Have summertime shoe habits left your feet worse for wear?

Flip Flops, tennis shoes, huarache sandals...

If summertime is leaving your feet worse for the wear, your shoes may be part of the problem. Get foot-smart with these tips from Cape Cod Healthcare orthopedic surgeon Natalie Nielsen, MD, a foot and ankle specialist who sees patients at Total Orthopedic Care in Falmouth.

Find the Right Shoe

Flimsy shoes may be a rite of leisure passage, but they can make some foot conditions worse, such as arthritis, tendonitis, and plantar fasciitis. (Plantar fasciitis is the painful inflammation of the plantar fascia, the main ligament on the bottom of the foot.)

Flimsy shoes can also cause inflammation that can lead to tendonitis and plantar fasciitis, according to Dr. Nielsen.

Her rule of thumb: If you can bend them in half, shoes don’t have enough support for your feet.

“A good pair of shoes should help distribute some of the pressure on your foot while you are walking. Good shoes can also lead to less stress on the ligaments, tendons and toes and help prevent you from getting painful foot conditions or worsening current foot problems,” she said.

Give Your Toes Room

Open-toed sandals give your feet room, Dr. Nielsen said.

“Even if you buy ‘so-so’ shoes with a wider toe box, that will help,” she said. “When your toes are too tight inside a shoe, that can lead to issues with bunions and foot pain; so avoid crowding.”

Arch Support Matters

If you have a flatter foot, arch support can help, Dr. Nielsen said.

"You can start with inexpensive arch support cushions over the counter at the local pharmacy or box stores," she said. "If these don't work, you can be seen in the office for radiographs and a clinical exam to determine what type of inserts may be best for you. Even ballet flats can be made with arch support, depending on the brand of shoes, or you can buy a pair that leaves enough room for you to add your own arch support.”

When are Flip-Flops OK?

Sandals and flip-flops are OK if they give your foot good support, Dr. Nielsen said.

“Some brands make flip flops with great support and style. For instance, Birkenstocks® have really good support, and a lot of my patients really like the newer brand, Vionic®, which has many stylish options without having to sacrifice good foot support,” she said.

According to Dr. Nielsen, Oofos®, a foreign brand like Vionic, also offer good support and different looks that many of her patients like. Even brands like Clarks make good sandals with stylish options that support your foot, she said.

“If you’re wearing flimsy flip-flops to the beach occasionally, that’s probably not the worst thing you can do, but that kind of shoe is not something you want to spend the day in,” she concluded.

What About Sneakers?

For exercise, Dr. Nielsen suggested wearing a good pair of sneakers with quality support. Hoka® and New Balance® are her top recommendations. Both have awesome support and come in a lot of varieties, she said.

What does Dr. Nielsen wear? Hokas sneakers for exercise and Calzuros, a backless clog, when she wears scrubs at the hospital. Calzuros, she said, “are very comfortable for a long day in the operating room, although they aren’t the cutest shoes. I think Calzuros are good for anyone who has to be on their feet for long periods of time.”

When to Call the Doctor

Swelling for a period of time or pain that is getting worse are both red flags and indicate a need to call the doctor, she said. In these instances, seek medical help sooner than later.

“Otherwise, if you’re having persistent pain that’s not improving by wearing good shoes or resting your foot or ankle for a few days or a week, it’s important to make an appointment. There are a lot of things we can do for pain control that doesn’t involve surgery, including physical therapy, cortisone injections, a brace, or helping you figure out which orthotic inserts or shoes are best for you. It’s never a bad idea to make a doctor’s appointment if you have persistent pain,” Dr. Nielsen said.

Stress fractures—which are hairline cracks in the bone—are a fairly common source of pain and usually get better with walking boots, she said. “But it’s important to be seen and diagnosed sooner than later when you have a stress fracture,” she added.

What if You’ve had Foot Pain for Years?

“A lot of people say their feet have hurt for years, and alleviating the symptom is often as simple as getting a cortisone injection under X-ray guidance,” Dr. Nielsen said. “Even if you’ve had pain for a long time, you shouldn’t avoid calling the doctor’s office to find answers and feel better.”

She explained that the bones and joints in the foot are mostly quite small. She sends people to see the radiologists at Falmouth Hospital for X-ray-guided injections that are precise and effective.

“Radiologists make sure the cortisone is going to the right spot, and many people can have their pain controlled for more than three months with one shot. You don’t want to have cortisone injections more often than three months, but people can have their pain controlled with cortisone shots two or three times a year this way, and avoid surgery,” she said.

If things aren’t getting better, there are a lot of surgical options for the foot and ankle that work well and a lot of people are quite happy with those, she said.