Diagnose Your Problem
Use this troubleshooting table to fix common foot and leg injuries.
|Strained calves||Burning pain, weakness, and cramping. Similar: an inflamed Achilles tendon, which causes soreness that radiates up from the heel.||Putting too much strain on muscles and tendons by overloading the calves—especially during extended uphill hiking—rather than sharing the propulsion with other, bigger muscles, like quads, hamstrings, and glutes.||Focus on strengthening glutes and hip muscles. If your glutes are strong, they will automatically kick into action on uphill hikes and prevent the smaller lower leg muscles from being injured by overuse. For immediate relief: RICE* and massage.|
|Rolling an ankle||A painful, swollen sprain after you trip on a rabbit hole or rock. Short-term, one ankle roll often leads to another, as the ligament is over-stretched.||The culprit is often one or more weak leg muscles that cause an unstable foot and ankle. The foot overpronates (rolls in) or over-supinates (rolls out)—which can lead to an ankle sprain with or without a rabbit hole.||Strengthen your lower legs and feet, and incorporate balance exercises into your routine. Hikers who have pronation and supination issues will benefit from insoles that provide lateral stability. Chronic ankle roller? Wear high-cut boots.|
|Sore quadsand/or knees||Sharp pain and cramping in the knees and related thigh area. A tight IT band often causes soreness on the outside of the knee and lower thigh.||Downhill hiking with a heavy pack is murder on weak knees and quads.Poor alignment of the hip, knee, and ankles can contribute to knee pain as well. Hikers with different-length legs are likely to have alignment issues.||Use trekking poles to decrease impact. Improve alignment and foot strike with good form. Also, strengthen core muscles so that your torso stabilizes pack weight, reducing strain on legs and knees. Stretch your IT band.|
|Hip bursitis||Localized pain caused by inflammation of the soft tissue overlying the hip. Hurts like hell with every step.||When you go from an office chair to hiking 10 miles a day while carrying a 35-pound pack—without sufficient training, as some of us do—your hips are bound to be a weak point. They’ll hurt, and cause gait problems.||Strengthen and stretch hip muscles, with emphasis on abductors (isolate these muscles with single-leg balance exercises). Stretch IT band. And improve stability by training with a balance board ($35, fitter1.com).|
|Metatarsalgia||This pain under the metatarsal heads—the bones just before the toes—feels like a sharp rock in your shoe. It’s often mistaken for an inflamed nerve.||Shoes that are too cramped in the forefoot or have too much flex can concentrate the pressure under the forefoot and result in pain. Forefoot striking or just long days on the trail can also exacerbate metatarsal stress.||Redistribute foot pressure more evenly. Insoles help, as do shoes that allow the toes to spread and function more effectively for shock absorption. Metatarsal pads (available at most drug stores) help prevent pressure from being concentrated on the ball.|
|Plantar fasciitis||Pain can range from a whole-foot ache to a stabbing sensation in the base of the heel. Often hurts most when you step out of bed in the morning.||The plantar fascia, the band of connective tissue running the length of the foot, links the heel to toes and supports the arch. When it becomes inflamed from overuse, you might have trouble even standing.||Train your feet for higher mileage (rule of thumb: increase distance by 10-15 percent per week). Massage to work out scar tissue: Roll the bottom of your foot over a hard plastic water bottle (for added therapeutic effect, freeze the water).|
Tips from the Pros
Two veteran thru-hikers share tips for racking up pain-free miles.
Justin Lichter: Completed the PCT, AT, and CDT in one year
>> I switch insoles about two-thirds of the way through the day, especially when I’m doing big miles. I think the different feel helps prevent overuse injuries.
>> A tight IT band pulls your knee out of alignment and causes pain. Massage the band with your thumb at night to keep it loose and relieve soreness. [The IT band runs along the outer thigh.]
>> Sleep with your feet elevated to prevent swelling and keep your shoes fitting right. I rest mine on my packed backpack. Jack haskel: 7,500 long-trail miles… and counting
Jack Haskel: 7,500 long-trail miles… and counting
>> Toughen your feet before a trip by applying tincture of benzoin to problem areas like your heels.
>> Avoid and treat ingrown toenails by not rounding the nails when you cut them. Try to keep them cut ‘square.’ If you have an ingrown nail, treat it in the field by notching a ‘V’ into the end of the nail at its center. This will open up some space for the nail to move back toward where it should be.
>> Make sure your shoes have enough wiggle room in the toe and that there’s no chance that your toes will touch the front on downhills. Hikers typically select shoes that are too small.
Toss Your Big Boots
A load carried on the feet requires five times more energy to haul as the same load carried in a backpack. Plus, heavy, high-cut boots can cause feet to drag, creating a floppy gait that may result in pain and numbness in the forefoot (number two complaint of AT thru-hikers) and blisters (number three complaint).
Keep Loads Under 40
U.S. Army tests have shown that the heavier the pack, the less distance covered. The reason weight trumps fitness? With loads over 40 pounds, the body needs to stabilize itself with shorter steps, spending more time on both legs.
Ease into Big Miles
Don’t overdo mileage at the start of the season or the beginning of a long-distance hike. An injury intervention program developed for U.S. Marine recruit training focused on incremental improvements. Participants gradually built up hiking miles over time, as opposed to high, hard miles at the start. The result? Hiking-related overuse injuries decreased by a whopping 55 percent. After a period of low activity (winter, injury recovery, hectic work schedule), stick to a conservative training plan that allows your body to adjust to new demands.
Strengthen Your Quads
Walking with a loaded pack causes your knees to bend
nearly twice as deeply as when you’re not carrying weight. Quad muscles (not calves) share a disproportionate share of the burden. That’s not a problem if you’ve done strengthening exercises, but it can stress the knee if you haven’t. In a study of Appalachian Trail thru-hikers, the top complaint was “acute joint pain” in the knees.
Lighten Your Load
U.S. Army tests have demonstrated that loads greater than 15 percent of your body weight cause your trunk to lean forward as a counterbalance. Lean from the ankles and hips—and don’t bend at the waist—in order to prevent back and neck pain. And avoid carrying heavy loads that pull on your shoulders or cause you to hunch forward.