Don't Do Flips for These Flops

The next time you change out of your dress shoes and into a pair of flip flops, you may breathe a sigh of relief—but your feet are still suffering.

Wearing high heels or hard loafers all day can result in foot discomfort and damage, but doctors say that thin-soled flip flops can be even worse for your feet—and your wallet.

Injuries resulting from long-term flip-flop wear can mean injury to your feet, knees, and even back, doctors warn. In worse-case scenarios, these injuries can lead to expensive surgeries to repair the damage.

We checked in with experts to get a rundown on some of the most common injuries caused by frequent flip-flop wear and the financial  damages.

Lower Back Pain & Herniated Disks

“People think that with flip flops you’re going to have foot pain, but flip flops actually change the way your foot strikes the ground and because of that, there are altered mechanics at the knee, the hip and the back. Your back will often take the brunt of those unnatural muscle movements,” says Annie Malone, a physical therapist at Athletico, an outpatient rehabilitation provider in Chicago.

Although most cases of back pain resulting from flip-flop wear can be eradicated by simply wearing more supportive footwear,  Malone says that in extreme cases, patients can get herniated disks in their spine. A herniated disk means the disk bulges and touch nerves in the spine causing pain an irritation that radiates down into the legs and feet.

“If a problem develops and it goes neglected for a long time, it can result in a surgery,” says Dr. Marlene Reid, a Chicago-based podiatrist with the American Podiatric Medical Association (APMA). “These are the most extreme cases, but we do see it happen.”

In the case of a herniated disk, patients can expect approximately six months of physical therapy, according to Malone.

Worst-case scenario cost:*

72 sessions of physical therapy at $300 per hour = $21,600

Back surgery= $60,000

Total= $81,600

Knee Pain & Meniscus tears:

“Because flip-flop wear changes the way your foot strikes the ground, it ultimately changes the way your knees respond to each step and it puts additional stresses on the ligaments, muscles and tendons in your knee,” says Malone.

For people with underlying knee conditions, flip flops are especially dangerous, she says. For example, many people can unknowingly have a meniscus tear in their knee (an injury to the disk that cushions the knee) that can be exacerbated with flip flop wear. She also says frequently flip-flop users can be at risk for developing a meniscus tear over time.

“Say you have a meniscus tear and you go out and walk around Chicago for eight hours in flip flops, you’re going to get home and say, ‘I have knee pain that is killing me and I have no idea what I did,’” says Malone.

She says a tear in a meniscus could potentially lead to six weeks of physical therapy and knee surgery to repair damage.

Worst-case scenario cost:*

20 sessions of physical therapy at $300 per hour= $6,000

Knee surgery= $20,000

Total= $26,000

Plantar Fasciitis (inflammation of the soft tissues on the bottom of the feet)-

Plantar Fasciitis is the most common ailment brought on by prolonged use of flip flops, according to Malone. “It happens when the arch of the foot is overstressed because there is no underlying support from a shoe. All of your body weight gets put on that arch when you wear flip flops so it's basically the equivalent of what would happen if you walked barefoot for several hours.”

The tissue on the bottom of the foot will get irritated and become very tight after several hours without supportive shoes, she says. But the initial pain won’t be severe—in fact, many people may have plantar fasciitis and not realize it. A sign of plantar fasciitis is a sharp pain in the foot’s arch experienced when stepping out of bed. This pain results from the sudden stretching of the arch as it’s hit with the body's weight. Stretching the arch of the foot can help alleviate the pain—if it doesn’t help, physical therapy may be necessary.

“Physical therapy is just one treatment modality for plantar fasciitis,” says Reid “Sometimes we will use cortisone shots, sometimes we will use stretching and shoe control. Each person’s treatment is different because each person’s foot functions differently.”

People who want to try stretching out their arches should put a golf ball or a tennis ball off the side of their bed. Before taking those first morning steps, they should roll the ball around on the bottom of the foot to stretch out those muscles, advises Malone.

Worst-case scenario cost:*

10-12 sessions of physical therapy at $300 per hour = $3,600

Bunions or Hammertoes:

“When you talk about injuries that can result from flip flop wear, we think about trauma or something that gets hurt, but the main problem with flip flops is the structural problems they can cause in the feet like bunions or hammertoes," says Dr. Ali Sadrieh, a doctor of podiatry at Evo Advanced Foot Surgery in Los Angeles. "Flip flops can cause them just as much as high heels.”

When the feet have no structural support, Sadrieh says it’s like a “free for all” for your feet. Tendons in the feet won’t contract or end up contracting too much and cause the toes to develop bunions or hammertoes.

“In a normal shoe, you’ll see calluses on hammertoes, but with flip flops they can remain hidden because there’s no top layer of the shoe to rub and cause a callous,” says Sadrieh.

Once flip-flop weather ends and sneakers and boots are back in rotation, the damage becomes more apparent. People may notice that the changes in their feet mean their favorite structural shoes don’t fit quite like they used to, and the bunions and the hammertoes will worsen, which Sadrieh says could require surgery to correct.

Worst-case scenario cost:*

Surgery per toe: $1,500 not including facility and anesthesia costs

Average number of toes affected: four

Average facility and anesthesia costs: $10,000

Total: $16,000

*Average cost figures supplied by Malone & Sadrieh