WHY FLAT SHOES MAY NOT BE BEST FOR YOUR FEET

Medically Reviewed by Dr. Sony Sherpa (MBBS) - November 06, 2023

A flat shoe is a type of shoe that is flat across the mid-foot or the innersole. This implies that the arch of the foot is unsupported, and the sole does not conform to the shape of your arch. Flat shoes include thongs/flip flops, dress or ballet flats, or casual flats. Flats are popular among women and are often perceived as a healthier alternative for regular use than heeled shoes. However, while flat shoes may be acceptable in some circumstances, wearing them frequently is not advised since they may lead to various foot, ankle, lower limb, or back disorders. They offer little shock absorption, and the toes frequently have to put in all the effort to keep the shoe on. This strains the sole, Achilles tendon, and calf muscles.

Lack of Arch Support

The foot arch is the curved structure formed by the tarsal and metatarsal bones, tendons, and ligaments that span the sole. Its form is similar to a spring. It bears the body's weight and cushions the shock brought about by movement.

The flexibility of the foot provided by the arches is what makes it possible to perform common locomotor tasks like walking, running, and other weight-bearing activities. The ideal foot type is frequently thought of as one with a normal arch, which has a mild curvature with the middle part slightly raised from the ground when bearing weight and one that evenly distributes weight over the foot. This arch type is linked to strong stability and a reduced risk of foot problems.

Flat shoes often lack these curvatures, which means they don't provide adequate arch support. Walking in flimsy shoes without sufficient arch support can overstretch, tear, or inflame important tissue bands in the foot. The plantar fascia is one such band of tissue that runs along the bottom of the foot.

In addition to plantar fasciitis (inflammation of the plantar fascia), flat shoes can lead to Achilles tendinopathy, characterized by soreness in the Achilles tendon and the calves. This is a result of increased stress on the Achilles tendon to keep the shoe on and the feet in alignment. Joint damage and flat feet can also be the long-term complications of prolonged use of flat shoes.

Absence of Shock Absorption

The joints are subjected to a great deal of pressure each time the foot contacts the ground while walking or running. Although the arch of the foot acts as a natural shock absorber, extra reinforcement with a shock-absorbing sole is recommended. Shock-absorbing soles function by reducing the impact that occurs when the foot strikes the ground. This can help reduce the risk of injury, alleviate pain in the muscles, and reduce impact on the joints.

Our two feet sustain the weight of our entire body and aid in the appropriate alignment of the spine. The vertebrae in the spine may fall out of alignment if we wear shoes that do not provide adequate support or put excessive pressure on one area of the foot. Misalignments, referred to as "subluxations" by chiropractors, induce back and neck discomfort, tension in the muscles, spasms, stiffness, and a limited range of motion.

A lack of shock absorption is also recognized to be a major cause of knee discomfort. Shock-absorbing shoes are proven to lessen knee discomfort while walking and running, which is typically beneficial for people with osteoarthritis. Flats lack soft and cushioned surfaces for the foot, which in turn results in a large amount of impact going through the muscles, tendons, and specifically the joints of the foot, making them prone to injury and deformities.

Risk of Overpronation and Underpronation

Heels have most often been regarded as the unhealthiest shoes to wear for routine purposes. So, does that imply flats are the best option for daily usage? Contrary to common perception, flats are not ideal to wear on a day-to-day basis. The risks of overpronation and underpronation with flat shoes are described below.

Overpronation

Pronation is associated with gait and how the feet and ankles function as one walks or runs. Pronation occurs when the foot first makes contact with the ground. The arch flattens to absorb the impact of the foot strike and prepares the foot for the subsequent phase of the stride.

Overpronation, or excess pronation, is when the foot rolls inward while walking and the arch flattens down. It is often associated with low arches and flat feet.

People who overpronate have their shoes worn out unevenly on the inside of the sole. Overpronation can lead to pain in the arch, heel, ankle, shin, knee, hip, and back. Achilles tendonitis, bunions, iliotibial band syndrome, plantar fasciitis, and shin splints are the possible complications.

Underpronation

Underpronation or excess supination is a less prevalent gait condition and is more typically related to high arches. Supination refers to the rolling of the weight to the outer edges of the feet. Their shoes eventually wear out unevenly on the outer sole. Underpronation can impact the entire body's alignment and result in conditions like plantar fasciitis, back and hip discomfort, and knee and ankle injuries.

Flat shoes are not suitable for both overpronators and underpronators. Those with overpronation require extra cushioning in the heel and midsole. Underpronators require cushioning on the outside of the shoe to counteract the inward and outward roll of the foot.

Foot Deformities and Increased Fall Risk

The consequences of improper shoes differ from person to person. In most cases, wearing ill-fitting shoes can result in calluses or ingrown toenails. Corns and calluses are foot deformities that are frequently brought on by wearing tight shoes through constant friction between toes and shoes in a restricted toe box volume.

