Stepping over rocks while on a remote trail is a good way to lose your balance and twist your ankle. Not so much a problem if you are near home, it becomes a major problem if you are miles from a trail.
At best, you will have a slow, painful hike back. At worst, a rescue team may need to be called to carry you out. Injuries to the feet are a potential problem for everyone who ventures outdoors, whether they are hikers, backpackers, hunters, or firefighters. Those who live in rural areas are also at risk, working in fields or in mountainous or hilly terrain.
Backpacker and podiatrist, Dr. James Alberen says, “Prevention is the key when hiking. Once you have a problem, you are in trouble.” He advises, “Foot problems are largely preventable and early treatment of those that do occur can stop them from worsening.”
Our lifestyle is the cause of many walking injuries of the foot. We tend not to walk or carry much weight during our normal daily activity, however, when we go outdoors hiking, hunting, or backpacking we carry heavy packs.
Even when we are in good physical shape and wear the right boots, we still tend to overtax our bodies causing sprains (injuries to ligaments that attach bones to bones), strains (injuries to muscles or tendons), and tendonitis (an overuse injury of tendons which attach muscles to bones).
Common causes of injury are inadequate physical conditioning, wearing ill-fitting or stiff boots, carrying too heavy of a load, not stretching muscles before hiking, and not taking adequate rest breaks.
Adequate physical conditioning at home will minimize foot and ankle problems or injuries in the backcountry. Exercises that strengthen the muscles of the knees, ankles, and trunk will improve balance and reduce the chance of stumbling and twisting an ankle. Lunges, squats, and stomach crunches done several weeks in advance of a trip will strengthen the muscles.
Make sure you have the right boots. Everyone’s feet differ in size, shape, and position, and improper fitting boots are the main cause of foot problems in the backcountry. Be sure to wear your boots enough to break them in before any long hike and don’t forget to make sure your toenails are properly trimmed to help prevent rubbing and blisters.
When selecting a new pair of boots, first evaluate their length. Try on a pair of boots your size while wearing the socks that you will wear while hiking.
Tap your toes towards the front before lacing them. If they are the right length, you should just be able to fit your index finger between the back of the boot and your heel. After lacing the boot, you should be able to freely wiggle your toes without feeling the front of the boot.
Boots are designed to flex at the area of the ball of the foot, generally the widest part of the boot. Make sure the distance from the ball of the foot to your heel matches that of the boot and that the boot flexes where your foot does.
Try flexing the boot while walking uphill (many stores have ramps to accommodate this), making sure that the heel does not come up more than about ¼-inch. Choose another boot if it does, as sliding in this area will cause heel blisters.
Foot volume is the space taken up by the foot. It varies tremendously among boots made by different manufacturers. There is no accurate way to measure volume, so judge it by the overall feel of the boot. There should be a supportive fit, adequate toe space, and no tight spots.
You should have ample room to wiggle your toes and your feet should barely touch the sides of the boot. A boot that is too tight will cause blisters on the top of toes, pressure on the arch, and may restrict circulation, causing numbness as your foot swells during hiking. If a boot doesn’t immediately feel good when you put it on, it will never be right.
Don’t believe a salesman that tells you it will fit better if you wear it for a while. Try different boots in different styles and by different manufacturers until you find the perfect one. Many better stores will allow you to “test drive” boots by wearing them indoors at home for a few days to make sure they fit.
“Flat-footed,” properly called overpronation, is the tendency for the foot to roll inward during walking. It is a common problem, often inherited, that causes loss of the arch of the foot, putting strain on the ankle and knee while jamming the toes against the end of the boot.
Severe ankle pain often occurs when hiking. In some cases, a pair of foampadded insoles, available at many stores, will help stabilize the foot better than the insoles that come with the boots. In more severe cases of overpronation, or if you have pain in the ankles while hiking, visiting a podiatrist who can make custom-made orthotic insoles for your boots and shoes.
By simply correcting the way one walks, the pressure is taken off the ankles and the pain stops. There are other things that you can do to prevent foot and ankle injuries. Wear as light a daypack or backpack as possible since less weight on your back improves your stability and decreases the stress on your ankles and knees.
Hiking or trekking poles make you much more stable over rocky ground and take a lot of the stress off your legs when hiking uphill. Injuries are often caused by twisting a joint while trying to regain balance after a stumble. Poles will act as extensions of your arms, giving you additional points of stability. This is especially helpful when hiking down steep and rocky paths.
Stretching leg muscles, especially the quads, hamstrings, and calves, for several minutes before beginning hiking and after a cooling down period, such as lunch, is important to loosen the muscles to avoid injury to the ligaments and tendons.
