Introduction
As the sun retreats behind a chain of snow-capped peaks in the distance, I can feel the air temperature begin to drop. I’m 18 hours into my attempt at running Patagonia’s Huemul Circuit. I’ve already crossed the glacier and both mountain passes. What lies ahead is about 5 miles of flat terrain; it should be easy. I have some pain in both feet, but it is manageable. My shoes are bugging me though. What seemed like a good fit on shorter trial runs is evidently not—my toes awkwardly press up against the toe box, and my heels feel compressed and hot. Suddenly I feel a stinging pain in my right heel as it makes contact with the ground, forcing me to alter my gait. I find a good spot to sit, take off my shoe and gingerly peel back the sock—what had been a small red spot hours ago has turned into a large blister and now opened up. I can feel the motivation to move fast draining out of my body. A new focus emerges: “one step at a time, don’t rush, there’s warm water and Neosporin at home.” The sun is now all the way behind the mountains. I grab my headlamp from the pack, curse myself for not bringing tape, and start walking. These last few miles are going to be slow and painful.
Foot health is integral to enjoying your hike
There are many ways to be uncomfortable on a hike. Heavy pack loads, bad layering systems, and insufficient nutrition can all lead to what is generally considered to be “a bummer” by the overwhelming majority of hikers. One of the worst discomforts to face on the trail is foot injury, which can come in many forms. Once a problem develops, there is likely to be a stinging (or stabbing, burning …) reminder every step of your journey thereon.
More serious foot injuries can greatly complicate the process of safely finishing a hike and may even necessitate an earlier exit than you had previously planned.
What do you need to do to keep your feet healthy?
Most advice on foot care comes from sources that don’t take into consideration the extreme stress that hikers and long-distance runners incur. When looking at material aimed at a more general audience, it’s easy to get the impression that foot care is simple and doesn’t require much effort. I’d posit the opposite is true.
Hikers subject their feet to repeated impact forces, usually compounded by uneven terrain and extra mass from weight carried on the back. Oftentimes humidity from sweat and wet conditions builds up inside shoes, causing problems with thermal layers of the foot. Furthermore, hikers expose their feet to dirt which abrades skin and inhibits its natural healing process.
Luckily, there are many things you can do to actively treat foot injuries as they develop while backpacking. Better still—avoid them completely by taking preventative steps before you even hit the trail.
In this article, we’ll give you a basic understanding of the most common foot problems that threaten the joyousness of your next adventure, and provide specific measures that you can take to improve your foot health and outcomes as a hiker/backcountry traveler.
Common foot problems (dermal vs musculoskeletal)
Many of the common issues that hikers face with their feet take time to develop. There won’t be a clearly identifiable moment when the injury occurs. It’s important to continually monitor the state your lower extremities are in as you hike and take note of any sensations as they arrive. Early diagnosis and treatment is key.
Being honest with yourself and stopping to address the problem before it worsens is the best strategy. For the most part, your options for injury management on the trail will be limited to mitigation. The scope for actually treating and healing a wound while hiking is small. Knowing when to stop to diagnose the problem as well as habitualizing a foot care routine when you get to camp are both vital strategies for early detection and prevention.
Injuries affecting the feet can be divided into two general categories—dermal and musculoskeletal. Dermal injuries are caused by friction and repetitive shear forces (sometimes exacerbated by prolonged exposure to water), whereas musculoskeletal injuries arise from some sort of impact—either acute or repetitive/chronic.
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Companion forum thread to: Keep Your Feet Happy and Healthy: A Crash Course for Backcountry Podiatry
Knowing how to properly care for your feet can make or break a hike, especially on longer trips. In this article, I examine available data on common foot and ankle injuries and discuss how to prevent them, as well as what to do when they occur in the field.
Well, well.
As many of you know, I tend to be a bit of a cynic. In my experience, very few members of the broad medical establishment (doctors, physios, podiatrists etc) have any real understanding of the walking/mountaineering field and what loads it can place on the body. Fair enough: they probably see very few cases.
