Foot pain after a trip: How to prevent in the future?

I think it would be very beneficial to see a good podiatrist — I had foot pain on the JMT, and found out that I needed more arch support. BTW, a GOOD podiatrist will not try to sell everyone expensive custom orthotics — mine recommended a $20 pair of Spenco insoles; problem solved!

"mine recommended a $20 pair of Spenco insoles; problem solved!"

As did mine which helped to clear up my plantar fasciitis.

I'd take some Advil PM at night to help with the inflammation in the meantime.

I got stress fractures in my foot in 2009 after hiking multiple 25 mile days in Rocklite 295s. I had about 200 miles in them and my feet always started hurting after 12-14 miles but I kept ignoring it. With my previous Soloman shoes my feet wouldn't hurt until 25 plus miles. On the trip in question I had hiked two 25 mile days in a row and near the end of the second day my feet were killing me (I swore then I was getting rid of those @$%# shoes) and the next morning one foot felt fine but the other one hurt and was slightly swollen and discolored. I never take pain meds on the trail but I loaded up on vitamin I and hike the 19 miles back to my car. I saw an orthopedic doctor two days later and was in a boot for the next six weeks. Officially it was from over use but I changed back to Solomon xa pro 3d's and haven't had a problem since even doing as much as 34 miles per day on rocky terrain.

Footwear is a personal thing but I need more protection then the Rocklite 295's provided. They did however fit fairly well and had a soft but excellent sole.

For me you can pry my Solomans off my dead feet.

Yeah, had similar pain a couple weeks ago after finishing the CDTs "El Malpais" lava section in thin shoes, then tile in thin dress shoes the next day for work. Ouch! After looking at all the options I put some "Sole" insoles I had laying around, elevating the feet. Problem pretty much solved the cheapest way, though if this hadn't worked I would've seen a podiatrist.

+1 to Spenco, but make sure they have metatarsal support.
+2 to seeing a Podiatrist whom you trust.

I had a very similar situation evolve this past summer, toward the end of a two week trip at Philmont, NM.

In particular, I developed a very similar issue under both my feet, specifically the day after a very long descent. (And I had my Superfeet insoles in my boots at the time.)

Since the problem hadn't "gone away" for a couple months, I finally went to a podiatrist who told me I needed to soak & massage my feet every day, wear Crocks in the home, and use an insole with metatarsal support. He recommended Spenco's.

look up "Capsulitus" and see if this is what it sounds like:

http://www.foothealthfacts.org/Content.aspx?id=1482

That arch pain in the morning reminds me of when I had plantar fasciitis. My latest foot problem was in the ball of the foot and when pushing off. Limped around for 6 weeks before finally went to a podiatrist. Turns out I broke a small bone the sesamoid and Im just getting back to start hiking after 8 weeks. I wish I had gone to the doctor much sooner.

Sounds like my plantar fasciitis. Especially that pain in the morning. I'm guessing you sleep with your toes pointed? (as opposed to sleeping with your foot at a right angle as if standing). The tendon along the bottom of the foot that healed a little bit through the night or after you're off your feet a long time, get re-torn as you stretch them in a weight-bearing way each morning. After 4 steps or 50, you're not micro-tearing them anymore and the pain goes away.

After putting up with it for a few months, I finally asked about it and I'm now weighing how much of the following I want to do:

– wear shoes all day long (so as not to flex my feet so much)

– wear stiffer soled shoes, especially for hiking

– put an ACE wrap around my ankle at night to point my toes less

– get a stiff brace for my ankle and wear it at night

Wikipedia has a good write-up on it. Age and weight are both risk factors. My own experience and that of the posters above suggest that a sudden increase in mileage (and weight-bearing miles) can be a precipitating event.

Recovery can almost always be non-surgical, but the length of recovery can vary greatly with different treatments.

That's more of a pain along the fascia along your arch, close to your heel, not along the pinky-toe side of your foot.

This is a common place for stress fractures, which is precipitated by stress reactions (if those stress reactions continue, then they turn into stress fractures). The tendon that controls your arch runs along the inside of your ankle, around the back of your inside ankle bone, under your foot, and attaches to the bump on the outside of your foot (on the pinky toe side).

