Pododermatitis is a worldwide health and animal welfare problem in captive flamingos (Phoenicopteridae). Since sub-optimal substrate or flooring has been described as a factor in the development of pododermatitis in poultry and raptors, it is also suspected to play a role in flamingo foot health. Small groups of flamingos were separated from the main group in an indoor enclosure with artificial grass carpet and, in earlier years, concrete flooring, with additional fine granular sand in the water basin for the study year. Feet were evaluated before and after the separation. Judged subjectively, foot lesions had shown a general increase in the indoor enclosure in earlier years. In contrast, lesion severity and prevalence, scored in accordance with a standardised protocol, decreased when fine granular sand was provided. Since flamingos were observed mostly standing on sand and as this represented the major differentiating factor between years, it is concluded that fine granular sand is a favourable substrate to maintain, and one that may even lead to an improvement in flamingo foot health.