The Sun New York: Ballet Flats, Flip-Flops: Love Vs. Pain

In the warm summer months, Patricia Davis prefers flat sandals, despite the pain she sometimes suffers.

“I love sandals in the summer,” Ms. Davis, shod in open-toe flats and carrying a second pair in her purse on a recent sunny afternoon, said.

Her commitment to her shoes is so strong that after heel pain forced a visit to a foot doctor, Ms. Davis received several cortisone shots so that she could continue wearing her shoes. “I wear them. I don’t care,” she said.

For many New York women, warm weather means trading supportive boots for stylish sandals and ballet flats. While at first glance flat shoes may appear to be a more comfortable option, the popular styles can be more harmful than low heels, causing injuries to the foot, leg, and back, experts say.

Doctors have linked the lack of support in sandals and ballet flats to a number of overuse injuries, among them heel pain, strain in the Achilles’ tendon, and plantar fasciitis — an inflammation of the tissue supporting the arch — as well as muscle and tendon strains throughout the leg. Such shoes also lack adequate cushioning and tend to cramp toes.

Dr. Rock Positano, director of the nonsurgical foot and ankle service at the Hospital for Special Surgery on the Upper East Side, estimates that 30% of his practice treats knee, hip, and back injuries that stem from foot strain.

“Ballet flats seem to be very comfortable,” Dr. Positano said, “but they make the foot work a lot harder than it is supposed to. They give absolutely no support whatsoever in the arch.”

Flip-flops may be even worse because they make toes grip and scrunch, causing “toe flexer problems,” a licensed physical therapist, Ann Duffy, said.

Older people in particular have a tough time with flat sandals, because as time passes, feet tend to lose some of their natural cushioning and to become wider, squashing toes. “It’s kind of like foot binding,” Ms. Duffy said.

The young are not exempt, however: Eight out of 10 women ages 18 to 49 say they experienced foot injuries as a result of uncomfortable or ill-fitting footwear, according to a survey from the American Podiatric Medical Association.

“Men and women have the same potential to have the same feet problems,” a New York City sports podiatrist and member of the APMA, Dr. Lori Weisenfeld, said. “Men do not have the same pressure put on them to wear shoes that are uncomfortable. Women get more injuries and more foot pain, more frequently.”

Diana Mai, an ice cream purveyor in TriBeCa, often wears ballet flats even though she is on her feet for five to six hours straight while at work.

“When I first started wearing them,” she said of her shoes, “I thought they were uncomfortable. I just figured you had to break them in.” Despite her heel pain, however, she “didn’t really want to stop wearing them,” she said. Instead, she bought some Dr. Scholl’s inserts to wear inside her shoes.

Doctors say there is no such thing as “breaking in” shoes; if they fit properly, they should be comfortable right away.

Exacerbating the problem of summer flats is New York City’s walking lifestyle, which can account for greater foot pain and muscle strains. Ballet flats are particularly unsuited to the hardness of city sidewalks.

Both ballet flats and flip-flops are now being worn all day long, though they were never intended for such long-term wear. Flip-flops are intended for the beach or poolside, and ballet flats are “more like slippers than shoes,” a Queens- and Manhattan-based podiatrist and foot surgeon, Dr. Michael Loshigian, said.

Many podiatrists say the ideal walking shoe has a roomy toe box to prevent cramping and a low heel of approximately 1 inch. A shoe of this height increases the arch, does not overwork the Achilles’ tendon, and can even make the stride more efficient.

“Our feet are built to walk on soft and varied surfaces,” Dr. Loshigian said.

Ms. Duffy, whose physical therapy practice has treated many patients with plantar fasciitis, has had the inflammatory condition herself. She said her feet feel best on grass, on the beach, and when barefoot. “It hurt most when I was in New York,” she said.

Still, Ms. Duffy added that “everybody’s foot is different” and said flat styles can be more comfortable and less harmful, depending on the structure of a person’s foot. “If you have a good arch, they will give you less trouble,” she said.

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