How flip-flops and other footwear affect your feet

May 05, 2011

Dr. Howard Osterman, president of the District of Columbia Podiatric Medical Association, will answer questions on what problems various types of footwear -- such as flip-flops -- can have on your feet.

The podiatric dangers of flip-flops
Advice for wearing flip-flops

Does it harm your foot to wear flip flops for most of the day if you don't have much of an arch in your foot?

The biggest problem with flip flops is that there is an inherent lack of support.  With too much walking on harder surfaces, the soft tissues get inflamed.

Today at Farragut North I saw a young professional woman adjust her flip-flops on the working escalator, while standing barefoot for a time. I rejected the instinct to give her a reminder about being careful about bare feet and slip-shoes on the escalator - I was going to be very mad at her if her leg ended up bloody and mangled on my morning commute! Is this truly a danger or am I just paranoid? Is there anything convincing to say to someone in this situation?

Injuries on the metro is common.  You are correct that as the shoes come off sharp edges and/or foreign bodies attack.  Also, who knows what bacteria/fungus can be picked up if you have a cut/blister, etc

What's your opinion on Nike Free, Vibrams and other similar shoes? I like the Nike Frees since they're light weight, but I'm not noticing much else...

I agree that these shoes have a real place in today's society.  I think that they are excellent replacements for flip flops and can be used for periods of time.  The problem is that is worn with an already sore arch/tendon/bone, it exacerbates the problem.  We then compensate the way we walk/run and creat new injuries

What about the use of flip flops with planar faciitis?

It can make plantar fasciitis worse by not providing enough support

Hi Dr. Osterman. I live in the tropics and while I try to wear sneakers (with my hard insert) as much as possible, I often don't for work or minimal walking outings. I still need sturdy footwear, though. I like Dansko sandals, can you recommend other brands that have really good, comfortable arch support? Thanks!

Sandals like Teva or Chakko can provide better support that flip flops.  What you look for are sandals with a strap around the ankle or one the has straps that come back to the ankle.  Otherwise you spend all day crunching your toes to keep the shoe on and the muscles get overworked

I see that there are more rocker shoes and sandals in the stores and on the internet now. I have been buying the expensive MBT Swiss shoes for several years. Are the knockoffs as good as the originals?

Alternates to the MBTs are the Skechers and some of the earth shoes.  They are fine, but everyone is coming out with some version, and many are not as good.  They can create achilles, hamstring and low back pain

I moved my family from VA to HI this past summer. My 11 year old son wears flip-flops (rubber slippers in local slang) every day since closed-toe shoes are not required at school. He also plays soccer and lacrosse year round here so he wears cleats 2 hours a day virtually every day as well. Do I need to require some different footwear to ensure healthy growth/development of his growing feet?

Flip flops are especially tough on kids.  They have growth plates, esp in the heel area that can become symptomatic.  It only gets worse with cleats.  Try to have him wear a more supportive shoe some of the time, to let the muscles rest and heal

Seems to me the argument against flip flops, and the the thrust of this article, leaves out an important aspect of the issue: humans evolved not wearing supportive footwear, so a major issue I would imagine is not so much a lack of support with most flip flops but that we have become so out of shape, over-weight, and over-reliant on unnaturally supportive footwear. Flip flops are not all to blame; our poor health and sendentary lifestyle is the real culprit here.

You are correct, the problem is not as much with the shoes, as is our use of them.  When we over do too much of a good thing, sprains and strains ensue.  If these shoes appeal to you, break them in slowly, don't try and do all day with a heavy activity level.  Use of these type of shoes can actually help build arch strength so some use is usually fine

My over-the-ankle medium hikers are already getting good and broken in with shorter hikes. What's your advice for keeping my feet comfortable inside of them while I'm carrying a 40 lb load over a two-week trip? Should I get inserts for extra support during the long days on the trail?

Absolutely get inserts.  They help the arch and muscles to not have to work so hard

I work at home and I'm generally either barefoot or in my flops in the warm weather. Is there a suggested # of days/week I should wear flops, go barefoot, and/or wear sneakers?

