They come in all colors and styles. They can be dressy, casual, or sporty. And they’re so easy to just slip on as you walk out the door. Good old flip flops!

So despite their versatility, style, and ease, flip flops may be the cause of foot trouble for some. Since they have no back/strap or support around the ankle or heel, the smaller muscles of the feet must work very hard to keep them from falling off as you step (making it more difficult than walking bare foot). In addition, they offer little to no arch support, which translates to increased strain to the plantar fascia as well as muscles along the bottom of the foot. This is why wearing flip flops on a regular basis can contribute to plantar fasciitis or Achilles tendinitis. In addition, they also aren’t particularly stable and can contribute to trips, twists, and falls, increasing the likelihood of ankle sprains or fractures.

Believe me, I love my flip flops for quick trips, lounging in the yard, and beach outings, but my feet get so sore as soon as I start to wear them in the summer. This is when I think about what I put on my feet. For any prolonged walking or standing, I try to select sandals or shoes that offer more support, contour, and cushioning. There are a lot of stylish, foot friendly choices out there now for summer footwear, including light weight, breathable sneakers that offer lots of arch support and heel stabilization. Shop around and be good to your feet…so you can enjoy every step of summer.

When I was in college I had my fair share of running injuries…mostly because I didn’t stretch enough. I developed Achilles tendinitis, which is an inflammation of the Achilles tendon, the thick, fibrous tendon that travels from the calf muscles along the back of the ankle.

When the Achilles becomes inflamed, there is less space within the connective tissue sheath that surrounds it. It can feel squishy, or even like it gets stuck as you try to flex and point the foot, due to adhesions that develop. These prevent the tendon from gliding smoothly. The pain can be mild or severe, and is worse during the push off phase of walking or running, or any time you point the foot and toes downward.

Often, there is associated weakness in the Achilles and possibly weakness in the anterior muscles of the shin, with tightness in the calf and Achilles. Both stretching and contracting of the calf muscles may reproduce pain.

Managing this type of injury requires frequent icing to reduce inflammation. Rest is also key. High impact activities, particularly any sports that involve running or jumping should be avoided. Cross friction massage is also very beneficial to improve circulation and reduce adhesions and promote optimal alignment of collagen fibers. It may be that flat feet or high arches contributed to the problem, and orthotics may be helpful in restoring better alignment to the foot and ankle. There are also braces and night splints available for more severe cases that allow the calf muscle to rest and have a gentle sustained stretch. Frequent active stretching of the gastracnemius and soleus, the 2 muscles that form the Achilles tendon, is also essential.

Seeking treatment early will help prevent a chronic inflammation from developing. Physical therapy can be very helpful in correcting any muscles imbalances, retraining the joint receptors, and helping to reduce inflammation with various modalities (such as ultrasound, iontophoresis, and electric stimulation). A PT can also help develop a sports specific rehab program to help get you back to your sport safely and as quickly as possible, teaching you ways to avoid the same condition in the future.

A bunion is a bony overgrowth that occurs at the big toe joint, often with an apparent visual change where the big toe angles in towards the other toes. As bunions progress, they can become problematic in terms of discomfort and difficulty with finding well fitting shoes.

If you have a family history of bunions, you may be more likely to develop one. In addition, pointy toe shoes contribute to bunions as they tend to rub on the inner side of the big toe joint as they angle the big toe inward.

The best way to prevent the growth of a bunion is to wear shoes with a wide toe box. If you already have a bunion, wearing a gel or soft plastic toe spacer will help keep the big toe in better alignment and reduce the pressure and deformity of the big toe joint. Orthotics may also help to improve the alignment and mechanics of the foot.

A bad hip, knee, or ankle can make climbing up and down stairs difficult and at times unbearable. The weight bearing, changes in range of motion and strength required to coordinate the shifts in balance are demanding on the joints and muscles, and an injury can greatly affect the ability to perform this everyday task.

If climbing stairs is a problem, try this: go up leading with the good foot, and down leading with the bad foot. By doing a “step to step” gait pattern (as opposed to step over step), the amount of weight carried by the injured leg can be reduced, thereby reducing pain.

I was talking with a nurse the other day and she said to me, “You’ll appreciate this…my husband just ruptured his Achilles Tendon.” The look of dread on her face was apparent, and she went on to share with me that he had ruptured his other one only a few years before. They knew exactly what lie ahead.

