Ballet flats are back. Here’s what the research says about how they affect your feet
<p><a href="https://theconversation.com/profiles/kristin-graham-1427672">Kristin Graham</a>, <em><a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em>; <a href="https://theconversation.com/profiles/helen-banwell-305575">Helen Banwell</a>, <em><a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em>, and <a href="https://theconversation.com/profiles/saravana-kumar-181105">Saravana Kumar</a>, <em><a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p>
<p>Ballet flat shoes – those thin-heeled lightweight slip-on shoes – are making a fashion <a href="https://www.vogue.com/slideshow/ballet-flats">comeback</a>. And it’s not hard to see why: they’re versatile, easy to wear, soft, flexible and often worn by celebrities.</p>
<p>We have often been warned of the dangers of high-heeled shoes, so you might think ballet flats are problem-free.</p>
<p>When you look at the research, however, a complicated picture emerges. There’s no definitive evidence to show ballet flats are generally harmful to foot health in the long-term. But ill-fitting ballet flats can be a problem.</p>
<h2>Make sure it fits, especially in the toe box</h2>
<p>An estimated <a href="https://pubmed.ncbi.nlm.nih.gov/30065787/">70%</a> of the population are wearing ill-fitting shoes. This mismatch between foot and shoe shape can increase foot pain, <a href="https://pubmed.ncbi.nlm.nih.gov/17507530/">reduce stability</a>, and can mean more blisters, corns and calluses. And habitual wearing of tight shoes has been <a href="https://www.sciencedirect.com/science/article/pii/S0958259207000533">associated</a> with bone changes in the toes and feet over time.</p>
<p>Many flats feature a shallow and narrow toe box (the part of the shoe where the toes go). A too-small toe box often doesn’t align with the shape of a foot and ends up squishing the toes. It can also <a href="https://www.sciencedirect.com/science/article/pii/S0958259206000770">increase</a> pressure on top of and under the foot, and <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-6-28">restrict</a> the movement of the forefoot during walking.</p>
<p>But a too-big toe box is also a problem. Too much foot movement within the shoe can cause pressure and friction on the skin, which can also lead to calluses, corns, blisters, and wounds.</p>
<p>A poorly fitting toe box can also cause micro trauma to toenails which, ultimately, can change <a href="https://www.researchgate.net/profile/Anuva-Bansal/publication/347522694_Traumatic_Nail_Disorders/links/60d6135592851ca94487df7e/Traumatic-Nail-Disorders.pdf">their look and thickness</a>.</p>
<p>So if you’re wearing flats, make sure you choose a shoe with the right sized toe box.</p>
<h2>What about the heel?</h2>
<p>Health professionals often recommend a small heel over a completely flat shoe. Very flat shoes can <a href="https://pubmed.ncbi.nlm.nih.gov/27498844/">place</a> <a href="https://www.sciencedirect.com/science/article/pii/S0268003307002082">more</a> strain on the soft tissues that support the foot arch – specifically, the plantar fascia.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27498844/">Research</a> has shown moving from a completely flat shoe to a small, raised heel reduces the tension force on the plantar fascia during standing activities.</p>
<p>On the other hand, other <a href="https://journals.lww.com/jpojournal/Fulltext/2009/01000/Effects_of_Shoe_Heel_Height_on_the_Roll_Over.7.aspx#:%7E:text=The%20roll%2Dover%20shapes%20seem,without%20a%20change%20in%20alignment.&text=Photographs%20of%20the%20prosthetic%20feet,shapes%20of%20these%20feet%20superimposed">research</a> has shown most people will adapt their ankle and knee motion to accommodate shoes of different heel heights.</p>
<h2>What about support?</h2>
<p>Ballet flats tend to have very flexible, thin soles and heel counters (the part, coloured red in this picture, that hugs the heel and the back part of the foot).</p>
<p>These thin and flexible structures mean flats are often accused of lacking support. But debate rages among foot and shoe experts about how important support is in the first place.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27729290/">Research</a> on barefoot-style shoes has shown walking in these types of shoes significantly reduces some loads on the knee compared to more stable supportive shoes.</p>
<p>Minimalist shoes have also been found to <a href="https://pubmed.ncbi.nlm.nih.gov/30102872/">increase strength</a> in certain foot muscles used when we push off during walking, running or jumping.</p>
<p>However, other research found stable supportive shoes can <a href="https://pubmed.ncbi.nlm.nih.gov/33428439/">improve knee pain</a> when walking more than flat flexible shoes.</p>
<p>The thin soles in flats mean there is little cushioning under the foot. While more cushioning can improve comfort, and reduce stress and strain on your foot sole <a href="https://www.sciencedirect.com/science/article/abs/pii/S0021929011001758?casa_token=gecXFCMi0LcAAAAA:TazyTd8TRaAl_bG0jprifYIUIlWRDwEH6bVeymBYTWups2iDGMuUjLs2gaNqsiNGHVJhHC3J9AdB">skin</a>, there is no evidence it reduces loads across the lower leg.</p>
<p>In fact, walking in cushioned shoes has been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/20191571/">increase</a> the load on the knee compared to flat, flexible shoes.</p>
<h2>So, what’s the verdict?</h2>
<p>The verdict is mixed. Yes, there’s evidence poorly fitting shoes and a flat heel can be detrimental, with consequences seen in the <a href="https://www.sciencedirect.com/science/article/pii/S0966636221000199">rearfoot</a> (around the ankle) and <a href="https://www.sciencedirect.com/science/article/pii/S0966636218300687">knee</a>.</p>
<p>But there’s also no hard evidence ballet flats cause long-term foot health problems.</p>
<p>What matters is choosing a well-fitted shoe to suit your foot shape and needs.</p>
<p>If you’re shopping for ballet flats, try to:</p>
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<p>choose a pair with a toe box that does not cramp your toes and has a sole at least as wide as your foot</p>
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<p>choose flats that offer at least some structure and support</p>
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<p>choose a pair with a small heel rather being than completely flat.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207806/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p>
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<p><em><a href="https://theconversation.com/profiles/kristin-graham-1427672">Kristin Graham</a>, Lecturer in Podiatry, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/helen-banwell-305575">Helen Banwell</a>, Lecturer in Podiatry, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>, and <a href="https://theconversation.com/profiles/saravana-kumar-181105">Saravana Kumar</a>, Professor in Allied Health and Health Services Research, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p>
<p><em>Image credits: Shutterstock</em></p>
<p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ballet-flats-are-back-heres-what-the-research-says-about-how-they-affect-your-feet-207806">original article</a>.</em></p>
