Maceration, Immersion Foot and Backpacking

[Ryan Jordan]

Companion forum thread to: Maceration, Immersion Foot and Backpacking

A short, detailed discussion on immersion foot and maceration, how to deal with it in the backcountry and when not to.

[Monty Montana]

As for stream crossings, I’ve always wrung out my socks and squeezed out as much water as I could from the foam parts of he shoe.  I’ve never for a minute believed the reviews that claimed “my feet were dry after 20 minutes of walking”…I call BS on that!

When I remember to pack them I use the Vincere Grip Socks (3.2 oz) for water crossings.  Removing and putting back on dry trail runners and socks is well worth it and easy to do.

But a brilliant compromise is one that I most often use and that you point out above: the Astral shoe, which is the shoe of choice of Jennifer Pharr Davis (sp?), who set one of the fkt on the AT.  It is similar in shape to the Altra shoes that are so popular (why?) but with a much sturdier build and they are not eternally constrained to maintained trails.  Here in the Missions the FS hasn’t maintained many of the trails for over 50 years…they’re pretty rough, if you can find them, and the Altras would be a big fail.

I also use plastic bread bags in the rain…shoe gets wet, but the socks stay dry.

[Bruce Tolley]

During WWI, the British Army used whale oil to prevent trench foot and required soldiers to carry three pairs of socks and change them twice a day.

[Jeff McWilliams]

Hydropel used to be very high regarded as a skin/water barrier with good results when used prophylactically .  Since it ceased production, people have been on the hunt for a suitable replacement, and many believe that dimethicone was one of the ingredients that made it work so well.

This thread on Reddit talks about replicating Hydropel by adding dimethicone to some other product such as Trail Toes.

I haven’t tried the recipe described there yet.  I’ve had reasonably good results with Gurney Goo, but I really haven’t put it to the test in any sort of really challenging environments.   Gurney Goo’s primary ingredients are listed as:  Petrolatum, Cyclomethicone, Bee’s Wax, Tea Tree Oil

By the way, ozokerite wax has a melting point anywhere from 79C to 95C.  Beeswax has a melting point of 62-65C

 

[SIMULACRA]

Am I wrong in the thinking here? But if you’re going to be taking off socks to wring them out of water, why not just take them off before hand. Either which way you’re taking them off. This way they are at least drier. Not directed at anyone in particular. Just from the article.

[Jeff McWilliams]

I’d agree with @simulacra.  Just take off the socks and pull out the insoles before the creek crossing.

 

[Todd]

Thank you Ryan for sharing this topic. I have heard so many times from the lightweight community the idea of just walking through streams. I’ve liked that approach but wasn’t at all thinking about this risk. So this awareness is awesome. So I’ll keep this in mind when considering my approach for a given trip, and keep the idea of removing my shoes as an option. And in sustained wet environments, will add a balm to my gear. Thanks again. Great article. Very beneficial.

[Roger Caffin]

Can’t say wet feet have ever given us any problems at all.

But NO GTX shoes! They make for ‘prune’ feet, and problems.

Cheers

[Ken Thompson]

https://andrewskurka.com/minimizing-the-effects-and-aftermath-of-wet-feet/

[J-L]

I’ve done a lot of backpacks in the Southwestern U.S. where you are constantly hiking through water. Canyon hikes where the trail is basically the river. The Middle Fork of the Gila River where there are 50 or more river crossings in every 10 miles. I haven’t had any problems with wet feet, even when things are cold. I use trail runners and synthetic socks, no balms. I usually sleep with wool socks at night to help dry my feet.

Even on the JMT, my friend and I hiked through every river crossing with our socks and shoes on. Never stopped before or after. Most people looked at us like we were idiots, but again, no issues. Maybe I’ve gotten lucky or maybe I’m not doing enough miles.

[DAN-Y]

Love Me Baby Me Butt Balm (good stuff, has zinc oxide, same stuff used by US military to prevent trench foot and crotch rot) Same stuff used by many off trail climbers.

https://blog.theclymb.com/tips/6-tips-for-keeping-your-feet-healthy-when-youre-getting-soaked/

https://www.amazon.com/Love-Me-Baby-Butt-Balm/dp/B001G3ZPQ4

 

 

 

[Geoff Caplan]

Well researched article – info here that I haven’t seen before.

But I’m not convinced by the argument for merino socks. Yes they hold water, but they hold it directly against the skin where it can be absorbed. I use Coolmax liner socks. They are very thin and quite hydrophobic, so hold very little water against the skin which is surely a good thing. They dry fast on the feet. They can be hand-wrung to near dry, especially if rolled in a trail towel. And they dry fast on the back of my pack. For the weight of a couple of pairs of loop-pile merino socks I can carry many pairs, and change regularly. If it’s cold I’ll layer them, with the driest pair next to the skin. Two or three pairs of liners dry far more quickly than a single pair of looped wool.

I use nappy/diaper cream as a barrier, which seems to work OK. I towel my feet dry at stops, air them and change socks.

If it’s warm I usually just walk straight through any streams, as my socks will be pretty dry within minutes. If it’s cold, I might take them off before a crossing to keep them dry.