The Achilles tendon is the thick, long band of tendon that runs vertically along the back of your ankle. It’s where tendons of the calf muscles (gastracnemius and soleus) come together, and it functions when you push your foot down. Actions like pushing off to run, jumping, and other high impact sports all require the Achilles tendon to be strong and pliable.

A more common injury in men, Achilles tendon ruptures are often seen in weekend warriors, though can also occur in seasoned athletes. When a person experiences a complete rupture of the Achilles, he may hear or feel a snap or pop, but with complete ruptures there usually isn’t a lot of pain since the nerve endings are no longer intact. The tendon may then ball up, like a roller shade would retract up, and a lump can be seen and felt in the calf. This type of injury requires surgery to reconnect the Achilles tendon in order to regain a normal walking pattern and daily function.

Following surgery, the rehabilitation course is a long, extensive process. For the first month or more, weight bearing is restricted and a walking cast is required. Physical therapy often begins with gentle non-weight bearing range of motion exercises to start getting the calf and Achilles used to movement again. This is in addition to modalities such as ultrasound, heat, and soft tissue mobilization and scar massage which help to increase circulation to the tissues, promote healing, and help reduce scar tissue and adhesions.

Over the next month, usually the walking cast is still required for all weight bearing in order to protect the Achilles, but additional stretches and strengthening are begun. The boot cast may be taken off (depending on the individual surgeon and case) during therapy sessions at this point. Eventually, and it can seem like forever with this injury, you’re told the walking cast can be removed and walking without it attempted. People are often surprised at how unable to walk they are, since the calf hasn’t had to work to push the foot off the ground. Many have to re-learn how to walk in a more normal fashion without a limp.

It is now that weight bearing strengthening and balance retraining begin for most individuals. Rising up on the tiptoes, using a balance board to shift weight, and progressing to other uneven surfaces, balancing on one leg, and more dynamic stretching of the Achilles are performed.

Return to sports and hobbies can take up to a couple of months more if running or jumping are required. (Maybe a good time to focus on your golf swing?) It is so important to gently warm-up and stretch before, during, and after play, to keep the Achilles soft, flexible, and less susceptible to re-injury.

Just don’t forget to stretch both sides!

If you are a runner, you should replace your running shoes every 3-4 months or 300-400 miles, or sooner if the soles show signs of wear. This ensures that your shoe continues to offer your foot–and as a result, ankle, hip, knee, and spine–adequate support and shock absorption. This will help reduce the likelihood of injury as you train and also if you are a recreational runner. It’s also a good idea to wear your running shoes exclusively for running to extend their life. You can keep your old shoes or buy an inexpensive pair for everyday use in your yard or around town.

My good friend sprained her ankle in high school and she repeatedly sprains it every few years…running to catch her train home from work, walking on the beach with her kids, and mis-stepping on the soccer field.

An ankle sprain occurs when the ligaments (usually on the outer ankle) get overstretched, resulting in pain, swelling, weakness, and difficulty walking initially. Although eventually healing occurs, the ligament never returns to its original length. Here is a great analogy: a ligament is like a rubber band. When it’s brand new, it’s tight and when you stretch it, it returns to its original size. However, if you take the rubber band and stretch it too far, it will get tiny little tears in it. From then on, the rubber band will always have damage to it and be more susceptible to further tearing. A ligament is very similar. Although when the ligament over stretches or tears it heals in the sense that scar tissue lays down and new collagen fibers grow, it never returns to its nice stable, tight length. As a result of this, chronic ankle sprains are a possibility.

There are measures to take to help prevent recurring sprains. Strengthening all of the muscles surrounding the ankle using resistance bands, body weight, and gravity will help provide dynamic stability and help make up for what the ligaments cannot do. Balance retraining exercises using uneven surfaces, wobble boards, and foam surfaces while balancing on one leg, catching or throwing balls, or pulling resistance bands will help retrain the joint receptors that maintain balance and help prevent the ankle from rolling. Proper footwear and the use of orthotics (if biomechanical problems exist at the foot and ankle) can also help prevent ankle sprains.

I think it’s extremely important that you work individually with a physical therapist following an ankle sprain, even a mild one. This will allow you to address scar tissue, loss of motion, flexibility, strength, and balance issues right away, and could prevent you from sustaining repeated sprains down the road.

