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Toe Woes...
Apr 27, 2006 00: 20 EST
This unfortunate climber blew a wheel, but we got him re-treaded; something as small as an ingrown toenail can sideline even the toughest mountaineer. Luckily, our clinic team is prepared to treat problems like this every season, but foot issues can be uncomfortable and even end an expedition in severe cases. As usual, an ounce of prevention is worth a pound of cure. Here are some useful tips reprinted from the text “Wilderness Medicine” ed Auerbach. Read on:
Hiking Footwear. Blisters are a common backpacking and hiking injury, but careful selection of shoes and socks limits this problem. The purposes of footwear are protection, cushioning, support, and grip. Selecting, fitting, breaking in, and caring for footwear help them last a long time and maximize comfort. Size footwear in the afternoon, since feet swell during the day. Also, try footwear on both feet before purchase. If one foot is larger than the other, select the size where the larger foot has the best fit.
Size your feet using a Brannock device, which measures not only the length and width of a foot but also the ball-to-heel (arch) length. When selecting footwear, check the length first. If your toes touch the end, leaving no space for the heel, the shoe is too small. When you slide your foot forward into an unlaced shoe or boot, you should be able to insert a finger between the footwear and your heel. If you can’t do this, the footwear is too short and will bruise your toes, especially on long downhill walks. When hiking, wear shoes that extend above the ankle to reduce the likelihood of an ankle sprain.
Footwear should fit comfortably with moderate tension on the laces so that they can be tightened or loosened as needed. To avoid blister formation, seams should not rub against any part of the foot. The tongue of the footwear should be aligned and laced properly; otherwise the tongue can slide into a bad position and cause blisters. Ankles should be comfortably supported by stiff heel counters or heel cups and should not slip with toe flexion, causing blisters because of repetitive rubbing. With the foot on the ground, there should be no more than 6 to 12 mm of heel lift.
The soles are protected with layers of cushioning thick enough to prevent bruising but pliable enough to allow natural heel-to-toe flexion. Thick soles insulate against cold and heat. The tread provides grip. Support comes from a fit that stops the foot from slipping inside the shoe but that is not so tight that it prevents the foot from expanding when it swells.
Socks. Many boots feature sock liners or booties made from vapor-permeable membranes, such as Gore-Tex and Sympatex, hung between the lining and outer aspect of the boot. These make boots waterproof when they are new, but most boots leak after a few weeks in wet weather. In addition, lack of breathability means that water vapor cannot penetrate the barrier, resulting in hot, sweaty feet. Socks cushion the feet, preventing abrasion. They also wick away moisture, keeping the feet at the right temperature and humidity. New synthetic materials, such as polypropylene, Capilene, and Thermax, wick away moisture quickly, making them good choices for an inner layer.13 Pile or fleece socks do not wick away moisture very well.
Wool offers many advantages. It is warm in winter, cool in summer, absorbs and wicks away sweat, and keeps the feet warm when wet. Furthermore, during long trips, it rinses well in cold stream water, can be worn for days at a time without wear, and does not matte down like cotton socks with terry loop liners.
It is worth the time to check socks for loose threads, knots, or harsh stitching that might cause blisters or sore spots. Flat seams at the toes are important. Bulky seams rub and cause blisters. Consider wearing one pair of fairly heavy socks (rag wool) and one pair of light liner socks next to your skin. With one sock, the boot and the outer sock tend to move as a unit. They rub against the heel and the top of the toes at the metatarsal heads. A lightweight liner sock tends to cling to the foot. As the boot moves, the socks rub against each other, not against foot skin.
Foot Hygiene. Keep toenails short and cut them square. Keep feet dry to avoid skin softening. Immediately stop walking and attend to the first sign of a sore or "hotspot" to prevent further injury. Protect any reddened areas with moleskin, tape, or molefoam. Be sure that the covering extends beyond the reddened area.
Avoid getting blisters. Once formed, they must be protected to prevent rupture and infection. If a blister has already formed, relieve external pressure by applying a doughnut-shaped piece of molefoam. A blister should not be unroofed unless absolutely necessary. If this is required, wash the area with soap and water and insert a decontaminated needle ("sterilized" by a flame or with rubbing alcohol) into the edge of the blister. Gently press out the fluid. Apply a sterile dressing. If the blister has already broken, cleanse and cover the area. Topical antiseptic ointment may be beneficial.
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