26/08/2024
This is an article in The Telegraph today which you may find of interest?
HEALTH
Why wearing summer sandals can be harmful
It may keep you cool but the footwear offers little support or cushioning – which can lead to sprains, joint damage and long-term pain, says Boudicca Fox-Leonard
Summer sandal season always presents podiatrist Helen Branthwaite with new patients, but this year her own mother was among them, having purchased a pair of pale blue Birkenstocks only a few weeks before.
Fancy footwork: Boudicca Fox-Leonard
Fancy footwork: Boudicca Fox-Leonard
“My younger sister had some and then my mum bought some too,” says Branthwaite. “She was totally attracted by the image around them.”
Days later her mum was complaining of foot pain. Branthwaite, the musculoskeletal lead for the Royal College of Podiatry, tried to warn her mother against using the sandals; with their lack of cushioning and arch support, as well as the absence of a strap around the back, her new Birkenstocks were just too much of a leap from her usual supportive Scholl sandals.
“Mum was used to having a drop at the front of the shoe so that it’s lower than the back.” says Branthwaite. The Birkenstock is much flatter, which forces her to stand and walk differently. It created an alteration in the ankle and the way that her muscles work so she had to use the toes more to keep them on, and stained the tendons.”
It wasn’t the Birkenstocks fault per se, says Branthwaite. When diagnosing any shoe problem, she looks for a mismatch between the function, anatomy and adaptation of the wearer and their shoe style.
“As soon as you put any shoe on it changes the way that you move. The way you progress through the foot, the forces on the foot and the way that the limb and spine move,” she explains.
Podiatrists joke that summer and flip-flops means it is heel pain season.
“I always see more cases of plantar fasciitis [heel pain] at the end of summer, and the majority are triggered by a walking holiday or long weekend spent in flip-flops or unsupportive sandals,” says Heather Smart, podiatrist and co-founder of foot specialists, ZeroSole.
In much of the world people wear sandals all the time and are used to the lack of cushioning and flatter sole. In the UK we spend most of our time in closed-toe shoes. Switching between the two types can cause problems, as our feet aren’t used to the different muscle activation and forces through the foot that sandals have.
In particular, flip-flops and sliders can cause tension in the tendons on the toes as you strain to keep them on your feet.
If you’re just wearing that suboptimal shoe to go down to the pool or to put the bins out, that’s not a problem, says Branthwaite: “The issue is when people try to wear a style of sandal their gait pattern isn’t used to for a long period of time.”
If your foot isn’t strong enough to adapt to the change, this can put it under excessive strain and lead to pathologies such as tendinopathies and heel pain.
Changing our shoe style changes our centre of mass, as well as the way that we use our feet, which can cause a chain reaction further up our body.
For example, people who have lower back pain may find it gets worse if they wear very flat shoes. It’s because of the natural curve, aka lordosis, of the spine, explains Branthwaite: “If you’ve not got enough ankle range of movement to be able to get your foot down flat then your pelvis will tilt accordingly to make you stand upright.” However, if you elevate your heel and move your centre of mass forwards the spine will sit more upright.
It’s not the only way our choice can have a ripple effect on our body. Telegraph News Editor Caroline Argyropulo-Palmer’s father suffered from lockjaw as a result of wearing sandals with no heel strap. Branthwaite explains how restriction in your usual movement pattern due to rigidity in the ankle can cause you to push your head forward to propel your body weight forward.
“That would put strain on the two joints that connect your lower jaw to your skull and lead to it stiffening.”
Wearing a sandal that restricts our ability to walk in our normal way so that our movement is more of a shuffle also increases the risk of an unexpected fall.
There’s no one style that fits all
While some struggle in sliders, others can march along in the same pair of flimsy footwear. That’s because gait is very specific to the individual.
Branthwaite sees patients who live in Birkenstocks and can’t wear anything else because they constantly wear them. The extremely flat style may also suit those with lower arches.
However some people’s anatomy favours a higher heel incline; for example if you have a high foot-arch, a 1 cm to 2 cm ramp can be more comfortable.
If you want a good all-rounder, Smart recommends Teva-style sandals over flip-flops. “They offer numerous fastenings and well-structured soles,” she says. For further support, she recommends Vionic sandals.
Age plays a part
In general, younger people tend to be more adaptable to different types of footwear. That’s because as we age our joints become stiffer and weaker.
“Once you pass 40 the muscle protein fibres change, and connective and collagenous tissues start to alter. Then the type of shoe we choose can become more of a problem,” says Branthwaite.
While you can develop plantar fasciitis at any age, it is most common in people between the ages of 40 and 60, owing to ageing ligaments that break down and lose elasticity over time.
An underexplored area of research, says Branthwaite, is the effect of the menopause and “the impact it has on the connective tissues throughout our body”.
How to get foot fit
“The people who adapt best to different styles of shoe are those who have a high level of variance in the shoes that they wear day to day,” says Branthwaite.
So if you wear trainers all day, every day then you’re only going to be able to wear trainers “because you’ve become so adapted to that scenario,” she explains.
“You wouldn’t just launch into a marathon without the proper training. It’s the same when we switch to summer sandals suddenly.”
Invest in strengthening your feet. Do things like standing on one leg, raise your heels so that you lift onto the ball of your foot. Wiggle your toes. Try picking a sock up off the floor. “These are all simple things that keep your feet strong,” says Branthwaite.
Right sandal, right time
A rule of summer-sandal thumb is to choose the footwear for the activity you are doing. “That will minimise any strain on the foot and reduce the risk of injury,” says Branthwaite. If you are off to a summer BBQ and all you are doing is getting out of the car, walking into a back garden and sitting down, then you can opt for the thin leather-soled thong with jewels on the front. A hike in the same sandals will cause prolonged force on the body as you heel strike, making periostitis – a bruise of the heel bone – more likely.
“That’s a common injury when people wear footwear with no cushioning,” she says. Instead choose a walking sandal that’s got straps and fasteners on and has a sole like a trainer.
Chuck out the old
Lots of sandals today are made out of high-shock absorbency materials used to make trainer soles. Over time and use, though, the cellular structure of the foam changes and becomes stiffer and harder. You may have noticed this with an old pair of flip-flops.
If you continue to wear them, the material behaves and becomes more like that of a thin leather sole. “Wearing a worn shoe significantly alters the forces and the way the joints move,” says Branthwaite. This will increase the likelihood of a foot injury.
If the tread on your shoe becomes too worn then you are also more likely to slip and fall. Equally, the same can be said for new leather sandals.
“Make sure to scuff the bottoms of new leather sandals to make them more grippy,” says Branthwaite.
Ultimately what sandal you wear is about how frequently you wear them and what you’re doing in them.
“Those are the key factors to consider when you’re making any footwear choice,” says Branthwaite.
