Are flip-flops, the quintessential symbol of leisurely summer living, ticking time bombs prepared to destroy the very foundation we stand on?

Probably not.

But there’s no denying that the footwear of choice for millions in summer – and year-round for some – can cause trouble if used improperly.

“A lot of foot conditions are seasonal,” says Dr. Kevin Logel, a foot and ankle surgeon with Raleigh Orthopedic Clinic. “In the winter, with closed-toe shoes we see a lot of bunions. In summer, we see problems with arches, pains in the forefoot, with stress fractures.”

“Flip-flops scare me,” says Doug Fogartie, for years a river rafting guide and now the mobile marketing coordinator for the U.S. National Whitewater Center in Charlotte. “They fall off more easily and your toes are more prone to sustain a serious stubbing.”

In the United Kingdom, where a more socialized form of health care makes it easier to track such matters, the National Health Service estimates that $62 million is spent annually treating 200,000 flip-flop related injuries.

The problem, says Logel and other medical people is that flip-flops are great for short excursions such as shuffling across a hot pool deck, scampering down the driveway to grab the morning paper, or getting to the beach from your beach house. But because of their minimal design and lack of contact with your foot, they’re a problem for longer-term use.

So what should the flip-flop devotees know to avoid becoming a summer statistic?

• Avoid wearing them 24/7. That lack of contact with the foot and minimal structural support can, over time, result in arch pain, plantar fasciitis, nerve damage and “kinetic stresses” resulting from changing your gait to keep the shoes on, according to the Department of Orthopaedics at the Mount Sinai School of Medicine in New York City. The simple act of gripping your toes to keep the shoe can result in trouble to your toes, ankles, legs, hips and back.

• Avoid wearing them in challenging conditions. All that foot exposure can result in broken toes and toe nails. Cuts suffered walking through debris or plant life are an easy entry point for germs. For the record, says Abe McCoy, a physician’s assistant in the Emergency Department at Rex Healthcare in Raleigh, most people have the common sense not to wear flip-flops when mowing the lawn. “Usually the people we see who have cut their feet mowing the lawn are wearing tennis shoes.”

• Don’t forget sunscreen. Melanoma – cancer that develops in the skin cells responsible for pigmentation – of the foot is more likely to go unnoticed than elsewhere on the body, according to the American College of Foot and Ankle Surgeons. If you wear flip-flops or sandals outdoors, put on sunscreen.

• Consider your age. Older people might want to avoid wearing flip-flops, says Raleigh Orthopaedics’ Logel. “Because the anatomy of the feet change, muscles tighten up, they atrophy, and with the clawing of the toes, they may not be good for older people.”

• Consider your weight. Larger people are at greater risk of ankle damage or stress fractures because of the lack of support, says Logel.

Any other reason to avoid flip-flops?

Yes, says Logel, to avoid getting a “flat tire” from friends. “That’s when they step on the heel and the shoe separates from your feet.”