Many times people who stress the arch control of their foot too much (i.e. wearing different shoes with different levels of motion control – either too much or not enough) can irritate the tendon attachment at the 5th metatarsal head (that bump on the outside of your foot).

The pain you feel in the morning is a collection of inflammation around the tendon, and when you begin to move around, working out the stiffness, it's painful.

The fact that it's going away is a good sign, and that you probably don't need to have it looked at. But I would look at your footwear – was the trail more uneven than you are used to? Or were your legs more tired than normal? Or was it just a rapid increase in mileage/speed/whatever?

And David – don't think of plantar fasciitis as anything being torn – it's not. It's just a disorganization of the collagen under your foot and the already limited blood flow is further reduced because of that degeneration. You aren't tearing anything……

The best thing you can do on your own for plantar fasciitis is stretch and massage your calves A LOT, then wear those night splints that hold your foot in 90 degrees all night. Don't worry about wearing your shoes all day – if anything I'd tell you to go barefoot more often! I can send you some good studies if you want to look at them about good self-treatment techniques if you want them…

One other possibility no-one has mentioned: a worn-out sole/insole.

My wife finds that when the sole/insole under the big lump behind the big toe gets depressed due to use, it's time to change to new shoes. That foam does compress after a while. We can check this easily by feeling around on the surface of the insole to see how much depression there is.

Cheers

Good stuff from Jennifer. I would add however that your plantar aponeurosis CAN tear, although rarely, and when it does, you are DONE.

One more alternative for plantar fascitis relief – look up "Strassburg Sock," which does the same job as a stiff ankle brace but which I personally found far more pleasant to wear (& light enough to take backpacking). IANAD, but it worked for me.

I had problems also. It really started when I began to hike in low arch support and hike a lot. Also, I work on my feet on a concrete floor all day so low arch support gave me what I hear is plantar faciitis or whatever.

I got some of the plantar faciitis insoles and they helped a tremendous amount, plus I got some high arch support insoles.

I di hike about 45 miles over a 3 days with the PF insoles in. For the first day or so I was rolling ankles fairly often but it never hurt, just stretched. Then I think the muscles that had weakened got a little stronger and I quit rolling my ankle at all.

Plus, and the main indicator of them working, when I got up in the morning my feet didn't hurt much at all, whereas normally they make me hobble for 10 minutes.

The PF insoles are my personal favorite of late for helping my feet out so much.

One option to get a stiffer sole without ankle support is approach shoes. I don't tolerate ankle support well (tall shoes rub my achilles and ankle bones and it can become excruciating).

I usually hike in trail runners, but I just got back from a 4-day trip in the Grand Canyon that included some technical climbing, so I wore La Sportiva Boulder X's instead. And I have to say, I was surprised at how good my feet felt. We had some very long days, mostly off-trail, and my feet felt sore, but not as much as they usually would with the trail runners. Because of this I'm considering taking the Boulder X's on my 14-day trip in December.

That said, new shoes in general could be the ticket, and stiffness might not be the answer. I once had some severe foot pain from carrying heavy loads for work. Then I forgot my Asolo boots one week and had to buy a pair of Hi-Tecs at a Wal-mart on the way there. The new boots had a very flexible sole. I used them for that entire week and then gave away the Asolos, because my feet felt so much better with the Hi-Tecs (even though cactus spines kept poking all the way through, and I ended up wearing the Hi-Tec soles completely through in less than 20 days of work!).

Thanks for the many helpful comments! They are much appreciated.

I'll definitely give the Spenco insoles a try with my 295's. The 295's are as comfortable as slippers, but after 5 miles on rocks, I wonder why I brought my slippers. :)

I have a pair of Solomon XA Pro 3D's which I wanted to like several years ago before the 295's. Although I have flat feet, the arch support in them was hard to get used to, and even gave me blisters on the front of the arch which I couldn't prevent unless wearing thick socks with liners. But, I might be able to use these shoes with the Spenco insoles. I'll give that a try also.

I'll increase the foot massage. I don't think it's capsulitis, as it feels more behind the capsule. It's hard to tell, but I think I've had that before.

I do often sleep with my toes pointed, although I've been trying to keep them in a normal position because that's the only position where I feel zero pain. I think I do often have some plantar fasciitis after hikes, so these tips are useful, but this pain is different.

