Hiking Hazards: Ankle Sprains and Foot Injuries

Its officially summer, and hiking season is here.  Snow melt has started, the run off is happening, and the trails will start to open up to explore all the beautiful mountains we have in Colorado.  Maybe you have bought new hiking boots preparing for this spring, summer, and fall?  Have you had difficulty with hiking boots in the past causing foot and ankle pain? Have you suffered an injury during a hike.  Hiking can take its toll on your feet and ankles.  Hiking injuries range from blisters and toenail issues, to more serious injuries like ankle sprains, and stress fractures.  Hiking up and down steep slopes and uneven terrain puts stress on the muscles, ligaments, tendons, and bones of the feet. Listed are some things you can do help select a boot and sock, prevent an injury, or treat an in-hike injury.  

Wear Proper Boots and Socks

I can’t emphasize this enough, invest in high quality hiking boots that can lessen the stress on the feet and ankles. Foot wear for hiking range from hiking shoes to mountaineering boots, but must be comfortable yet meet your needs and level of hiking.  Fit is critical, and should be the first thing to consider. While you want to have a snug fitting boot, consider having enough room in the toe box to wiggle your toes, especially if wearing two pairs of socks. In fact, wear the socks you will wear hiking when trying on the boots. For proper length, have a thumb’s width from the end of your longest toe, which isn’t always your big toe, to the end of the boot. The heel should be snug, but not tight.  If there is too much “wiggle” in the heel, it may set you up for a heel blister, so wearing proper fitting hiking boots will decrease the chance of blisters and toenail issues. Always break in and condition your boots before going out to hike. Leather always takes time to soften so your boot will conform to your feet. Because of swelling in the feet, it’s always wise to try on boots at the end of the day, and if you wear orthotics bring them too.   Look for boots with steel or graphite shanks to provide good stability.  Insulated boots may be necessary if hiking through water or in colder temperatures, but can also cause your feet to become hot and sweaty.   

When selecting a sock for hiking consider the fabric, cushioning, and sock height. Nothing will make a hike more miserable than developing a blister because your socks became wet. Invest in synthetic/wool socks which act to wick away moisture, reducing friction and blister formation.  Wool socks are also anti-microbial, decreasing the potential to smell. Merino wool is the most popular wool sock.  Wearing wool over a synthetic sock will help keep the feet warm, and please AVOID cotton socks.  Cotton socks trap moisture and will cause blistering.  

Hiking Injuries

Common hiking injuries include blisters, bruised toenails (subungual hematoma), ankle sprains, neuromas, achilles tendonitis, and plantar fasciitis. 

If a blister forms during a hike, if possible, pop it, drain it, but leave the roof, or the skin intact.  Apply a triple antibiotic ointment, and cover with a band-aid.  The boot may need to be adjusted to reduce the friction, if that was the underlying cause.  If you have any moleskin available, place a piece over the area on the boot causing friction. 

If you start to get some bruising and bleeding under the toenails (Runner’s toe, Subungual hematoma), then it’s almost always coming down the mountain where the toes are jamming into the end of the boot causing the trauma.  Consider tongue pads and/or the heel lock method for a hiking boot to prevent this.  Often times the blood collection dries, while other times the nail may need to be removed. 

Pain in the ball of the foot is a common condition with hiking boots resulting in nerve inflammation, often times referred to as a neuroma.  If this occurs, on rest breaks take the boot off for awhile to reduce the pressure on the nerve.  Another potential option depending on the make and structure of the boot is to re-lace it.  Unlace the boot, and instead of starting on the 1st eyelet, skip it, and start the lacing on the 2nd set of eyelets thus reducing some side-to-side compression of the boot. These are almost always caused by ill-fitting shoes or boots. 

The achilles tendon is another structure that I often see get injured during a hike.  Going uphill can put excess strain on the tendon causing the rest of your hike to be uncomfortable.  Rest, cold water, and some stretching can ease the pain if out on a hike. 

Plantar fasciitis is probably the most widely known foot condition.  Plantar fasciitis is a strain of the ligament on the bottom of the foot and sometimes people think they have a heel spur.  Heel spurs on the bottom of the heel don’t cause heel pain.  That is a myth.  This condition can be very painful if happens on a hike, and might be the hardest condition to bet better on a hike of the things listed here.  Ice pack, lidocaine patches, calf stretches, and Ibuprofen or equivalent might be the things you may have to get you through the hike.  

Medical Supplies

Carry supplies such as band-aids, wraps, antibiotic ointment, moleskin (precut some rectangular pieces), and even topical analgesics in case of an injury.  There are also instant ice wraps that are low volume that can be carried with you in case of injury.  Those are handy if you have an ankle sprain, and can be used multiple times.  Even carry some of the lidocaine 4% patches that can help with some aches and pains.  These are all low volume things that can fit in your backpack or day pack.  Additional things to bring are Tylenol, Ibuprofen or Advil, gauze pads, adhesive or paper tape, and antiseptic wipes.  

So these are some on-the-hike things that can happen, and some general treatment ideas that you could implement.  As always, if any of these things are a long lasting issue, then you should seek a professional medical care.  Enjoy or hikes!  Enjoy the summer!  Stay safe!!