(originally posted at The Trek – https://thetrek.co/pacific-crest-trail/foot-care-on-the-trail/)
Warning: there are some potentially scary and gross pictures of my previous foot injuries in this article.
Other warning: I am not a doctor.
Let’s talk about feet. With 3,000 hiking miles on mine, I’ve run into more than a few gnarly situations. This is not a humblebrag. I want to share some of the things I’ve dealt with, in hopes that others might learn from my mistakes and experiences. The human foot is a remarkable structure, a biological suspension bridge that gets flexed, twisted, and shocked thousands of times a day. You only get one pair, and there’s no return policy.
Some common foot problems people run into on the trail are blisters, general wounds, foreign objects, plantar fasciitis, heel spurs, fallen arches, and broken bones. These are in addition to the normal arthritic pains us older hikers get. Those we keep as a bonus.
Pretty much everyone is familiar with these, although some people are more prone than others. When I hiked the AT in 1999, I had the heels of my feet wrapped in gauze and white medical tape almost the entire time. In my case, it was poorly fitting shoes, combined with what I think were the wrong insoles. There’s a lot of theories about blisters; too tight shoes, too loose shoes, or just the wrong shoes. People who are not cursed by blisters will often assert that “you have the wrong shoes” – and while blindingly obvious, this does nothing to help.
My Awesome Blisters from PCT 2017
People I didn’t even know would approach me after learning my name, and ask to see my feet. Instagram is a wonderful thing. Seriously – “Oh hey, you’re Smokebeard? Can I see your feet?” Reading back through my trail journal – and you should definitely keep a journal – I noted blisters at the end of the first day at Lake Morena. “Good long day, got some blisters forming on the front of the balls of my feet – maybe pushing off too much? Feet sore but OK for now.” I had bought shoes a size too large to account for my feet swelling, but forgot to wear double socks. My strategy was to oversize the shoes, then double up the socks to fill the volume until I my feet spread out.
There’s a great difference of opinion on whether you should pop a blister. What I do is bandage it, but leave it alone until the pain of the swelling is too much, or until the pressure of walking pops it. At that point I make sure it can drain well by poking some more holes along the edge of the blister with a sanitized safety pin. Don’t let a popped blister get gunked up with dirt and then stick closed with all that trapped inside. That provides a great breeding ground for nasty bacteria.
I also supinate, meaning I put stress on the outside of my feet when I walk. After a while this squeezed the flesh pad on my heel against the rigid heel cup of my insoles. After doing this for days, this happened – note the blister on top of the blister. The angry red around it is a hint that it’s infected. If you want to know for sure if something’s infected, smell it – if it smells like feet you’re OK; if it smells like roadkill, it’s infected. Ultimately I soaked this in Epsom salts until it was all pruny, then cut off all the dead skin to let it heal. Gross!
Clean your feet every night. Period. And clean your socks, watching for burrs, seeds, grit, pebbles, anything that might irritate or embed itself into your foot. On the PCT last year, a lot of people used wet wipes each night to make sure their feet were clean. A sandy, gritty, hot, sweaty environment is a terrible place for your feet. On day four or so, I ended up with a foxtail, a burr-like grass seedpod, stuck in my sock.
Not noticing it, I started walking, and the repeated pressure of my foot combined with the barbed/one-way nature of the seedpod forced it into the flesh of my foot. Each step I took pushed it farther in. Because I already had a blister on the ball of my foot, I didn’t really notice the pain; it already sucked. After seeing a doctor about my obviously infected blister, I ended up cutting it out with my knife. After this I switched to the antiseptic Wet Ones wipes and gave my feet a thorough going-over each night.
Plantar fasciitis is an inflammation of the stretchy parts (tendons) of your arch – think of this as the cables in the suspension bridge. The more your foot flexes, whether due to poor muscle tone, floppy shoes, or rough terrain, the more force these tendons have to exert to keep your foot from coming apart. After a period of time, they just can’t anymore, and become inflamed. It manifests itself as pain on the arch side of the heel, or pain just behind the ball of the foot.
