Especially in colder climates, summertime means the bliss of putting away coats and boots and hauling out shorts and flip-flops. It's great to step outside, wriggle your toes and literally cool your heels without restriction. Best of all, you can just slip them on and go - no lacing, zipping or buckling required. But are flip-flops your best bet for foot health? You probably already know the answer is not so much.

As the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) reports, 198,437 emergency room visits in 2014 were due to shoe-related injuries, and flip-flops were blamed for 25,300 of them.1

Podiatrist and foot and ankle surgeon Dr. Christina Long, from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, says summer is the time people with flip-flop-related foot conditions start showing up at her door. Most of them are due to the unstructured nature of flip-flops, which result in a lack of support for your feet. Medicine Net quoted Long:
"Flip-flops don't offer any arch or heel support, and you have to grip them with your toes to keep them on. Wearing them for too long or for the wrong activity can cause a lot of different problems."2
Dr. Jordan Metzl, from the Hospital for Special Surgery in New York, says he sees a lot of people coming in for help with pain due to suddenly wearing flip-flops every day after having worn better-constructed shoes all winter.3 Much of the pain comes from having too much pressure placed on your tendons and bones, known as "overuse" injuries, and even from altering your foot structure.


Flip-Flop Fascination: Versatility and Functionality, Not Durability

Flip-flop soles are usually made of cushiony rubber, foam, synthetic materials, fabric or leather. Some are even made of plant-based material, such as hemp, which is naturally antibacterial, antifungal and breathable.4 The popularity of flip-flops has a lot to do with their shower- and beach-ready practicality, so while a few designer models may sport a stacked or wedged heel, and others purportedly offer an "ergonomic" sole, the vast majority are flat.

A lot of people, especially women, enjoy collecting several pairs in different colors. They're casual, fun and versatile. Much of the appeal is wearers' ability to mix and match with different outfits, not necessarily for durability or even comfort. Flip-flops are generally pretty inexpensive, which is part of the problem because it typically reflects the quality and lack thereof. Many can be purchased for as little as 5 bucks a pair. Long contends that this popular footwear is generally fine if you're wearing them for a short time.
"Flip-flops are fine for short-term use, especially if they have at least some arch support and a cushioned sole. They're good to wear at the beach, around swimming pools, in showers and locker rooms at the gym, on short trips to the store."5
What about that whole "viral or bacterial infections" part in regard to wearing flip-flops? A Cosmopolitan article notes that flip-flops can expose your feet to bacterial, viral and fungal infections, especially if you have cracked heels, because:
"They're likely covered in some nasty things, like Staphylococcus. This bacteria can irritate the skin on your foot or (in a worst-case scenario) lead to amputation. How severe exposure to Staphylococcus gets depends on whether you have open wounds - like micro-wounds from exfoliation during a recent pedicure or actual cuts - and your state of health when you pick up the bacteria."6
So What's the Problem With Wearing Flip-Flops?

Their trademark construction dictates that they fit loosely on your foot, thong style, by a Y-shaped strap that passes between your big toe and your second toe, with no supporting straps along the top, sides or around your heel. Many sandals do have such straps; flip-flops do not. As such, there's nothing to protect those exposed areas of your feet. Wearing them on a routine basis may start causing a number of different problems, and even injury, podiatrists caution. Problems include:

The hammer toe problem comes from having to grip them with your toes to keep them on if you're going up or down stairs or through sand on the beach. And if you choose to slip them on for a day of shopping or walking, they'll likely start killing your feet before the day's over. In fact, Today also reported results from a recent survey that 25 percent of women admit their flip-flops sometimes hurt their feet.7

People have opened doors and painfully scraped the skin off the tops of their feet, tripped and fallen over their floppy flip-flops, slipped right out of them when wearing them on wet surfaces (or on hot, sweaty days) or stubbed their toes. This is even true for children wearing flip-flops to walk or play in. Also, moisture from sweaty feet will eventually promote bacteria growth.

In fact, Long mentioned more serious and painful conditions such as stress fractures and plantar fasciitis, which is inflammation of the band of tissue stretching from your heel to the ball of your foot. They can also throw off your natural stride, which may cause shin splints or pain in your Achilles tendon.

Flip-Flop Studies and Surveys

Experts also say a lack of arch support in most flip-flop designs can be a problem, because if they're worn for very long, they can cause and/or exacerbate foot, back and even knee problems, and often all of the above because the pain moves upward from your feet. According to researchers at Alabama's Auburn University:
"We found that when people walk in flip-flops, they alter their gait, which can result in problems and pain from the foot up into the hips and lower back. Variations like this at the foot can result in changes up the kinetic chain, which in this case can extend upward in the wearer's body."8
Involving 39 college-age men and women, study participants wearing flip-flops the first day, followed by traditional athletic shoes the second day, were recorded by video walking a platform that measured vertical force as their feet hit the ground and measured stride length and limb angles. According to the study, the flip-flop wearers:
"Took shorter steps and ... their heels hit the ground with less vertical force than when the same walkers wore athletic shoes. When wearing flip-flops, the study participants did not bring their toes up as much during the leg's swing phase, resulting in a larger ankle angle and shorter stride length."9
A 2008 study reported that such footwear "can wreak havoc on the rest of the body, with distinct and noticeable effects on everything from the wearer's posture to their gait."10