This routine seems to work. As a Brit I’ve spent a lot of time with wet feet and have never had any kind of problem, touch wood…

 

[DAN-Y]

After you have dried your feet apply Desenex or it’s equivelant. The stuff Ryan suggests using doesn’t do squat to keep moisture away from skin.

 

Desenex 2 % Topical Powder
GENERIC NAME(S): Undecylenic Ac-Zinc Undecylena, Miconazole Nitrate, Undecylenic Acid

Uses
Miconazole is used to treat skin infections such as athlete’s foot, jock itch, ringworm, and other fungal skin infections (candidiasis). This medication is also used to treat a skin condition known as pityriasis (tinea versicolor), a fungal infection that causes a lightening or darkening of the skin of the neck, chest, arms, or legs. Miconazole is an azole antifungal that works by preventing the growth of fungus.

https://www.webmd.com/drugs/2/drug-15324-787/desenex-topical/miconazole-topical/details

 

[Tipi Walter]

I agree with John on this one.

I just got back from a 21 day backpacking trip in the Southeast mountains and stayed in wet boots for the entire trip—which included 68 creek crossings.  It’s much easier in the warm months to just stay in my hiking boots and not get into crocs/water shoes/barefoot for every crossing.

My feet stayed soaked for days at a time but in camp I always wore my crocs as camp shoes and always had a pair of dry smartwool socks for camp and sleep.  The longer time you spend in camp the better off your feet will be.

[Roger Caffin]

The problem with continually treating your skin with medication like anti-fungals is the same as continually taking antibiotics: after a while all that is left is the ‘bugs’ which are resistant to whatever medication you are using. Then where are you?

It’s a problem. Me, I just wash my feet with soap every night and then dry them carefully.

Cheers

[DAN-Y]

The problem with continually treating your skin with medication like anti-fungals is the same as continually taking antibiotics: after a while all that is left is the ‘bugs’ which are resistant to whatever medication you are using. Then where are you?

Not true, we’re talking about suface treatment of skin, not internal medicine/antibiotics.

[Rex Sanders]

Why should your skin be any different from your guts?

Antifungal resistance in dermatology
The rampant use of antifungal therapy in immunocompromised individuals marked the onset of antifungal drug resistance. Fungal resistance can be microbiological or clinical. Microbiological resistance depends on various fungal factors which have established due to genetic alteration in the fungi. Clinical resistance is due to host- or drug-related factors. All these factors may cause fungal resistance individually or in tandem.
http://www.e-ijd.org/article.asp?issn=0019-5154;year=2018;volume=63;issue=5;spage=361;epage=368;aulast=Pai

The global problem of antifungal resistance
Cellular stress induced by drug treatment promotes adaptation, which contributes to breakthrough resistance. Drug exposure also drives the emergence of resistance.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30316-X/fulltext

Antifungal Resistance
Fungal infections that are resistant to treatment are a public health challenge. We all have a role in preventing these infections and reducing antifungal resistance.
https://www.cdc.gov/fungal/antifungal-resistance.html

— Rex

[Roger Caffin]

On the skin or inside your guts: it makes zero difference. What we are concerned about here is the forced evolution of drug resistance.
The problem with anti-fungals is just the same as with antibiotics, just less well known.
As Rex said.

Cheers

[DAN-Y]

Not so in relation to trench foot and crotch rot. It’s all anecdotal!

[Roger Caffin]

Papers published in The Lancet, the CDC and IJD are ‘anecdotal’?
That’s not how I read those references.

Cheers

[DAN-Y]

If the 2 of you are affraid to use the antifungal……don’t!

The US Government issues it to all Military branches. I’ll continue to use it, I’m not in fear.

Cheers

[Geoff Caplan]

Dan

I think you’re misunderstanding the issue.

Rex is pointing out that indiscriminate use of antifungals is causing the evolution of resistant strains that will be a major threat to all our health. It’s not a question of being afraid to use them – it’s a question of being a responsible citizen.

I’ve walked for half a century on wet terrain without a single infection by simply using common sense precautions. And none of my walking friends have had infections either.

The use of an antifungal prophylactically is simply overkill and unjustifiable when it could be contributing to the development of resistant strains.

[John S.]

This is an interesting and confusing topic with all of the previous names used.

Maceration, to me, must have evidence of skin breakdown and not just wrinkled skin. Wrinkled skin is over hydrated or hyper hydrated skin. Maceration, in my opinion, must also have skin breakdown such as fissures or sloughing, either of which will open the door to secondary infection.

Supra, to me, is an anatomical prefix meaning “above”. A better word would have been super-hydrated but then why bother with that. Wrinkled skin is over hydrated, not supra-hydrated.

RANT Just like there is cold injury, there should also be wet injury and not all of this “immersion” stuff. I guess use of the term immersion sounds more scientific. END RANT

In cold conditions (?skin temp 59 degrees F or down to 32 F) the current general term is nonfreezing cold injury (NFCI). The types of NFCI include trench foot (land based), immersion foot (water based), chilblains (pernio) and cold urticaria. In warmer weather the two conditions are warm water immersion foot and tropical immersion foot (more severe). Is it all a continuum of wet injury and how temperature is a secondary factor (in addition to the added skin changes of chilblains or tropical immersion foot)? Feel free to disagree.

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