It is not so many days of the week but more how many hours in a day.  A couple of hours is generally fine, and not for athletic activity

As podiatrist for local basketball teams, you doubtless have ample experience with feet outside the bell curve. Is there anything I should be particularly concerned about with regard to the health of my size 14AA feet?

It is more the AA heel than size 14 shoe.  Making sure that you have a proper fit is essential.  Too many times people try to fit the heel and cram their toes in to fit.  It is bettter to fit the toes and we can pad the heel.  A good podiatrist or shoe fitter can be of invaluable service 

Doctor, thank you so much for doing these type of chats. I have said for years that sandals and flip flops are simply not good for your feet. I am an ultra-endurance runner (31 to 100 mile races) and I have so many friends and co-workers that come to me, usually around June/July complaining of foot pain (usually PF) and don't understand why. Almost 90% of the time its because they wear flip flops/sandals everywhere they go because of the warmer weather. I try to tell them why this is and they look at me dumbfounded. Well, lets see..most of these types of "footwear" have no support, change the way your foot naturally strides and strikes the ground and you probably wear them everywhere! Thoughts?

It gets back to overuse.  These tend to exacerbate any potential injury.  Certainly they can create some as well, but so can poorly fitting running shoes.  The best suggestion is to see a sports medicine specialist of the lower extremity to see if these shoes, in moderation, not full time, would be OK

Hello. I'm not a fan of flip flops, but I love my Rainbow sandals. They provide great support. I wish I could find ballet flats with that kind of support. With that being said, do you have any suggestions of insoles I can buy to be used when wearing ballet flats? What type of insoles and what brand? I think I have a high arch (my feet tend to roll inwards when I walk). Thank you!

Most over the counter supports are for flat feet, not high arches.  Typically a custom orthotic would be most beneficial.  These can be made small enough to fit most ballet flats

As a woman expecting a baby in early August, I planned on wearing flip flops to accommodate the hot weather and my expanding feet. Any suggestions on a substitute?

Pregnancy has multiple issues.  Certainly the feet will swell but also hormones weaken ligaments in the pelvis to aid delivery.  hese hormnes also can stretch ligaments of the feet.  Getting a good running shoe is most appropriate, but if sandals are a must, Teva or Chakkos are good.  Naot or Merrells are a little more fashionable

Please don't instill fear in people unnecessarily. There's as much or more bacteria, fungus and other pathogens in our shoes as there is out side them. I grew up in the suburbs of northern VA going barefoot in warm weather whenever possible. I developed tough, callused, strong feet and I never got sick from not wearing shoes. As for flip flops, I find the too uncomfortable because of the constant toe scruntching necessary to keep them on your feet. I prefer sandals with an ankle strap.


I've been struggling to get over plantar fasciitis for a few months now, and I've been wearing my sneakers more or less full time. I'd love to be able to wear some sandals with the warmer weather, but I'm afraid I will pick shoes that do not have adequate support. Any tips for picking shoes that won't aggravate my foot? Or should I just expect to wear my sneakers all summer?

Try sandals with a stiffer sole.  More of a platform sandal is ok, like Rocket Dogs or some Steve Maddens.  The idea is for stability and a thicker sole.  Do not do anything stiletto style.  You want the width of the shoe to be about as wide as the heel bone.  That way you dont have to balance on the shoe

My two girls (ages 5 and 9) LOVE flip-flops and prefer them over tennis shoes. I buy them better quality flip-flops, like Sanuk, but wonder if their feet are at risk for problems later on. What do you think?

Actually at their age they are very appropriate.  Moderate use of them helps with muscle development and strength.  Might not be a great choice for the Amusement park, but for running around it should be fine

Are there any brands of shoes you've found particularly good for individuals with a moderately high arch? I've found Salomons to work well.

A high or moderately high arched foot tends to well with a small heel on the shoe.  Typically the achilles can be tight so a small stacked heel can be more comfortable

What do flip flops do to your toes (and feet) over the long run? Are we going to have entire generations with massive foot problems? Similar to what is happening to hearing--First with concerts noise and now with ear buds.