Sprained ankles which are common backcountry injuries, are caused by tripping on uneven ground or over rocks and logs. The vast majority are inversion injuries, where the foot turns toward the middle of the body and the ankle turns outward stretching or tearing the ligaments on the outside of the ankle.
Signs of a sprained ankle include pain and swelling on the outer part of the ankle. With a minor sprain, such as one that stretches or partially tears ligaments, the individual should be able to bear their own weight and walk.
If the injured individual cannot stand and put weight on his foot, suspect a complete tear of the ligament or an ankle fracture. Since it can be difficult to determine between these, splint the foot and ankle and evacuate the injured person for x-rays and medical care.
Standard treatment for any sprain or athletic injury is summarized by the acronym RICE—rest, ice, compression, and elevation.
Take the stress off the ankle by resting to prevent further damage to the ligaments. Apply ice early to reduce the swelling and pain. It should be used for up to 20 minutes 3 to 4 times per day. Swelling will return once the ice is removed unless a compression wrap is used.
Place padding, such as gauze, socks, or gloves, over the sprained joint and wrap with an elastic bandage from the toes up to and over the ankle. It should be comfortably tight and loosened if there is increased pain, numbness, or tingling of the foot or toes. Elevate the ankle to reduce swelling.
Continue the RICE treatment for the first 72 hours. Non-steroidal anti-inflammatory medications, such as ibuprophen (Motrin) 600mg three times a day with food, can be taken to reduce both inflammation and pain.
After the initial RICE treatment, if the individual can put weight on their foot and walk, the ankle should be stabilized to prevent further injury. This can be done in several ways.
One to two inch cloth tape can be placed in a crossweave or bas – ketweave pattern over the back of the foot, ankle, and leg. SAM splints can also be used to give enough stabilization for an individual to walk. With the boot or shoe on, wrap the SAM splint around the foot and secure with tape. They may need to be periodically adjusted or tightened.
Splints can also be made from other available materials, such as strips of foam sleeping pads, blankets, or similar materials.
This is a progressive overuse injury of the Achilles tendon, the tendon that attaches the calf muscles to the heel. It may occur when walking or running uphill with a heavy backpack, often with cool and unstretched muscles, or after long periods of hiking.
Symptoms include a dull ache or pain in the Achilles tendon, especially when jumping or running, mild swelling, tenderness to touch, and possibly a grating sound as the tendon rubs against its sheath. There may be no pain at rest. The individual will be able to put their full weight on the foot and will be able to walk, although in pain.
Treatment includes rest, ice, compression, and elevation (RICE). Stretching the Achilles tendon gently keeps it flexible. If the individual cannot walk or put their weight on the foot, the Achilles tendon may be completely torn (ruptured). The tendon may have snapped in half or pulled away from the bone and the individual will feel as though they were stabbed in the back of the ankle with a knife.
Treat with RICE, splint the ankle, and evacuate the individual, as they may need surgery to repair the ruptured tendon.
Another overuse injury is plantar fasciitis, an inflammation of the connective tissue sheath that encloses the muscles and tendons of the bottom of the foot. Causes include excessive hiking or running, especially when the foot is improperly cushioned, the arch is inadequately supported, or when the foot is overloaded by carrying a heavy backpack.
Our body is accustomed to carrying our normal weight and planter fasciitis occurs when feet are suddenly burdened by this additional weight.
Symptoms include pain on the bottom of the foot that is worsened by bearing weight. Rest, ice compresses, and non-steroidal anti-inflammatory medications are used to treat plantar fasciitis.
A splint may be worn at night to hold the foot in a neutral position and slightly stretch the plantar fascia. If the individual must continue to walk, the painful foot can be taped to provide arch support.
Once you get home, see a podiatrist to determine if a custom-made orthotic may prevent future problems when hiking.
Blisters are one of the most common, debilitating injuries in the backcountry. They are caused by the friction of rubbing between a boot and skin of the foot.
A reddened, sore area, called a “hot spot,” develops first and is a warning sign. If the rubbing continues, a pocket of fluid develops and the outer layer of the skin separates from the deeper layer causing a blister.
Blisters often form on the back of the heel when walking steeply uphill and on the tip of the middle toe or under the toenail when going steeply downhill. Moisture from perspiration of the feet or from getting your feet wet while hiking breaks down the skin and predisposes it to blisters.
Wearing a thin polypropylene or nylon liner sock under a heavier wool or wool-and-nylon blend can help. The liner sock wicks sweat and moisture away from the skin and any rubbing will occur between the socks, not between your foot and the boot.
Some people’s feet sweat more than normal (hyperhydrosis). They find foot powder or an aerosol antiperspirant used on their feet may help keep them dry, reducing the chance of blisters and Athlete’s Foot.
