Columbia Advanced Chiropractic Blog, Body at Work

Last year, Howard County Public Schools banned the use of flip flops. Apparently, the was an increased incidence of lower extremity injuries and the school system figured that by reducing flip flops, that the injury potential would be reduced…So, does this make sense or not?

Well, simply put, yes, it makes sense!

When you put on a thong/flip flop, you have to hold onto it with your big toe and second toe. This is something you don’t see with any other footwear products and for good reason…it’s not a natural thing to do.  When you have to grip the thong, you are immediately changing your gait.  This is a bad thing. This goes along with not having any strap or support around your ankle.  The normal gait cycle involves heel strike with the lateral posterior portion of your calcaneus. The calcaneus bone is made for impact so we should use it for this. With flip flops, because you don’t tend to heel strike, you end up ‘flopping’ around and more or less hitting the ground with your mid-foot.  The mid-foot is not made for impact…you can take a look at the bones of the feet to understand why this is.

So, when you do not heel strike, that energy from impact has to go somewhere else…and where it goes is not meant to take the additional force.  Normal gait consists of:  heel strike, foot flat loading, mid-stance, heel rise, toe off (Windlass Effect), and mid-swing.  Wearing flip flops shorten your stride length and allow for dropping most of the impact pressure on the mid-foot, as it by-passes the heel strike.  This change in gait can result in altered biomechanics of the foot, ankle, knee, hip, and low back/pelvis…this, in turn, can lead to pain syndromes.  The problems are compounded the longer you wear the flip flops…they can really have deleterious effects on your body.

Many ‘gait specialists’ point out that the problem with flip flops is that they do not have good arch support.  In reality, this is hardly the issue with them.  You can find flip flops with good arch support, but this does not negate the effects the flip flops have on your stride.  Simply put, as long as you are gripping something with your toes and you do NOT have any support/strap around the calcaneus, you cannot walk as you should and you are doing harm.

My patients know that I don’t like flip flops because of problems they cause. Many of my patients over the years have related to me that wearing shoes or sandals with more support help reduce symptoms of foot, ankle, and knee pain. This makes sense.

How about all those big toes you see bent to the outside (really considered adduction)…this position creates a great environment for bunions and further toe malformation.  The adductor hallucis muscle is simply not meant to work this much, and when it does, you end up with deformed toes!  Can flip flops have a major effect on the musculature in the foot as the toes have to squeeze to hold the flip flop on?  You betcha!  This only gets worse as you get older.

So, back to the school situation.  I agree that flip flops lead to more injuries…we’re not even counting people stepping on the back of them and the person spraining their ankle!  Common sense dictates that wearing flip flops in the shower or on the beach is fine…short periods of time are of no concern.  The bigger problem is children (or adults) wearing flip flops all day long, day after day…this frequency will ultimately lead to a disturbance in normal gait mechanics as well as toe deformation, and with such, injury will occur.

Instead of wearing flip flops, try a sneaker or sport sandal.  I am a fan of Keens as they have an open-foot feel yet they tend to have ample arch support, do not have a thong between your first two toes, allow for proper gait, and protect the front of the foot.

Please feel free to post your thoughts on this topic.  I’m excited to hear what people have to say.