Avoiding Big Foot Problems on the Trail

By Deborah Sanborn

Frank Wolf didn't just get lucky when he finished the Sandakan jungle trek with feet intact. No trench foot, skin-burrowing parasites or blisters to speak of. His secret? Don't leave anything to chance

“I wore running shoes. They’re breathable, and flexible—there’s no real hard spots in a running shoe, so if you don’t have much weight on your back, it’s the way to go.” He also wore two pairs of socks, with a synthetic layer closest to the skin, and was constantly on guard for what he calls “hot spots”—any irritation that started to flare in one specific place. “When I got a hot spot I’d slap on a moleskin or band-aid so it wouldn’t get to the stage where it’s going to blister.”

At the Calgary Foot Clinic, Ken Unger, a doctor of podiatric medicine, basically confirms that Wolf got it right. “I’m a big fan of running shoes,” he says, though cautioning that you need the right shoe for your foot. Synthetic socks are best for activity, since they wick moisture away from skin and dry out faster. (Wet feet invite fungus and infection.) And as a medical volunteer at the Boston and Calgary marathons, Unger has seen the beating feet can take during strenuous activity. While it’s true most trips don’t demand the kind of precautions of a jungle trek or marathon, there are lessons to be learned there. Mostly, however, comparing notes helps to show that avoiding common foot problems during any adventure is absolutely possible.

Blisters

  • Mostly caused by poor quality, excessively hard or ill-fitting footwear.
  • Are abrasions to skin caused by friction and pressure of shoe. If shoe is rubbing improperly, dermal and epidermal layers of skin shear away from each other, and ensuing inflammation produces clear fluid.
  • Fluid is not harmful, unless bacteria is somehow introduced to the sac, which makes a good culture medium; by piercing with non-sterile pin, or if skin is broken, for example.
  • If fluid is clear, leave blister alone; put moleskin or band-aid over top to ease abrasion.
  • If large and causing pain, use sterile pin to drain it, but leave skin on top; it makes a good biologic dressing, says Unger.
  • If fluid is bloody or cloudy, there might be damage to deeper skin and is more serious. Unger suggests draining and “de-roofing” them (taking top layer of skin off), disinfecting with iodine or alcohol, putting dressing and anti-microbial ointment on top.

Athlete's Foot

  • A fungus that grows mostly between toes, due to excessive sweating or moisture on foot.
  • Causes rash that is benign, except when scratching breaks skin, allowing microbes to enter. It’s this secondary infection, says Unger, that you have to watch for.
  • To prevent: keep feet dry; wash feet with soap every night; use anti-fungal powder in socks; wear synthetic or wool blend socks.
  • To treat: use anti-fungal cream twice daily on rash.

Dr. Unger's Foot Care Advice

  • Make sure shoes and socks are proper for your trip and fit your feet well.
  • Never wear new shoes or boots travelling or trekking; break in well before you go.
  • Make sure you can do the mileage, in the types of conditions you’re going to be encountering, before leaving. “Once you’re there, it’s a whole different story.”
  • Cotton is your enemy for activity: it retains moisture, which increases friction on skin. Unger advises going to an outdoor store for socks. “They’re worth every cent. A good sock can make the difference between a good and a bad day.”
  • Clean feet every night, air-dry feet periodically during day.
  • Take extra inserts or insoles for additional support and comfort, but types you’ve already tested for your foot and shoe.
  • Don’t walk barefoot, especially in developing countries.

Q&A with Dr. Ken Unger of the Calgary Foot Clinic

Outpost: Travellers tend to do a lot of walking on any trip, which you say can cause stress fractures. Why is that?

Unger: When the bone in the foot is given more stress than it can physiologically keep up with, it can weaken and crack. And it takes surprisingly little to do! I had one patient who went antiquing in Connecticut, walked about eight miles, and came away with a stress fracture. A healthy fit guy, and he ended up with a broken bone in his foot because of a sudden increase in activity. We call those “march fractures” because recruits in the army often get them—you throw 30 pounds on their backs and hike 15 miles, and their bones just aren’t ready. It takes time to get the bones ready.

OP: How do you prevent a fracture?

U: By working up. If you know you’re going to be walking ten miles a day, work up to that amount over time. And wear a good shoe—a lot of people head out in a flimsy sandal through the city, which doesn’t give the foot enough shock absorption or relieve stress. So the bones have to pick this up.

OP: What should you look for in a running shoe?

U: They come in several types—from anti-pronation to supination to neutral shoes—and you have to match the proper shoe to the person. A lot of people put a light canvas shoe in the same class as a running shoe, but I certainly don’t. You need something with good support, and a good break point. If you flex a shoe you’ll notice it’s going to bend in certain places. You don’t want the shoe to bend significantly in mid-foot. A good shoe should bend at the ball of the foot, where your foot bends. Of course, if you’re going off trail a light hiking boot is more appropriate. Shoe gear should be appropriate to the situation, should match the terrain. If the path is well-formed [a running shoe] might be reasonable. But if you’re on uneven ground, having ankle support is important.

OP: What do you advise about over-the-counter insoles or inserts for the average consumer?

U: One that fits in the shoe comfortably is key. Having a shoe where the original insert comes out is helpful, so you’re not putting one on top of another, but putting a more supportive one in. You should use it for a period of time beforehand too, so you know it’s going to be comfortable. Don’t buy a new insole and leave the next day for Paris. You want to plan ahead for these things.

OP: Are there any exercises a traveller can do to prepare their feet for long days?

U: Do the same exercise you anticipate doing on your trip. If you anticipate climbing and gaining elevation, do that before you go. If you expect to walk ten miles a day, be in shape before you go. Stretching of the Achilles muscle group is certainly something I recommend, since those are the muscles that’ll tighten up the most. A “heel drop” off the back of the stairs is an exercise I have my patients do the most.

OP: Poor water quality and unsanitary conditions are always a concern for travellers in less developed countries—if you’re taking a shower, for example, do you really have to worry about microbes you might pick up through your bare feet?

U: I don’t think they’d be harmful unless you had an open lesion on your foot where they can enter. But certainly in these countries there are parasites. I recently saw a man who came back from Peru with tongiasis, which is “sand fleas of the foot.” They just burrow into the foot and grow and create these little nodules. Those are things that travellers can run into—certainly you have to be aware of things like the flora and fauna in those areas. I always advise wearing some kind of shoe. I just saw a girl just back from Hawaii who stepped on a beer can on the beach in the water. That kind of thing can really wreck a trip.

For more info on foot care, check out the Calgary Foot Clinic website. The information in this article is intended as a guideline only, and in no way should replace a proper consultation with a doctor or at a travel clinic. Always get individualized medical advice before travelling.

 


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