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Trading future health for current fashion

Photo by VIRGINIA DIAZ

Judy Barnes, office manager for Spring Hill podiatrist Dr. Joseph Barta doesn’t always follow her boss’s advice as her favorite pair of shoes have 3-inch heels. Barta says if a woman must wear heels, stick to 2 inches or lower and choose chunky heels or wedges over thin ones because they give more stability.

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By VIRGINIA DIAZ

Hernando Today correspondent

Published: October 15, 2009

Easy, breezy flip flops are all the rage. High fashion and low tech, they come in all kinds of colors and are decorated with everything from sea shells to rhinestones. You can get them with college logos and one company even makes them with a built-in bottle opener.

Kids love them and parents love their low price. But, like the other end of the shoe spectrum, spike heels, the fun flip flop is trouble afoot — especially for young people.

"In the last year I've had a dramatic increase in the number of kids I'm seeing because of flip flops," says Spring Hill podiatrist Dr. Joseph Barta. "It can be anywhere from 9 to 16 years old where I'm usually seeing the increase. And it doesn't have to be an athletic kid or an obese kid. It's hitting all of them."

The problem isn't just in Hernando County. Since flip flops have become so popular, podiatrists across the country are seeing more patients complaining of foot pain and a higher number of people showing up with serious foot injuries.

For example, a podiatrist in Dallas, Dr. Marybeth Crane, who is also a spokesman for the American College of Foot and Ankle Surgeons, is seeing the same alarming trend in her part of the world. She says she's had an entire soccer team of 16 year old girls come to her complaining of the kinds of foot pain more common in older, overweight people. Problems she too attributes to flip flops.

"It's typically a tendonitis and it's typically on the inside of the foot," says Barta. "The inside of the foot pronates (points toward the outside). Your medial arch collapses and the toes are actually pointing outward. It's also creates an inflammation of the growth plate in the back of the heel. And that is very prevalent."

The basic problem with flip flops is support — they offer none. They have very little cushioning, no arch support and they force whoever's wearing them into an unnatural toe gripping, foot slapping way of walking. This is particularly risky for young people.

Barta explains, "Their growth centers have not finished closing. They're very vulnerable to a flat foot deformity which then leads to additional bunions, additional hammer toes and another symptom called metatarsalgia which is actually pain on the ball of the foot. It's just a snowball effect. They can get bad enough at some point that their only hope is going to be a surgical correction."

Flip flops were originally designed for limited use. "They give you some basic protections to the bottom of your foot to walk around poolside or in a surface that may be warm during the summer," says Jim Christina, DPM, director of scientific affairs for the American Podiatric Medical Association. "They let your foot be as flat as they can be. If vacationers are at the beach or Disney World and they're walking in flip flops for days on end with no support, it's very common to see arch and heel pain."

In Hernando County, Barta sees far too many kids who wear flip flops to school. And the ones who are active in sports go from flip flops to equally non-supportive cleats, which means they have very little foot support at any time.

There are other types of shoes popular with kids that parents should beware of. Retro and trendy sneaker types like Keds and Converse brands offer a little more padding than flip flops but virtually no arch support.

The little ballet flats that girls flock to are in the same category as flip flops. Constant wearing of these shoe types will also lead to problems down the line.

Sore arches and heels, which is the most common complaint, can escalate to chronic condition that include inflamed Achilles tendons and plantar fasciitis which is an inflammation of the connective tissue between the heel bone and toes.

Other conditions that could develop from wearing flip flops include heel calluses from the pounding feet take, hammer toes from the gripping and irritation between the toes which can lead to fungal infections.

Another danger is the increased chance for injury to unprotected feet. People who do yard work in flip flops are more likely to have injuries from lawn mowers, weed whackers and shovels. And, in this area, there's also the distinct danger of insect and snake bites.

Flip flops or any kind of very loose shoes also pose a driving hazard. The American Automobile Association's manager of driving operations, bill Van Tassel, PhD, recommends, "Whatever you wear on your feet make sure it's not so loose that it pops off and interferes with pedals."

When it comes to flip flop wear and kids, Barta has no good news for them or their parents. "As far as the kids — they wouldn't be caught dead in that because all they want is flip flops. I have to come flat outright and tell the kid — you're either going to do as I say or you're not going to get better, so you make the choice."

On the high end

For women fashionable footwear is a double whammy. They go from wearing flatter than flat flip flops to walking on tippy toes in high heels.

A study published in Arthritis Care and Research shows that people who wore unsupportive footwear like high heels, sandals and slippers are much more likely to suffer pain in later years. It also showed that men don't have the same kind of foot pain as women because they wear different types of shoes.

The study adds further proof of what is already generally known and disregarded by most women — high heels are bad for you.

Judy Barnes, who is Barta's office manager, is well aware of the pitfalls but wears high heels to work anyway. She says it's a matter of looking professional.

"I do have to go with the heels and 90 percent of it is the job. I'm in a profession where I have to wear dressier clothes and you just can't match the clothes with something that's not dressy," explains Barnes.

"I mean you can wear a nice business suit but then if you wear clogs or flats it would kind of take away from the fact that you have a $100 business suit on or a $50-60 dress on. That's exactly how I feel. I'm not going to put on any of my business suits without a pair of heels."

Barnes admits to having a pair of 4-inch heeled boots that she loves and a couple of pairs of 3-inch heels. To keep the pain down, she tries to wear lower heels to work as much as possible.

"I have some short boots but they are 2.5- or 3-inch heels thinking that the front is wider so they'll feel better. And they do feel better during the day but it still has a little effect on my ankle and my calves. The ball of my foot doesn't hurt so much — it's the hamstrings. My hamstrings are really bad. I actually worked out with a trainer and he told me your hamstrings are very bad because of your heels."

Barnes says she already sees the beginning of bunions on her feet. Bunions are largely the result not just of the heels but of pointy shoes that squeeze toes into toe boxes that are too small. Hammer toes can develop for the same reason. But the most common condition in former high heel wearers that Barta sees are neuromas.

"It's actually so common it has a man's name. It's called the Morton's neuroma. that is so prevalent among former high heel wearers. It's a painful inflammation of the nerve typically between the 3rd and 4th toes," says Barta,

"I'm frequently seeing those young retirees coming down from up north having worn high heels for 20 or 30 years. Now they're older, everything starts to hurt. They blame it on moving here but it's not."

Solution is a bitter pill for some

The best way to prevent foot problems is with good, supportive footwear. But that costs and with the economy as it is, buying better made, more expensive shoes is tough if not impossible.

But, medical experts maintain that in this situation, getting what you pay for could end up being more expensive in the long run if it involves medical costs or, in extreme case, surgery later on.

"I wish I could make people understand. Most people have 20 pairs of shoes and pay $5 a piece for them because they're just shoe hogs. But it's so much more important at this point — especially in that 9 to 16 year old age — to get the right shoe. Unfortunately they're going to cost more. It's better to have one good shoe than 15 pairs of worthless one."

For More Information

If you'd like more information on healthier footwear choices for you or your children, here are some websites to visit.

American College of Foot and Ankle Surgeons — www.footphysicians.com

American Orthopedic Foot & Ankle Society (AOFAS) — www.aofas.org

American Podiatric Medical Association (APMA) — www.apma.org

Virginia Diaz writes regularly for the Hernando Today Health Today section. She lives in Brooksville and can be contacted at diazvirginia@bellsouth.net.

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