According to recent footwear trends, in the battle between looks and comfort – looks is winning. Everybody’s favorite summertime shoe (a flat piece of rubber and toe thong) may actually be the culprit to different foot injuries and chronic pain in places that arise far from the feet.

Apparently flip-flops have become podiatrist’s best AND worst friends. I’m sure the growing number of injuries doesn’t please these doctor’s schedules, however, spring and summertime are great months for their billing departments! Dr. Howard Osterman, 20-year podiatrist of Washington D.C., claims that he sees at least one patient EVERY DAY in September for flip-flop related injuries. The most common diagnosis from the shoes is overuse injuries such as stress fractures. The long bones of the foot, metatarsals, develop stress fractures when stress is applied over-and-over-and-over to the structure without support. That means you can plan on trading your cool-looking flip-flops for a leg boot sometime in September after a long summer of foot torture.

While we walk around in flip flops, and in all shoes without laces/straps, we are forced to curl our toes up and hold the shoe on our feet to avoid letting it fly off the foot. This slight but ever-so-important gait adjustment leads to compensation patterns and unusual stresses compared to wearing sneakers or walking barefoot.


The new generation of flip flop manufacturers advertise flops with increased arch support, shock absorption, and stress reduction. Does this mean we can frolic as we wish in flip-flop shoes as long as they’re expensive and cushion-ny? Footwear experts agree that these alternatives are preferable to the flat rubber flip flops found piled high in a $1 box at the discount store. However, patients at risk of tripping and falling should be cautious about wearing any type of flip flops, including patients with lower extremity disorders who use walking assistance and those who struggle with balance. These folks need a stable foothold and proper proprioception of the feet.

A study in 2014 reported that wearing flip-flops was associated with greater maximum ankle dorsiflexion and tibialis anterior activation compared to barefoot subjects and subjects using enclosed shoes. Osterman stated that “The longer you are in flip-flops, the more potential for low back and hip issues.” Our feet absorb impact from the ground pushing on us during every single step we take. It’s supination of the foot (the natural rounding and use of the outside of our feet) that is eliminated by flip-flops.  The compensation patterns that arise from wearing flip flops lead other issues up the kinetic chain: potential knee, hip, and/or back issues. 

If you wear flip-flops often, you should incorporate exercises to help keep your ankle mobile, stable and strong. Doing this will certainly help offset the “damage” that flip-flops inflict on the body.


The take home: Flip flops aren’t the healthiest footwear choice, but there are options and occasions where they may cause less harm. Wear your flip-flops while walking down to the beach, or walking across a burning hot pool deck.

Issues arise during chronic use of flip-flops for things like every day footwear, or long distance walking such as shopping and dog walking. As with all things, listen to your body. It will tell you what’s right versus what’s wrong. Sore knees after spending time in flip-flops is not a coincidence. And maybe your back doesn’t hurt “because it always hurts during hotter weather” — change your footwear and get back to us!