Common foot deformities due to improper footwear include:

• Bunions (Hallux Valgus): Bunions develop when the bone at the base of the big toe enlarges, which can cause the foot to invert, leading to discomfort and swelling. Bunions are more common in women who wear narrow shoes.
• Claw toes: Claw toes are deformities of the toes characterized by the curling of one to four toes of the foot. Severe forms of this condition can cause the toes to be deformed in the shape of an inflexible claw.
• Hammertoes: This is a condition that causes the joints of the second, third, fourth, and fifth toes to flex unnaturally, forcing the toes to curl up rather than lay flat on the ground. Likewise, preexisting conditions like diabetes and nerve damage increase the chances of infections, swelling, and wounds in the feet.

Improper footwear can often lead to loss of balance and bad gait. This can significantly increase the risk of a fall. Fall risk should be considered when you choose your footwear since it can otherwise lead to injuries. The risk of falls is especially high for the elderly, whose muscular strength and balance are already impaired.

Shoes linked to increased fall risk are:

• Shoes without adequate fixation (shoes without laces, straps, or buckles) are not good for foot health.
• Shoes with significantly high heels are linked with greater rates of falling compared to other shoes.
• Shoes that have narrow heels have a very narrow area to support the weight of the body. The narrower heels have more pressure exerted on them. So, to reduce the pressure being exerted on your foot, you need to avoid very narrow heels. In particular, pencil heels are very dangerous.
• Poorly fitting shoes (loose or worn–out shoes, shoes that are too big for your foot)
• A reduced contact area of the sole and smooth treads are linked with an increased risk of falling.
• Slip-on shoes, such as slingbacks or flip flops, and shoes without fasteners are known to cause people to fall. These do not offer proper support to the feet.
• Shoes with poor grip can fall off and can cause you to fall or slip.

Recommendations for Better Foot Health

When it comes to selecting shoes, one needs to think about the age group, activity, surface, and requirement for support. An appropriate shoe is one that fits the arch of the feet and provides the right support without causing discomfort. Doctors and physiotherapists can be helpful when seeking footwear recommendations.

The characteristics of a good and safe shoe, according to podiatrists, are:

• The shoe should fit well and be neither too loose nor too tight on the feet. Some people may need footwear specially made to accommodate and protect swollen feet and ankles.
• The footwear should have a high back or collar to support the ankle.
• A firm sole is desirable. The sole is ideally not thin or worn out as it does not support the foot well. It must not be too thick as this can hinder our sensation of foot position.
• Slip-resistant soles with treads for good grip are advised.
• Square heels are recommended to improve stability. Wedge heels are also recommended.
• If your shoe has an adjustable fastener, laces, buckles, or Velcro on the front to prevent slip-offs, then it is considered good for foot health.
• The footwear should have about 1 cm of free space at the end of the longest toe.
• It is ideal for shoes to have removable footbeds to allow them more room to fit insoles.
• Subjective comfort is very important. It should be comfortable for you. It should not pinch, rub, or slip at the back.

If one has any foot defects or deformities, customizing shoes can be beneficial in aiding with gait and preventing the issue from worsening. Off-the-shelf orthotics, or those prescribed by a podiatrist, can help avoid sore feet and counter many common foot conditions. Selecting shoes that reduce the likelihood of slipping and falling is just as important.

Footwear recommendations from podiatrists and healthcare professionals are to be taken seriously. Likewise, alternating shoes from one day to the next can help to vary the posture of the foot and disperse stress across a greater range of joints and muscles. It also allows shoes to dry out, thus reducing bacterial growth.

Conclusion

Flat shoes, although seemingly good choices for footwear, are not recommended for constant use. Most flat shoes lack proper cushioning and arch support - crucial factors to prevent joint injuries, plantar fascia inflammation, tendon diseases, knee pain, backaches, and various foot deformities.

Certain foot conditions like overpronation and underpronation require tailored shoes with proper cushioning that prevent gait abnormalities, fall injury, and worsening of the existing problem. Ill-fitting shoes are to be avoided at all costs. For some people, switching footwear is the only treatment they need to have pain-free feet, so it is necessary to understand the kind of shoes that fit your feet. An appointment with a podiatrist is highly recommended if you have a foot issue that needs to be dealt with.

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References:

1. Paterson, Kade L et al. “The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms : A Randomized Trial.” Annals of internal medicine vol. 174,4 (2021): 462-471.
2. Umar, Haddaya et al. “Impact of routine footwear on foot health: A study on plantar fasciitis.” Journal of family medicine and primary care vol. 11,7 (2022): 3851-3855.
3. Ioli, James P. “By the way, doctor. I know high heels are bad for the feet, but when I switched to flats, my feet started to hurt. Why?.” Harvard health letter vol. 34,10 (2009): 6.
4. Wagner, Amy, and Sarah Luna. “Effect of Footwear on Joint Pain and Function in Older Adults With Lower Extremity Osteoarthritis.” Journal of geriatric physical therapy (2001) vol. 41,2 (2018): 85-101.

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