My shoes and insoles aren't very worn. I'd say I have around 100 miles on them.

Jen:

Tendon inflammation at the 5th metatarsal head seems to somewhat match the pain, although my pain is just behind the head, and maybe somewhat in-between the 4th and 5th metatarsal. Bearing weight normally only causes slight pain now. Walking is about the same as long as I'm careful to walk more on the inside (big toe) side of my foot. Other than that, I can do anything with my foot painlessly except push hard on the outside bump, just behind it, or squeeze the foot there.

"But I would look at your footwear – was the trail more uneven than you are used to? Or were your legs more tired than normal? Or was it just a rapid increase in mileage/speed/whatever?"

I did a series of two 2-3 day fall trips two weeks apart after not hiking much at all during the summer. The first trip left me with a bit of general food soreness and stiffness, but no real localized pain.

The trail was a little different than I'm used to in that there were more places where the footing was unstable due to leaf-covered rocks and branches, and it was muddy enough that some of these rocks would slide out from under me. I had to bear weight on the outside edge (5th metatarsal) of my foot more than usual, generally suddenly and without warning.

One more detail: I have fairly flat feet.

I, too, experienced the most excruciating pain last summer after trying to boost my mileage by shoving off hard on my big toe instead of just striding. The pain around the ball of my foot was phenomenal and went on for weeks in spite of massages, ice, vibrator, etc. Then I fortuitously came across the New Balance Ultra Arch Support at Onlineshoes. It's very different in that incorporates a metatarsal arch support, a bubble that is about three inches long in the middle of the insole; Superfeet Orange at one time had this bubble – though smaller – but they have since discontinued that feature. Well, the long and the short of it is that in about a couple of weeks the pain was entirely gone! As far as I'm concerned it was a miracle. Maybe Jennifer can tell me what that was all about.

Andy, you've gotten a lot of good input, but your only first move should be to see a podiatrist or orthopedist. Don't rely on internet diagnoses from fellow hikers, no telling if what they have suffered from is what you have, and anything you try without a professional diagnosis could do more harm than good. Think of the excellent input you've gotten here as starting-point possibilities, not a treatment plan.

As for your specific pain, lots of good info already.

To prevent it in the future, get a shoe with a rock plate. I live in AZ and every last one of our trails is nothing more than fist to ball sized scree and talus. It's brutal on your feet. I find that 10-15mi is a limit for me too on it. Having a rock plate distribute the point contact better is very nice on the feet. I don't think it particularly increases your fatigue range unfortunately as there are other muscular endurance issues associated with rubble hikes, but it does ease the damage done.

I only use thin soled shoes on dirt, everything else gets a rock plate.

I suspect a lot of foot pain is from not building up slowly to these tips.

Start with short training day hikes and build up to longer mileage and heavier loads and more rocky tails and then even off trail (if that is your goal) over a period of time… gets your feet and the rest of you body and joints used to what you're requiring of it.

Weekend warriors (or once in a while backpackers) that don't do some conditioning will suffer.

Billy

When you say Spencos, specifically which one? They make several different types.

I hiked in Altra Lone Peaks this summer, and after long days my arches were quite tired-I ended up putting Leukotape along the inside of my arches. I love the zero drop, and wear zero or low drop shoes every day, no heels for me! I am working on arch stability and strengthening my hip stabilizers to reduce pronation (thanks, Jen!), but when doing long days a little arch support might help.

Andy,

A couple of years ago I had a pair of Innov-8 GTX 390's that I really wanted to love. I did three trips in them and my feet were killing me after each trip. The boots seemed to fit perfectly but when I had my local cobbler look at them (and measure my feet) he told me that they were too narrow for my foot.

If you've not had other issues with your feet (and you've been posting long enough that I know you're not new to hiking) then assume it's the boots and not you. Head to a good cobbler and have them measure your feet and the boots and I think you'll find what I did: You need to sell the Innov-8's on Gear Swap.

Good luck… I've battled it on/off for my entire hiking life. I found certain boots and inners that work. I don't know how to describe it but I know what fits and works for me now but for years I suffered through experimenting to find out.