Mr Lee’s article is a rare exception to this. I read the article with great interest and found myself nodding my head so many times. I did not agree with everything – I prefer Micropore to Leukotape for instance, but those a fine details. I emphatically agree with the need for large toe-boxes!
My thanks to AL for a great contribution.
Cheers
Years ago, a guy in a bar told me that to treat my plantar fasciitis, I should get a lacrosse ball (or something of similar texture) and roll my feet over it. I guess I should have listened to him.
I have few foot problems, but my second toes on both feet will always have black toenails. Even with wide toebox footwear that fits well and serves well in all other aspects, I end up with black toenails. Even with a heel lock tie method, even with different kinds of socks, if I don’t include a silicone toe protector, those toenails will turn black. It only hurts for a while, so I no longer really worry about it. If I have to wear dressy sandals in the summer, toenail polish effectively covers it up! But no suggestion I have ever read has solved this problem for me. I’m grateful that’s all the foot problems I have!
Excellent summary!
I tend toward minimalist / zero drop (my notes) but agree they aren’t for everyone and require an extended training period. Â I have watched a number of people end up with achilles tendentious when suddenly switching to zero drop shoes.
One sock I would add to the list would be XoSkin toe socks.
Thank you for the article – good to read.
I have short, wide, high arched feet and have always struggled with hiking footwear. Used to need lots of preventative taping.
I recently had custom orthotics made by a podiatrist- a revelation. I thought they would make my feet more squashed, but they do the opposite. By supporting the longitudinal and transverse arches of my feet, they make my feet less wide and way more comfortable. Needed to be introduced gradually. No more tape!
Ps I like silverlight socks- they don’t smell (extraordinary!!) And hug my feet closely. I was worried that the slight compression would be uncomfortable, but I find it really good. Not for night , tho – the compression makes my feet colder.
That’s weird, I just noticed that on my second toe the toenail turned black. Only on my left foot though.
I think I have plantar facaitus. Heel sore. If I pull my big toe towards me and masage the tendon between heel and big toe it feels better.
And if i stretch and go up on my tip toe and back down.
Maybe I need an arch
Maybe the good feet store if I can believe their commercials :)
Second toe bashing: same here. I’ve heard felt tongue pads are effective to push the foot back in the shoe, something I plan to try.
My right foot is like a canoe paddle having broke the baby toe twice (maybe 3 times), torn the plantar, and broken the ankle twice. There isn’t a single pair of trail runners I can find that fit the width as a result.
Care for those tootsies!!
For me, plantar fasciitis felt like dozens of needles all over the bottom of my feet, from the heel to the front pad, but mostly in the arch.
If I wear shoes with a rubber toe cap (like Keens) and the size is right, I don’t get black toe nails unless I fall and kick a rock or something.
Sometimes my pain us enough I have to stop. Then some lifting on tip toes and it’s better. Or, worst case, take my shoe off and masage that tendon.
Most of the time I have no pain.
This is just barely a problem.
The pair of boots I used to have were pretty good, but then i started getting blisters and blackened toenails. The guy at REI recommended a boot with a wider toe box and I haven’t got one blister. And no blackened toenails until just now.
Good article, thank you.
Socks: I wear polypropylene liner socks (Fox River) in the Summer. They are cooler and lighter than any SmartWool or Darn Tough merino. There’s something slightly sus about that study. :)Â For sure, fabric weight is a confounding factor.
Orthotics: I get some metatarsal pain behind the big toe on my right foot from repeated footsteps on rocky trails. I have some knee injury on that side, so maybe I step differently. I try to land on heel and the outer edge of my foot, to no avail.
Rock plates help but are not a full solution.
I’ve tried several insoles. Sole brand has an insole with a metatarsal pad that is in the correct spot to help, but the pad is not thick enough to do the job. If I add a stick-on pad between the metatarsal and my arch (behind the metatarsal joint), then that prevents the pain.
It is annoying to find the correct location and to keep the pad in place. I found that 3m pads stick better than Dr Scholls.
Are there other techniques for metatarsal pain that I may be missing?