You can try to mitigate this by getting sturdy shoes, doing sufficient pretrail training to toughen your feet, and by stretching out your calves. Believe it or not, the tension along the bottom of your foot is also controlled by the band of tissue in your calves. By making your calves more pliable, you’re reducing the tension on the tendons of the feet. There’s a sort of walking boot thing that you can buy cheaply that holds your foot in a position to stretch out your calf. I’ll often wear mine for a half hour or so while on the computer, working, etc. This is a good thing to do ahead of time. You can also wear zero-drop shoes, either just to help stretch your calves, or for hiking. They’re all the rage now, with the logic being that there’s no biological reason to have your heel lifted. Some people swear by them, others hate them. Whatever you do, do not decide to slip a pair on on day one and start walking. The additional strain on your (untrained) calves can cause injury.
Heel spurs go along with plantar fasciitis, or more chronic arch fatigue. The body responds to the stress by adding more bone where the tendons of the arch connect to the heel. Remember these tighten the arch to resist flattening during a stride. At the attachment point, your body beefs up the connection in response to chronic pain and inflammation.
Like a suspension bridge, the structure of the foot is a more-or-less rigid side, held in tension by tendons that run the length of the arch. As weight is applied to the foot, it compresses, lengthening. The tendons of the arch resist this tension, holding the arch intact. But like rubber bands, tendons can only stretch so far before permanently stretching, or breaking. A fallen arch happens when the tendons of the arch can no longer hold the foot in tension. The result is flat feet. In this condition there’s nothing to back up the bone structure of the arch, meaning that the bones and ligaments take all the load. This is kind of the end-game of plantar fasciitis; the tendons just give up and either tear or permanently stretch. Think of a rubber band that you stretch over and over; eventually it just gets limp.
There’s a variety of orthotics and replacement footbeds that can help support the arch, as well as simple arch support wraps that go around the foot. Many hiking socks also specifically put spandex or lycra in the area around the arch, to help provide tension and share the load. If your feet feel great after switching to a new pair of socks midday, or even when you put on a brand new pair, this might be why. That additional support is relieving the strain on your foot, giving it a chance to rest.
Broken Bones – Jones Fracture
On day two I wiped out pretty badly, and felt a click in my foot. Like so many other times when I’ve rolled an ankle, I sat there for a minute or two, cursed, and moved on. Over the next three weeks the pain did not get any less, and by mile 369, I was done. I was pounding Aleve pills like Tic Tacs (don’t do this) and it wasn’t helping. I rested up in Wrightwood, then got down to a clinic for an X-ray. They confirmed that I had a nondisplaced Jones fracture. A Jones fracture is a break of the fifth metatarsal. These are notoriously hard to heal, since the blood flow to your feet is minimal. It took me a good five months before I was able to hike and work out again at full speed. I think the spill I took on day two didn’t help, but it was the repeated pounding of three weeks, 20-plus mile days, in too-tight, too-flexible shoes.
There’s not much you can do to avoid breaking a bone, besides avoiding breaking bones. Good, solid shoes, and well-conditioned legs and ankles can help. Keeping yourself in good physical shape, and don’t push yourself past the exhaustion point. When you’re tired, your form suffers, and your ability to correct a mishap drops.
Care for Your Feet and They’ll Care for You
Despite all the terrible things that can happen to your feet, most of the time nothing bad happens. Be aware of the way your body works, keep it in tune, and it will give you years of service. I suppose it’s like a good-quality car; if maintained, it will last a long time. A few last thoughts:
- Buy good shoes. You don’t put cheap tires on a Ferrari.
- Keep the weight off. Between steps, one foot carries your entire weight; be gentle.
- Watch where you step. Don’t ask the structure of your foot to do more than it can handle.
- Stay in shape. Your entire core and lower body helps keep you on track. Don’t neglect your other muscles.
I’ll see you guys out there. May your step be light and injury-free!