According to Shroyer of Austin University “(w)hen you wear flip-flops, you kind of scrunch your toes to keep the flip-flop on your foot. 1). Hence the characteristic flip-flop shuffle that can be described as an unnatural, toe-gripping, foot-slapping gait, he explains. It is this gripping action that leads to the following signs and symptoms of hammertoes: Contracture and eventually flexion deformity of one or both interphalangeal joints of the second, third, fourth, or fifth (little) toes. The first joint or metatarsophalangeal (MTP) joint is cocked upward (mild hyperextention), middle joint or proximal interphalangeal joint (PIP) bends downward as well as the tiny joint at the end of the toe or the distal interphalangeal (DIP) joint are curled downward like a claw 2). Depressed top of toe deformity. Second toe involvement most common especially when the second toe is longer than the great toe. Associated hallux valgus deformity at the great toe. Corns or plantar calluses develop secondary to abnormal pressures and are located at the distal toe, the dorsum of proximal interphalangeal joint (ITP) and beneath the metatarsal heads that leads to pain or irritation when wearing proper shoes causing people to revert to plakkies for comfort. High longitudinal arch and a rigid foot 3) Pain over the dorsal aspect of the PIP joint. Occasional pain over the plantar area of the metatarsal head, especially if the MTP joint is hyperextended, subluxed, or dislocated. In addition, patients with MTP instability often complain of pain over the dorsal part of the MTP joint, and they may describe the sensation of a lump in the plantar area of the MTP joint. Patient assessment It is important that the visual assessment is done while the patient is standing. This is to appreciate its functional significance 4). Accompanying deformities, such as hallux valgus, combined hammertoe and rotational deformity, and cavus foot deformity, must be recorded. 5) Passive correction of the deformity should be attempted, because this will help determine which treatment options are appropriate for the patient. 6) References: Auburn University . AU study shows that overuse of flip-flops can lead to orthopaedic problems http://wireeagle.auburn.edu/news/359 http://www.eorthopod.com/public/patient_education/6482/claw_toes_and_hammertoes.html http://www.fpnotebook.com/Ortho?Foot?HmrT.htm Houglum, P.A. (2005). Therapeutic Exercise for Musculoskeletal Injuries.  Champaign, Ill. : Human Kinetics  http://book.google.co.za http://www.emedicine.com/orhoped?TOPIC457.HTM...