When hiking, stop several times a day, wash your feet, and put on dry socks. Rest with your feet elevated to reduce heat and swelling. Before putting your boots back on, put on dry socks, making sure to avoid wrinkles in the socks as they can cause blisters.
Many distance hikers carry several pair of liner and heavy socks, changing them three times per day. The pair that was just removed can be tied to a backpack to dry and can be reused before being washed in the evening. Your feet will feel much better and you will avoid many blisters if you follow this advice.
After the first 15 minutes of hiking, stop to adjust boots and check for any hot spots. Any warm or sensitive areas should be treated with moleskin, Band-Aid Blister Block, Spenco 2nd Skin, or similar material which will act like a second layer of skin.
If you find yourself without any of these, you can improvise by using first-aid tape or even duct tape, although it does not breath.
If a hot spot is allowed to continue, a painful blister containing clear fluid will rapidly develop over the irritated area. It may be small or large, but will eventually get large enough to burst on its own creating an open wound and potential for infection.
If a blister is small and intact, it may be treated like a hot spot with a protective covering. Sometimes it is helpful to cut a circular hole in the material, slightly larger than the blister, and place the hole over the blister. It must be thick enough to keep the blister from rubbing against the boot, even if several layers need to be added.
If the blister is large, it is better to drain the fluid to relieve the pain and remove the inflammatory fluid that can delay healing. Use a sterilized needle, scalpel blade, or safety pin (to sterilize, heat over a match to red-hot and then let cool) to puncture the blister at its base and press the fluid out.
Do not remove the skin over the blister or you will be walking on a painful open wound. Apply an antibiotic ointment over the blister to help prevent infection and cover with a protective covering.
Many hikers find Spenco 2nd Skin to be a better choice than traditional moleskin. It is a hydrocolloid pad that protects, cushions, and absorbs fluid from the blister, while acting as a bacterial barrier to prevent infection. It can be left in place for up to five days and will detach from the skin naturally, without tearing the skin off the blister.
If a blister bursts on its own you will have a painful open wound that is at risk of infection from the microorganisms on your foot. You will know if it becomes infected from the increased pain and the pus draining from the wound.
Remove the dead skin overlying the blister with small scissors, clean the wound with soap and water, and treat like any other open wound, applying antibiotic ointment and a sterile dressing.
Other foot problems
Other foot problems Besides injuries, Athlete’s Foot and cracking skin are two irritating and painful conditions that plague hikers and other outdoorsmen.
Athlete’s Foot is due to normal fungal organisms present on everyone’s foot, both on the skin and nails. These fungi normally consume thick skin, called callus, keeping the skin soft. If unchecked, calluses will grow thick, crusty, and the skin will crack, a common problem among individuals who go barefoot or wear sandals all of the time.
In warm, moist conditions, the foot does not receive adequate ventilation and the numbers of fungal organisms rapidly increase. This leads to loss of all callus formation, making the foot more susceptible to blisters.
The skin of the foot and toe becomes thin and the fungus begins to feed on live skin causing an itchy, scaly, red rash, most commonly between the fourth and fifth toes. They can crack, blister, or ulcerate causing painful open sores in what is called commonly known as Athlete’ Foot.
On the soles of the feet, Athlete’s Foot presents as itchy, dry, flaking skin, sometimes with small blisters. Prevention is the best treatment for Athlete’s Foot.
Wash your feet daily, being careful to dry well between the toes. Keep your socks dry and wear liner socks that wick sweat away from the skin rather than cotton that stays moist. Once in camp, change into a pair of lighter shoes or sandals to let your feet ventilate better.
If Athlete’s Foot occurs, it can be readily treated with over-the-counter anti-fungal medications available as liquids, ointments, or powders. Treat until symptoms are gone, at least for a week.
When feet are too dry or shoes rub against the feet, a thick callus forms and cracking of the skin occurs, especially on heel, ball of the foot, and toes. These cracks become painful as they pull apart the live skin and do not heal well because the callus material is dead skin.
As calluses start to thicken, an individual can prevent cracking by wearing socks to increase moisture in the foot and by using creams that decrease callus formation, such as Ureacin-20, available from your podiatrist or physician.
Thickened skin can be removed before it starts to crack by sanding with a sanding block available at a pharmacy or even with a sandpaper disk on a battery-operated drill.
Walking injuries are the most common, yet most preventable, injuries in the outdoors. Pre-trip physical conditioning, proper fitting boots and socks, daily foot care in the field, and early treatment of any problems will go a long way in making your trip an enjoyable one.
Remember, “Once you have a problem, you are in trouble.”
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