Walking Well: Feet

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The general approach to foot problems should be to make a diagnosis, figure out the cause, remove the problem for both treatment and prevention, and then apply specific remedies. The major factors that cause foot lesions are obvious to any hiker and include excessive moisture and heat on the skin surface, friction on skin by socks and shoes, and impact from foot strike.

The body can deal with these threats if the severity and duration are limited as with normal activity. If they are more intense, as in hiking, a mild, early lesion develops. A few minutes or hours of rest may allow recovery. It is important to know the limits that your feet can tolerate and stay within them. Markedly exceeding friction or impact limits causes mild to moderate blisters, pain, or other lesions.

Blisters are best prevented by physical conditioning before the hike and then starting out with low mileage for at least two to three days. Even if you are well-conditioned, at least do low mileage the first day because trail conditions may be different from your training conditions. For example, you may have trained on streets; trail rocks present a different challenge. Well-fitting boots (usually about one size larger than street shoe size) with cushioned insoles (Spenco, etc.) are essential, although trail running shoes are used by some experts. Thick padded socks (Thorlo trekking for example) are helpful. Some find polypropylene liners useful. Whichever kind you choose, remember that good foot care includes keeping your socks at least relatively clean.

Treat hot spots by soaking feet in cool streams at least at the end of the day. Keep feet dry during the day by airing them in the sun and drying or changing socks at least once a day at lunchtime. If you are doing longer distances, airing at least two, three, or more times is desirable. If blisters develop, check the fit and adequacy of boots and socks and then treat by lancing with a sterile needle or pointed scissors at the base of the liquid-filled swelling. Try to keep as much skin intact as possible for rapid healing. Relieve pressure by creating a raised protective ring with moleskin (or molefoam) or callus protectors. A coat or two of New Skin (collodion-like liquid) or Skin Shield helps strengthen the skin.

I have not found Second Skin wet dressings effective but some hikers report reasonable results. You can use a Band-Aid, moleskin, or even duct tape to cover the lesion. Other less effective treatments include rubbing alcohol, antibiotic creams, and Ace bandages. A hiker in the middle of the Maine 100-mile Wilderness had a painful infected blister. In desperation he applied Absorbine Jr. at night, an intensely painful treatment, and was amazed and gratified to see it healed in the morning.

Foot pain can be acute or chronic, mild, or severe, and can occur in many locations around the foot. A 55-year-old retired policeman reported severe pain on both sides of the back of the base of the left heel that was severe enough to interrupt his thru-hike. A foot doctor found negative x-rays and gave special surface steroid treatment, which was minimally helpful. The hiker received a prescription NSAID (non-steroidal anti-inflammatory drug) and consulted a pharmacist who suggested a daily dose of 1600mg of ibuprofen. The patient decided that since his pain was so severe, he would take this drug at double the suggested dose. After more than a month he was beginning to have gastrointestinal problems (a known irritation caused by these drugs), which was when I talked to him. I told him to stop the drug immediately.

Analysis of his case suggested that his boot was too small, the insoles were not sufficiently impact-absorbing, and his hiking style included forceful heel strikes. He was heavy (190 pounds) and carried a weighty pack (over 40 pounds). He had nearly recovered so I agreed that he could resume his hike with low daily mileage, soaking feet in cold streams to minimize inflammation, wearing larger, better-fitted boots with thicker absorbent insoles, and with gentler stride style and careful daily attention to foot status. His left foot was larger and his boots should have been fitted to it. Most boots come with factory-installed thin cardboard inserts that should be discarded and replaced with high-quality insoles. He should discard non-essential items and opt for the lightest weight equipment to reduce his pack weight. He planned to consult books and tapes by experts in lightweight hiking. He could resume ibuprofen if necessary, but at the lowest effective doses, and may complete his hike healthy.

Foot edema or swelling can result from boots laced too tight, although some increase in foot size is normal on the trail due to gravity from standing and impact. Nutritional inadequacy, especially possible protein deficiency, can contribute to edema. A balanced diet is essential; eat enough protein along with carbohydrates. Try elevation of the feet in the shelter at night to help reduce edema

I have previously discussed the"Numb Toes Syndrome," which affects about 64 percent of hikers. Most had mild loss of sensation. The subsensitivity may begin a week or two into the hike. Normal sensation usually returns after the hike and recovery may be complete in about two months. The mechanism of this sensory loss appears to be pressure on the bottom of the foot from pack weight in foot strikes, which causes damage to the sensory nerves to the toes. These nerves run in the sole of the foot and when damaged recover at the rate of about one inch a month, depending upon the hiker's condition; age, diabetes, and other diseases impair healing. Preventive measures can reduce or delay numbness and include well-fitting boots, cushioned insoles, good socks, foot soaking, and good general foot care. There is no effective treatment.

Article © Dr. Vernon G. Vernier