connects your heel to your toes, and helps provide support to your arch. This tissue can be supported by strengthening the muscles of the foot (that's another blog for another day soon) and also by wearing shoes with good arch supports. But many flip-flops have very little contour to their soles, allowing the arch to collapse and the plantar fascia to become stretched and inflamed. Pain under and slightly in front of the heel with weight bearing, especially early in the morning, that slightly decreases over the day but never resolves is the hallmark of this condition called plantar fasciitis. Once this condition comes on, treatment is sometimes complicated and lengthy and will require time off your feet and correct shoes.The Solution: More and more flip-flop manufacturers are starting to put arch support features in their shoes. Look for those types of flip-flops to help your arches stay up and healthy. You can also do exercises to strengthen your foot muscles, but we will get to that another day.
Hammer-Time!
The Problem: Flip-flops use a simple toggle to keep your foot in the shoe. That requires you to use your toes to grip that toggle with every step which doesn't happen when you wear closed-toe shoes. That repeated gripping can lead to inflammation of the tendons in the toes (usually the second, third, and fourth) that causes the toe to become permanently flexed and pointed downward. This condition is called hammer toe, and can be very painful.The Solution: The obvious answer is to not wear flip-flops, but come on...it's summer! This condition is not frequently caused by flip-flops but is something you should be aware of if you develop early signs of toe flexion. Choosing open shoes that use straps across the top of the foot rather than a toggle between the first and second toes is also a smart option. If you feel that you're developing this problem, change shoes and/or seek treatment immediately.
The Infection Section
The Problem: Feet are dirty. Don't be offended, but yours are probably no exception. Think about all the stuff you walk across in a day that contacts your shoes. With flip-flops, there is no barrier between your skin and those foreign substances. Bacteria, viruses, fungi--these can all now get direct access to your feet and take advantage of any small open wounds or scratches you may have that allow a point of entry into your body.The Solution: Washing your feet regularly is always important to prevent this kind of problem from getting a foothold (Sorry; I had to use that pun at some point). Inspect your feet daily as well and address any wounds, scratches, or cuts that you find. Keeping your feet protected and clean will help keep you healthy this summer.
Finally, Shin Splints and Knee Pain
The Problem: Flip-flops can cause problems beyond the foot as well. The overuse of the muscles of the shin to control the foot position in a shoe that offers no structure or support can cause shin splints due to fatigue and inflammation that lead to pain. The lack of arch support also causes the feet to roll in when walking (pronation) which changes the angle of the knee. If your femur (leg bone) and your tibia (shin bone) don't align normally to make the knee joint stable, you risk irritation and injury to the knee. Excessive pronation can also lead to an inner ankle sprain.The Solution: There are many ways to address these issues. First, always look for the supportive style of flip-flop to give your arches some help. Second, you can be proactive and use a foam roller to reduce the tightness in your shin muscles and your IT bands in order to lessen some of the strain these two muscles can put across the knee.
Dangerous But Not Deadly
Now don't get me wrong: I love flip-flops just as much as the next guy, and I'll never give up my red, white, and blue set for the 4th of July. But I have seen every one of these injuries limp into my clinic at least once during the summer over the years and the common thread has been flip-flops. They're a summer tradition, but there are some risks and warning signs that you should know. But with a smart shoe choice and a little preventative care, you should be ready to rock the summer with your toes in the sun.If you have any questions or need treatment, you know where to find us. Have a great summer, and be well!
Seth Alley, DC, CCSP
Doctor of Chiropractic
Certified Chiropractic Sports Physician