Expert Advice and What to Look for in Flip-Flops

The American Podiatric Medical Association (APMA) recommends buying the most comfortable flip-flops you can find, but also that you look for soft, high-quality leather. Medicine Net offers more advice to get the most in quality and comfort:
"Gently bend the flip-flop from end to end, ensuring that it bends at the ball of the foot - it should not fold in half - and make sure your foot doesn't hang off the edge of the flip-flop. The APMA added that all of your shoes - not just flip-flops - should be slightly bigger than your feet."
However, if you give your flip-flops the "bend" test, which is basically folding one in half, and it bends easily, that's the type that will offer your feet the least support and, arguably, the most pain. Not surprisingly, the APMA also suggests that if you're tackling a hike, running, standing for an extended length of time, walking long distances, playing sports or doing yard or garden work, a sturdier shoe may make your feet - and you - much more comfortable, although there are experts who believe going barefoot may be best of all.

Another bit of advice regarding when to skip flip-flops is when you drive. If you've ever done it, you know how easy it is for your foot to slide and the offending flip-flop to end up stuck between the brake or gas pedal and the floor. Ditto for riding a bicycle, as the pedals can separate your foot from your flip-flop, causing you to tumble.

Is Going Barefoot Better?

In the search for a natural lifestyle, there may be no better exercise than putting your best bare foot forward by Earthing or grounding - literally connecting with the earth - as it's healthier for you than you might imagine. Your body, being electrical, benefits from direct contact. One study put it this way:
"Emerging scientific research has revealed a surprisingly positive and overlooked environmental factor on health: direct physical contact with the vast supply of electrons on the surface of the Earth. Modern lifestyle separates humans from such contact. The research suggests that this disconnect may be a major contributor to physiological dysfunction and unwellness."11
Study results listed better sleep, less pain, tension, muscle soreness and stress, reduced electric fields on the body and improved heart rate variability, glucose regulation and immune response. It concluded with the suggestion that Earthing may be as essential in supporting health as getting plenty of sunshine, clean air and water, nutritious food and physical activity.

Further, the inflow of free electrons from the Earth's surface may help neutralize free radicals and decrease both acute and chronic inflammation, which are the bottom line in many health conditions and premature aging. In fact, the earth may act as a sort of "umbrella" to help your body adapt to deflect harmful agents. Improvements in hypertension, rheumatoid arthritis and fasting glucose levels may be seen.12

Aside from grounding, going barefoot may strengthen your feet and lower legs while enhancing proprioception, which is the unconscious perception of movement and spatial orientation arising from stimuli within your body itself - especially among children.13 So you may want to forget about those flip-flops! If it's been awhile since you've allowed your feet to be tickled by grass or put your toes in the sand, it costs nothing, and you may be surprised by the physical, physiological and emotional benefits.

More Advice on Flip-Flop Maintenance

If you have no intention of throwing out the 82 pairs of flip-flops you've so lovingly amassed, it's at least a good idea to break your feet into them gradually when warm weather arrives, not to do an immediate exchange. "You need to build into them. Don't go crazy right away," Metzl says.14

Additionally, don't wear the same pair or even two pairs every day all summer. Change them out every so often, especially in light of the buildup of bacteria when they're worn repeatedly without having a chance to dry completely. Further, while flip-flops can protect your feet from fungi and bacteria that can be acquired by walking barefoot around pools, locker rooms and changing rooms, as well as from hot sand on the beach, the rubber and plastic many of the cheapest varieties are made from may exacerbate such problems.

Here's some great news: If your flip-flops are becoming a little worse for wear, or begin taking on an unsavory odor, some can be cleaned rather than tossed. Clean My Space 15 offers tips on several types and the best ways to clean them; sometimes it's as simple as throwing them into the washing machine. Rubber flip-flops can be scrubbed with an old toothbrush in the tub with water and liberal amounts of baking soda to make a paste.

Let them set for about five minutes. Do the bottoms, too. Rinse and set aside to dry and you're good to go. Alternately, soaking them in a solution of half water and half white vinegar is a smell solution, followed by baking soda if necessary.

Suede sandals may benefit from gentle rubbing with fine-grit sandpaper to get rid of scuffs and dirt. Saddle soap, like the type cowboys have used on leather saddles for decades, softens, cleans and reconditions leather and even helps deal with odor. In a last-ditch effort to save people from themselves (at least those in the flip-flop-wearing category), Today offers this advice:
"Look where you're going. Flip-flops offer little to no protection against broken glass, and other sidewalk debris. If you're not willing to give your feet a cover, then at least keep your eyes open and remain alert."16
Sources and references here.