Know the New Hiking How-tos
Hiking without Pain
Several fairly simple foot and leg problems can sideline a hiker, for weeks or even months. However, the astute individual can recognize the signs and symptoms of the problem before it escalates and take preventative measures. Three such problems include heel pain, ankle sprains, and shin splints.
Heel pain, also known as plantar fasciitis or a heel spur, is one of the most common foot ailments. Patients routinely present themselves to the doctor limping to avoid their sore heel. Usually they report suffering with the pain for many weeks or even months. They waited to seek help and continued with their normal activities, including hiking, because they were sure the condition would simply go away. Instead, it usually worsens.
Heel pain is an inflammation of the ligament, or fascia, which connects to the undersurface of the calcaneus, or, heel bone. In some cases, additional bone is formed as a result of the chronic inflammation, giving rise to the term “spur.” Once inflamed, the condition can become stubborn, requiring multiple different treatments to achieve complete healing. Knowing the early signs of heel pain is important, as early intervention can greatly shorten the recovery time.
A primary symptom is a dull ache or a strong, sharp pain elicited with each step and usually worse with a first step taken after getting out of bed or rising from a chair. The degree of pain experienced can be mild, moderate, or severe.
When one first notices a dull ache in the heel generated with each step, it’s time to seek treatment. The first recommendation is to reduce high impact activity until symptoms subside. This includes cutting back on hiking. Do not hike “through” the pain and expect it to go away. It will not abate, but only get worse.
The next action is to begin a stretching program, bending the foot upward with the knee straight. This will stretch the Achilles tendon. Hold this stretch for about 5-10 seconds and repeat 5-10 times in a row. Repeat this several times a day. In addition, rest the painful area on an ice pack for 5-10 minutes at a time a couple of times a day.
Perhaps most important, purchase a quality arch support to place inside all shoes and boots worn. The only brand I recommend is Superfeet, and the style I suggest is called Performance Green. Additionally, a few days of an anti-inflammatory, such as ibuprofen, taken regularly for 2-3 days can be helpful.
If identified and treated early, heel pain symptoms can subside quickly, and you can resume regular activities, including hiking.
One of the biggest orthopedic threats on the trail is the ankle sprain. Volumes have been written about how to treat an acute ankle sprain. Those who have been stopped in their tracks with this injury know how painful it is and how debilitating it can be. Recovery from a serious ankle sprain can require months of recuperation. For those susceptible to weak ankles, prevention is the best strategy. Do not rely on your high-top hiking boot or even your high-top backpacking boot to prevent you from spraining your ankle. No matter how thick the leather, it cannot withstand the force of an ankle rolling outward.
If you know you are prone to ankle sprains, incorporate strengthening exercises into your daily routine: move your foot outward against a fixed object, such as a wall or table leg, and hold the position for about 5-10 seconds; repeat that activity 10-15 times in a row. Perform the same exercise moving your foot inward as well.
The most important step to take, however, will be to wear a rigid ankle brace whenever you hike. To prevent a sprain, the brace must be rigid, so, an elastic ankle “sock” will not be sufficient. Leading ankle brace manufacturers include Aircast and Donjoy. I recommend and wear an Aircast Airsport Ankle Brace. The Donjoy Velocity model is also well regarded. I wear the brace whenever I hike, whether I am wearing trail shoes or backpacking boots. Wear the brace on the problem ankle only, unless both ankles have a history of spraining. In that case, brace both ankles.
Shin splints are a much less common ailment than either heel pain or ankle sprains. Nonetheless, shin splints can still sideline a runner or weekend hiker for extended periods of time.
The problem occurs in the muscle group that is located on the outside of the lower leg, below the knee and extending down toward the ankle. With repeated pronation, or rolling in of the foot, for prolonged periods of time, the muscles and tendons are strained and respond with acute inflammation and pain. Every subsequent step, especially a forceful step as occurs in running or hiking, exacerbates the problem. The treatment includes long periods of rest and some physical therapy.
If one has had a problem with shin splints in the past, the best path to prevent a reoccurrence is to address abnormal pronation of the foot. Again, I recommend trying a pre-fabricated arch support, such as a Superfeet Performance Green arch. If the foot requires more support, or is a high-arch foot not amenable to an off-the-shelf arch support, contact a podiatrist about being fitted for a custom foot arch support, called an orthotic.
Stretching the lower leg muscles prior to hiking or exercising will also he helpful in preventing a new episode of painful shin splints.
Howard E. Friedman is a podiatrist in private practice in Suffern, NY, treating hikers and non-hikers. He is a frequent contributor to Trail Walker.