Plantar fasciitis is the inflammation of the connective tissue that runs along the bottom of the foot. I’ve had this in both feet, probably because I have flat feet and like to run. (And at the time over 15 years ago, did not do a whole lot of stretching.)

If you have pain along the bottom of your foot, most notably first thing when you get out of bed or after prolonged periods of sitting, plantar fasciitis may be the culprit. The best things you can do to help alleviate the pain and swelling associated with this is to rest, stretch, and ice it.

• Rest means you should stop high impact exercise, such as running to allow the tissue to heal.
• Stretching of the plantar fascia as well as the calf muscles is also crucial for this type of injury. I usually recommend that my patients stretch 3-5 times per day. In addition, prior to getting up in the morning, flexing, pointing, and circling the ankle helps loosen up the arch of the foot so the first few steps aren’t quite so agonizing. If the pain is severe or chronic, a night splint can be helpful to keep the calf muscles stretched to prevent tightening overnight. You can also massage along the plantar fascia with a tennis ball or a one inch dowel to break up scar tissue along the bottom of the foot.
• Ice the bottom of the foot with a cold pack. If you can tolerate it, you could use an ice cube on the bottom of the foot and do an “ice massage” to the area. You can also roll your foot along a frozen water bottle to get the benefit of massage and icing simultaneously.

People with flat feet or high arches may benefit from orthotics to help provide some support and/or shock absorption to the feet. Wearing well-fitting, sport specific footwear is another way to help prevent and treat plantar fasciitis. Plantarfacsiitis can be persistent, but if you are faithful with stretching, resting, and icing, and commit to wearing proper footware, relief within your reach.

If you’re at all like me or my running friends, at some point you’ve probably been off the road due to some type of injury, ache, or pain. Whether it be knee pain, hip pain, back pain, or foot pain, these injuries can be frustrating and halt your training or fitness routine. It’s highly advisable to discontinue running if you have an injury, as the high impact and repetition of running can cause more harm. That doesn’t mean, however, that you need to discontinue all activities. Here are a few alternative things you can try:

1. Swimming or Aqua jogging

Getting into a pool and swimming laps or using a water belt to do some aqua jogging is a great way to keep fit and active while minimizing strain to the muscles, joints, and ligaments. You will be able to maintain strength, flexibility, and cardiovascular health so once your injury heals, returning to running will be less difficult.

2. An elliptical trainer

Using an elliptical machine partly simulates running, but without the high impact. Since your feet stay planted, you eliminate impact but can still work for speed, strength, and endurance. Depending on the type of injury, the elliptical may still cause you pain. Adjusting the incline up or down may be a way to eliminate discomfort for some people.

3. Speed Walking

If you’re a runner through and through you may scoff at the idea of speed walking. This low impact workout still provides an excellent cardiovascular workout and promotes muscle strength and joint mobility. Speed walking up hills or on an inclined treadmill can be more difficult than running if you’re unaccustomed to such a routine.

4. Power Yoga

This form of yoga gets your heart pumping and works to challenge the muscles and the mind as you move through various poses. In addition to helping improve joint and muscle flexibility, it provides a wonderful opportunity to strengthen the lower body in multiple planes and directions.

As hard as it can be to stop a sport you love, it is so important for your rehabilitation and recovery to allow your muscles and joints some rest and protection. Finding alternative ways to exercise may help bridge your return to running, and also may open a new door to cross training, which may lessen your chance for injuries down the road.

My feet hurt just looking at these shoes! Although stylish and festive, these shoes worn by my relative at a Christmas party are on the what not to wear list and here’s why:

1. The toe box is too narrow: The front of the shoe is so narrow and pointy, causing the toes to all get squished together. This can aggravate and contribute to problems such as bunions. (Which, in case you’re interested, this wearer has had surgery to correct and has been scolded by me on many occasions for wearing such footwear.)

2. The heel is too high and thin: In addition to risking an ankle sprain on icy walkways, prolonged and frequent wearing of high heeled shoes causes tightness in the calf muscles. This can contribute to problems such as Achilles tendinitis and plantar fasciitis.

I’m not suggesting that orthopedic shoes be worn to social gatherings, but selecting a shoe that offers style with room for the toes, arch support, and a wider heel that offers more stability would be preferable.