title: Does flip-flop style footwear modify ankle biomechanics and foot loading patterns?
abstract: BACKGROUND
  Flip-flops are an item of footwear, which are rubber and loosely secured across the dorsal fore-foot. These are popular in warm climates; however are widely criticised for being detrimental to foot health and potentially modifying walking gait. Contemporary alternatives exist including FitFlop, which has a wider strap positioned closer to the ankle and a thicker, ergonomic, multi-density midsole. Therefore the current study investigated gait modifications when wearing flip-flop style footwear compared to barefoot walking. Additionally walking in a flip-flop was compared to that FitFlop alternative.
  
  
  METHODS
  Testing was undertaken on 40 participants (20 male and 20 female, mean ± 1 SD age 35.2 ± 10.2 years, B.M.I 24.8 ± 4.7 kg.m(-2)). Kinematic, kinetic and electromyographic gait parameters were collected while participants walked through a 3D capture volume over a force plate with the lower limbs defined using retro-reflective markers. Ankle angle in swing, frontal plane motion in stance and force loading rates at initial contact were compared. Statistical analysis utilised ANOVA to compare differences between experimental conditions.
  
  
  RESULTS
  The flip-flop footwear conditions altered gait parameters when compared to barefoot. Maximum ankle dorsiflexion in swing was greater in the flip-flop (7.6 ± 2.6°, p = 0.004) and FitFlop (8.5 ± 3.4°, p < 0.001) than barefoot (6.7 ± 2.6°). Significantly higher tibialis anterior activation was measured in terminal swing in FitFlop (32.6%, p < 0.001) and flip-flop (31.2%, p < 0.001) compared to barefoot. A faster heel velocity toward the floor was evident in the FitFlop (-.326 ± .068 m.s(-1), p < 0.001) and flip-flop (-.342 ± .074 m.s(-1), p < 0.001) compared to barefoot (-.170 ± .065 m.s(-1)). The FitFlop reduced frontal plane ankle peak eversion during stance (-3.5 ± 2.2°) compared to walking in the flip-flop (-4.4 ± 1.9°, p = 0.008) and barefoot (-4.3 ± 2.1°, p = 0.032). The FitFlop more effectively attenuated impact compared to the flip-flop, reducing the maximal instantaneous loading rate by 19% (p < 0.001).
  
  
  CONCLUSIONS
  Modifications to the sagittal plane ankle angle, frontal plane motion and characteristics of initial contact observed in barefoot walking occur in flip-flop footwear. The FitFlop may reduce risks traditionally associated with flip-flop footwear by reducing loading rate at heel strike and frontal plane motion at the ankle during stance.
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, M6 6PU UK.
authors.forename: Carina
authors.initials: C
authors.lastname: Price
authors.affiliation: School of Health Sciences, University of Salford, Salford, M6 6PU UK.
authors.forename: Vaidas
authors.initials: V
authors.lastname: Andrejevas
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, M6 6PU UK.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Findlow
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, M6 6PU UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Graham-Smith
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, M6 6PU UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Jones
keywords: Electromyography; Flip-flop; Gait; Loading rate