They dont necessarily do anything to your toes/feet, but if pain arises we become more sedentary.  That can lead to obesity, diabetes, heart disease.  We already have an epidemic of these issues and can be reduced with exercise.  If we hurt, we sit and don't walk

I heard that birkenstocks are bad for your feet. Are they as bad as flip flops? They are made of leather and have rigid soles.

Birks are not as bad as flip flops.  They give much more support, but not as good as a good running shoe.

Hello. I used to have inserts that were made for my feet by physical therapists. I can't afford that any longer. What is a good substitute? Do you recommend any certain type of running shoe for folks with over-pronating feet?

Orthotics/arch supports made by a physical therapist is usually NOT covered by insurance.  These CAN often be covered if made by a podiatrist

What is your opinion of Christopher McDougall's book, Born to Run, where he extols the virtues of distance running in bare feet or footwear as simple as huaraches? He makes a good case that minimalist shoes - or none at all - combined with proper conditioning are much easier on feet than running shoes designed to alter a person's gait. (My flat-soled $15 martial arts shoes are extremely comfortable on grass and sidewalk alike.)

The book generated alot of discussion in our profession, and that is very good.  It makes us go back and re-evaluate our line of thinking.  I dont necessarily agree with his principle though.  It is not for everyone.

So, what is the difference in the type of support you'd need for each?

Flatter feet typically need more of a stiff sole, while higher heels need more of a cushoined insole. 

Good afternoon. What are characteristics of a good, supportive shoe? Thanks.

Stiff soles with adequate shock absorbtion is paramount.  Enough room in the toes is important as well.

When you talk about flip flops, you're generally talking about the plain old rubber shower shoe variety, right? Because there's a big difference between a flat sole flip flop and, say, a Teva flip flop - I pretty much hate wearing any others anymore because the Tevas provide better support than some of my tennis shoes!


What is your opinion on just going barefoot most of the time (when appropriate)? Is it better or worse than flip flops?

Barefoot can actually be better than crummy flip flops or sandals.  Trying to keep a poorly fitting shoe on the foot creates more stress than barefoot

I have plantar fasciitis and a heel spur in my left foot. I wear supportive shoes with inserts all the time, except for sleeping and showering, so I don't experience any pain. But I'm wondering if you have a recommendation for a non-custom orthotic for these conditions? I have a small (size 6) and wide (D width) foot with high, rigid arches. Thanks.

There are alot of good choices of OTC insoles.  Ask a podiatrist for examples.  Some, like Suserfeet or Sofsoles are at good running stores, others are sold exclusively through doctors offices.

Hi Dr. Osterman, I have no arch so do I need support? Seriously, my feet are totally flat. I like to wear fun girly shoes but usually end up in flats for work because I can't hack it all day in heels. Any thoughts for the archless? What kind of workout shoes should I look for?

Custom supports can be very helpful creating an arch that you were not blessed with at birth

I am starting to develop a bunion on my left foot (big toe) and I think it's due to walking in the Pentagon all day in dress shoes that are hard on my feet. It is getting painful. now that the weather is warming up, I will start to wear more flip flops. Do you think this will give my bunion a chance to heal on its own -- and, is it even possible for a bunion to get better on its own?

This will not get the bunion to 'heal' but will reduce pressure on it It may actually get the bunion to 'grow' and will become more tender when you return to fall shoes

I've looked to see if orthotics would be covered under many different insurance plans. They NEVER are- doesn't matter who makes them (podiatrist or other). If you have an insurance plan that covers them, keep it. I haven't come across one yet. In light of this, would you care to offer a suggestion on over-the-counter options that are best?

Superefeet sofsole, spenco all make excellent supports.  There are a myriad of styles for a variety of ailments

I notice a lot of people can wear 'soft' shoes but my feet ache like the dickens if I don't have strong support above as well as below. Although I also like to be barefoot at home as much as possible and my feet don't ache from that. Is that common?

More than you would think.  A shoe that bends at the wrong place is worse than no shoe at all

Thanks for the opportunity to chat.  Hope this was informative for the audience.  Dr Osterman

In This Chat
Dr. Howard Osterman
President of the District of Columbia Podiatric Medical Association, fellow of the American Academy of Podiatric Sports Medicine and team podiatrist for the Washington Wizards and Mystics basketball teams.
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