Foot Problems With Backpacking

Foot problems in the wilderness can quickly become a much bigger issue. It is estimated that over 90% of hikers have experienced painful foot issues. Depending on how long the foot problem lasts, it can have an impact on a person’s ability to continue their backpacking experience. Prevention is worth a pound of cure.’ This is so true with shoes. You need to know where to prevent foot problems in the wilderness.

From a medical perspective, it is challenging to assess these types of patients because of the complexity and multiplicity of joints within the foot. There are 28 bones in each foot, which is nearly one-fourth of all the bones in the entire body. There are also 30 joints and more than 100 muscles, ligaments, and tendons. These make the feet flexible so that they can adapt to uneven surfaces, but it becomes complicated when there’s an injury.

Protecting Your Feet for Wilderness Activity

Arch Supports

This becomes an essential issue in backcountry medicine, especially with hikers and trekkers, because they typically carry an additional load on their backs. A person with a low longitudinal arch, or flat feet, often stands and walks with their feet in a pronated position, where the foot everts. This makes the person susceptible to heel pain, arch pain, and plantar fasciitis.

With high arches, there is less surface area for absorbing impact. This places excessive pressure on the back part of the foot and the forefoot areas. This can make a person susceptible to foot conditions such as heel pain, metatarsalgia, and plantar fasciitis. Having proper arch support becomes vital in making the backcountry trip successful. Most shoes have useless inserts, rather than arch supports. These should be removed, and arch supports placed inside. If people really need new shoes but cannot afford them, arch supports are a less expensive alternative and offer significant help.

Proper Shoe Fit

While it may seem counter-intuitive, you don’t want your shoes to be tight or press too hard on your feet. In doing so, they will increase the force on your skin, increasing the chance of a blister.

Here is how to fit your shoes:

• To check the proper fit around your heel, place your index finger between your shoe and your foot. You should be able to slide your finger between them with little force. If your finger cannot fit, the shoes are too tight. If your finger has too much room, the shoes are too large.

• Stand up with the shoes on and make sure you have a half-inch (about the width of your finger) between your longest toe and the front of the shoe. Your toes need wiggle room so that you don’t get blisters, calluses, or damaged toenails.

Lace Your Boots Properly

Every foot and every boot and shoe is different. You can nullify the benefits of your good pair of boots by not lacing or tying them correctly, and you can correct poorly fitting shoes or boots by changing the lacing. There are some general ideas about how to lace up properly.

Clip Your Toenails

From a medical perspective, it is critical to clip your toenails before a hike. If they’re too long, your boots or shoes will push into the nails. The nail(s) will be traumatized, and blood will form under them, causing a subungual hematoma. The nails will then lift from their beds. This is painful and might quickly end the hike or trek.

Wear the Right Socks

There is no definitive data to show that wearing two socks is better than wearing just one sock while hiking or trekking. It comes down to personal preference. What is clear is having the appropriate sock to protect your feet. If you choose to have two socks, the first sock should be a thin, skin-tight, moisture-wicking synthetic sock. Its purpose is to reduce friction by fitting tightly onto your foot and reducing moisture by wicking it away from your foot to your second (outer) sock. The purpose of the second (outer) sock is to reduce friction by serving as a cushion between your foot and the boot and to reduce moisture by absorbing it from the first sock.

Hiking socks are rarely made from a single fabric, but rather from a blend that creates the right balance of comfort, warmth, durability, and fast drying. These are the most common materials you’ll find in hiking socks:

• Wool: Wool is the most popular hiking sock material and is recommended above all others. Most wool socks use blends of wool and synthetic materials for better durability and faster drying.

• Polyester: Polyester is a synthetic material that insulates, wicks moisture, and dries quickly.

• Nylon: This is another synthetic option that is occasionally used as the primary material. It adds durability and can help improve drying times.

• Silk: A natural insulator, silk is comfortable and lightweight, but not as durable as other options. It's occasionally used in sock liners for reliable moisture wicking.

• Spandex: Many hiking socks include a small percentage of spandex. This elastic material helps socks hold their shape and keep bunching and wrinkling to a minimum.

Avoid 100% cotton socks at all costs. There’s a reason runners and hikers have adopted the phrase “cotton is rotten.” It absorbs and collects sweat but dries very slowly. This means that when they get wet, they stay wet.

Blister Care and Hot Spots

A blister is a pocket of fluid between the upper layers of skin, but still under the epidermis. These are called the stratum corneum (dead layer calluses are composed of) and the stratum spinosum, the living layer that gives rise to the corneum. These types of blisters commonly develop on the feet when performing activities such as hiking and climbing. Blisters can be filled with serum, plasma, blood, or pus, depending on how and where they form. Blisters are formed by friction. Friction is formed by the ‘normal’ force. The normal force is caused by the shoe pushing on the foot.

Repeated sheering friction forces cause a mechanical separation (cleft) within the stratum spinosum. Initially, it is an empty space, but hydrostatic pressure fills the cleft with fluid, causing a blister to form. The maximum possible magnitude of the friction force is a function of the local normal force and the static coefficient of friction (mu). Many successful preventive strategies are aimed at reducing this coefficient of friction and reducing the normal force. Having proper material in one’s socks and having shoes that fit well are ways to lower the coefficient of static friction, as well as the normal force.

Friction blisters usually form a ‘hot spot’ (sore spot) first. If one of these does form, place a dual-layer pad over that area. Blist-o-ban is one such material. These pads address the two causes of friction blisters, the coefficient of friction, and forces on the skin. The dual layer will allow the bandage to glide smoothly in all directions, deflecting friction and shear forces away from the skin. The key to preventing blisters is to reduce ‘hot spots’ by properly breaking in boots and reducing moisture by wearing wool socks.

You can treat a blister that has already formed, by cutting a hole in moleskin or duct tape and placing the ring around the blister. This reduces the pressure placed on the blister. This should help reduce the pain too. It is not recommended to open or drain blisters that are small (<2cm or <0.75 in).

When should a blister be opened? The answer is not clear. In general, if the blister is 2 cm in diameter or larger, then it is likely to rupture spontaneously and may be amenable to initial treatment by intentionally rupturing it. However, there is no best answer to this issue. In those cases where it is large enough, or it has already ruptured, wash the area and puncture the base of the blister with a sterile needle or sterilized safety pin. Debride the external flap of skin from the blister, apply an antibiotic ointment, and cover the blister with a sterile dressing. This can be protected with moleskin or mole foam. Hydrocolloid dressings have increased in popularity, also providing protection and comfort.

Disclaimer: This article has been developed for educational purposes only. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, please consult your medical professional.