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I have suffered from metatarsal pain for years. I went through many custom and off the shelf orthotics. None of these offered any relief. I went through most every shoe that could fit a wide foot. With no relief. I worked with a podiatrist and tried all manner of pads, had x-rays that revealed nothing and had a Cortizone shot or two with little affect.I found relief by getting the thickest cushioning I could find. I place a 2 mm thick, flat carbon insole between the bottom of the shoe and the factory insole. The carbon insole provides protection from sharp rocks and is purchased on Amazon. the shoe is a new balance foam X plus trail three. My metatarsalgia issues have been eliminated for a two year period. The shoes are capable of lasting many months. I typically replace them when I start feeling slight metatarsal discomfort. the shoes offer excellent stability, despite thick cushioning because the outsoles flare out around the entire bottom of the shoe, providing a wide platform. They are available up to 4E.
Sciatic pain,. My feet hurt when I don’t walk.
Thanks, Stephen. That’s somewhat similar to my shoes with rock plates. I see a bewildering range of carbon insoles on Amazon, from $15 to $150. I see that the “carbon” Superfeet have the carbon in the wrong place — not sure what they are for, but they don’t appear to be for metatarsalgia.
Do you by any chance recall the brand you liked?
The 3m pads that I linked above work by elevating the arch slightly. If you place the pads over the joint then it won’t help, because the idea isn’t to pad the joint, it is to raise the joint so that less pressure is applied to it when landing (and spread that pressure across the arch, which seems to be able to take it).
A pad does the job for me (I only need one), but it is finicky to get placed correctly. I usually have to reposition them several times before I get it right. Doing that, of course, compromises the adhesive. I don’t have a good solution for that (other than Gorilla tape).
My basic goal with the route I have gone is to protect the bottoms of my feed from overuse, and I concluded I needed as much cushion as I could get, rock plate-like protection from hard, rocky surfaces, and room for my wide feet. This approach does it for me. It might not be for you. The only way is to order a pair and see how they feel. One of the interesting features is that the flared outsole makes side-angle twisting pretty rare.
There is probably one factory in China that makes most of these. I have purchased various brands, they all seem the same.  Mine are 1.97mm thick. Size 10.43″ for my size 11 shoe. This link might take you there: https://www.amazon.com/Recovery-Orthotic-Reducing-Arthritis-Alternative/dp/B0BHW5BH2W? ref_=ast_sto_dp&th=1 The brand is Alfredex.  They all have sharp edges, so I apply Gorilla tape at the perimeter to prevent them from cutting the interior perimeter stitching of the shoe. If the insert is too short, it will cause lugs to start to separate. If that happens, they can be reglued. If the insert is too long, you will require too much force to place it in the shoe, so you may need to experiment. I am aware of the placement of the pads you described. I have used them and I had a bump similarly installed on a custom orthotic. All useless for me. Your results may be different. I have used carbon superfeet. Useless for me, they don’t do what I wanted to achieve.
You can read about my shoe here: https://runrepeat.com/uk/new-balance-fresh-foam-x-more-trail-v3 I pretty much agree with their opinions on this shoe. I own six pairs of these now, to guard against model changes. This should last two years. They actually work well in snow, with microspikes. The snow does not penetrate the mesh. The thick foam provides excellent insulation from the snow. When it gets really cold, I wear 40 below booties which are wide enough to fit over these shoes. Depending on the conditions, I then switch to Katoohla K10 Hiking Crampons or snowshoes.
I used to listen to the Doctors of Running Podcast. They get into the weeds on numerous topics. They are all Phd Physical Therapists who run. Very interesting. Listen to Podcast 214, which deals with even higher stack shoes that didn’t exist when I started wearing the New Balance Shoe. Be aware that the forces on your feet in this shoe for hiking are different than for running, which is their topic. As a hiker you will have lower joint loading forces, although some increase will occur on descents.
Excellent. Thank you for the links.
Of course your feet are not mine. I’m just looking for ideas to try.
FWIW, Altra sells Stoneguard inserts which may be similar.
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