Arch rivals

"I feel free in my slippers."

Fourteen-year-old Mekiah Tong’s quiet declaration speaks volumes for Hawaii’s long affection for the flat and cheap footwear that’s been part of our island culture for generations.

In fact, slippers are seen by many as a statement of local identity, worn at all but the most formal of occasions (and sometimes even then) and by Hawaii travelers and college kids on the mainland who stubbornly bare their feet no matter how low the mercury drops. And surely the fact that you can slip them off and on with ease when entering someone’s home makes zori a logical choice in Hawaii despite all the warnings they would ruin your tootsies.

But now, as the barefoot-is-better movement gains momentum and new designs include firmer soles and arch support, there is growing medical backing for the idea that slippers may not be so bad for your feet after all, when worn appropriately.

Orthopedic surgeon Spencer Chang at Straub Clinic & Hospital said that "slippers are maybe even better than shoes sometimes."

"In my opinion, slippers, when compared to shoes, more closely mimic being barefoot. Constant wearing of shoes causes the little intrinsic muscles in the feet to atrophy. … Those muscles support the arch, and if put to rest with arch support, they will weaken," said Chang, who was giving Mekiah’s feet a look-see.

"I’ve found kids who wear shoes have a higher rate of flat feet compared to those who wear sandals or slippers. Those who wear no shoes have a lower rate of flat feet."

Not everyone in the medical community is sold on the idea that slippers are a good thing. The Mount Sinai School of Medicine Department of Orthopaedics reported an increase in injuries such as plantar fasciitis (a painful inflammation of the thick tissue on the bottom of the foot) related to wearing slippers — having them on all day, walking on concrete or pavement, or donning them while exercising or playing sports.

Other problems include broken toes and toenails; foot, back, hip and leg pain from lack of shock absorption; and even deadly melanoma (don’t forget to apply sunscreen to your feet!).

Flimsy slippers that don’t provide stability can also cause problems for people who overpronate — meaning their feet roll excessively.

"Those cheap ones you find in sundry stores are worse than going barefoot," said Honolulu podiatrist Gregory Morris. "You just slide them on and they offer no support. They’re OK for walking short distances and for no more than 15 minutes."

Morris, a surgeon at the Queen’s Medical Center and Pali Momi Medical Center who deals with foot and ankle problems, said youngsters should get used to wearing shoes and sandals with arch support at around 3 to 4 years of age, especially since so many kids are involved in organized sports and are at risk for leg and foot injuries. (Mekiah’s 12-year-old brother Micah is getting medical attention for arch problems aggravated by playing basketball. Micah is a self-professed "sneaks" enthusiast who doesn’t wear slippers.)

"More support for the arch and the foot, the better, and shoes offer better foot protection from things like glass and sharp sticks," Morris said. "A little heel or wedge added to footwear, elevated higher than the toes, can help those with foot problems feel better after 10 to 15 minutes of use."

Chang agrees that people shouldn’t wear slippers when engaged in sports and other strenuous activities. But he also cited a 2011 report by the European Foot and Ankle Society recommending that young children with flat feet be encouraged to walk barefoot to strengthen foot muscles and develop arches instead of using arch-support insoles.

"In general, flip-flops appear to be suitable for normal feet but not for patients with foot (problems)," the report said.

So while "slippahs" will always have their place in Hawaii, the best advice may be to wear them casually and in moderation.