The Failings of Flip­‐Flops: Why Singaporeans Are More at Risk from Flat Feet

February 16, 2016

‘Flat feet’ or pes planus is a condition in which the arch of the foot is lower than usual. However, this can be a misleading term as flat feet can be divided into ‘rigid’ or ‘flexible’. Rigid flat foot is a rare condition in which the bones of the foot are fused together. On the other hand, flexible flat feet are much more common. This is where the joints of the foot move excessively and do not fully support the body’s weight when standing or walking. There are varying degrees of this condition and there are multiple factors which can contribute to it such as age, family history, medical conditions, previous injuries and weight gain (e.g. during pregnancy).

All infants are born with flat feet and it can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

Flexible flat feet can occur in approximately 10-20% percent of the population. However, due to the increased ligament flexibility found in Asian populations, estimates suggest that flat feet may occur in as many as 1 in 5 Singaporeans.

Flat feet may put a strain on your muscles, ligaments and joints, which may cause tiredness or aching in your feet, legs, hips and back when you stand or walk for long durations.

Treatment is usually only required if the flat foot is causing pain in the foot or the lower limb. If there isn’t any pain, treatment is not indicated simply as a result of having a flat foot. However, in severe cases, treatment may be advisable in order to prevent any possible future problems.

Contrary to popular belief, having a flat foot does not necessarily increase the incidence of injury and it does not always cause problems. As a physiotherapist, I’ve seen many patients who have ‘flat feet’ but are pain free. But flat feet coupled with the a poor choice of footwear can be a big risk factor for pain, and in particular, a certain type of footwear… flip flops.

Flip Flops

The Problem with Flip Flops

Most Singaporeans own several pairs of flip-flops or slippers. They are hugely popular and are seen by many as the ideal choice of footwear in hot weather due to their comfort and convenience. However, such a choice of footwear might be a real health flop.

Aside from the obvious lack of protection (meaning you're more vulnerable to dropped objects, stubbed toes and infections), being dangerous to drive in, and making you walk slower, your favourite pair of flip-flops could be seriously damaging your feet.

Healthcare professionals will tell you that flip-flops are too flat, too thin and can lead to many foot problems. They should thus be avoided in for prolonged walking because they offer no arch support, heel cushioning or shock absorption. Furthermore, the thong that sits between your toes when wearing flip-flops can also be dangerous as it forces wearers to clench their toe muscles for grip to keep them from flying off. This can lead to repetitive stress on the foot and ankle, leading to overuse injuries or deformities such as hammer toes or claw toes.

This type of shoe can accelerate the problems associated with having a flat foot. The complete lack of arch support in flip-flops means those with flat feet who tend to over pronate already have nothing to limit from further excessive pronation, thus putting more strain on an already stressed arch.

Plantar Fasciitis

Among the most treated flip-flop induced injuries is plantar fasciitis, an inflammation of the tissue along the sole of the foot. It is most often sparked by all-day wear, with flat footed, overweight or sedentary wearers even more susceptible since their arches are already under strain. The feet are the foundation of your whole body and the base of your skeleton. Therefore it’s not surprising that wearing flip flops can have a domino effect, putting stress on your joints, which may result in ankle, knee hip or back aches.

Our bodies are designed to tell us when things aren’t working properly, typically in the form of pain. In the correct shoes you should be easily able to walk for a solid 2-3 hours without feeling discomfort. If your feet or any other part of your lower limbs hurts while walking or standing, there’s a good chance your footwear is playing a part. An easy test to try is to try walking in flip flops for an hour or so and then note how long it takes for any aches, pains or tiredness to set in. Try the same thing again in a sports shoe and take note of how you feel after an hour. Granted everyone will be affected differently, but chances are, walking in a sports shoe will be much more comfortable than flip flops.

We have already written a blog on things to look out for when choosing a shoe, so this can provide with some tips when shoe shopping. If you’re unsure then there’s always expert advice on hand to help pick the perfect shoe for you.

Hopefully I have convinced you how vital it is to wear supportive footwear. For those who ignore such advice and insist on continuing to wear flip-flips, slipping them on for short durations or by the pool should be ok, but moderation is key. Problems arise when flip-flops become your main choice of footwear.

How can PhysioActive help?

It’s important to recognise the problem as early as possible since its severity tends to worsen with time. Treatment would focus on specific aspects or parts of the foot that require modification or healing. This may be achieved in a number of ways.

  • Specific exercises: Calf stretching exercises and specific foot strengthening exercises can be advised by our physiotherapists.
  • Footwear: It's vital that you are wearing supportive footwear. We can help advise on footwear.
  • Insoles or orthotics: These can be used to help to restore and support the foot’s normal arch and alignment. Our podiatrist or physiotherapist can provide further details on appropriate insoles or orthotics.

Thanks for reading!

This post has been written by physiotherapist Liam Mc Ginley.

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