SPORTS PODIATRY The Hiking and Climbing Foot— Part 1 This popular recreational sport requires specialized footgear. By Perry H. Julien, D.P.M. setting out for an hour on the com- Hiking and climbing have seen a munity nature path. Minutes, hours surge in popularity over the last sever- This article is the sixth in a seven- or days into their journey they start al years. People are hiking as part of part sports podiatry series written by to experience foot or ankle pain. Is it their overall fitness programs and members of the American Academy of due to the foot condition about teenagers are participating in pro- Podiatric Sports Medicine. This sport- which they have been meaning to grams such as Outward Bound that specific series is intended as a practical see their podiatrist or is it the old hik- involve extensive wilderness travel. “how-to” primer to familiarize you ing shoes they have recently taken Families are also taking “adventure with the specific needs of patients who out of storage? Or could it be a com- travel” vacations in the United States participate in these sports, and the bination of some underlying lower and abroad, and planning guided ex- types of injuries and treatment chal- extremity condition and a pair of peditions to places such as the 19,344 lenges you’re likely to encounter. newly purchased boots? Regardless of foot Mt. Kilimanjaro. Technical hik- the reason, foot pain in hikers and ing and climbing have also grown t could be someone preparing to climbers can at the very least make a tremendously despite the inherent climb Himalayan peaks, a family trip less enjoyable, and in instances risks in these activities. Iplanning a hiking vacation to the where one is far from medical care The obvious effect of the in- Grand Canyon, or an elderly couple can make for a dangerous situation if creased participation in these activ- Getty Images/PhotoDisc ambulation becomes difficult. Continued on page 70 www.podiatrym.com SEPTEMBER 2004 • PODIATRY MANAGEMENT 69 Hiking & Climbing... ities is the proportional increase in the number of foot and ankle prob- lems that are occurring. These in- juries can result from aggravation of pre-existing lower extremity pathology, injuries resulting from the foot-boot interface, or the added biomechanical demands placed on the lower extremity as a result of terrain, footwear and addi- tional weight from backpacks that can sometimes weigh over 60 pounds. It is important, therefore, for the sports medicine podiatrist to Lightweight, midweight, heavyweight backpacking and mountaineering boots be familiar with the types of hiking and climbing in which their pa- tained, level nature paths to cient in the wilderness and take ap- tients may be participating, the rugged wilderness terrain in re- propriate steps to prevent injuries proper assessment of hiking and mote regions of the world. Hik- from occurring. ers and trekkers may carry day- Ice Climbing packs with food Ice climbing is a form of climb- and water for ing that involves ascending frozen short excursions waterfalls or ice formations using to expedition- ice axes and crampons which attach style backpacks to climbing boots. Crampons fit se- that can hold up curely to the bottom of “crampon to 70 pounds of compatible” boots and have special- gear. Footwear needs and the predis- position to lower ex- tremity in- Double plastic mountaineering boot juries are dependent climbing footwear and the types of on the type of terrain, foot and ankle problems commonly the distance and length encountered in hikers and climbers. of time spent hiking, and In this way the podiatrist will be the amount of gear that better equipped to treat the hikers needs to be carried. and climbers seeking care. Mountaineering Into the Wilderness Mountaineering is a form To understand the biomechani- of hiking that involves cal demands placed on the lower mountain ascents using tech- extremity when hiking and climb- niques derived from all ing, one needs to first appreciate forms of climbing. Hikers the different disciplines that fall and trekkers can be faced under the broad category of hiking with challenging weather and climbing. This knowledge is conditions; mountaineering helpful when evaluating and rec- often involves traveling in ommending footwear and when as- harsh conditions that in- sessing and treating injuries that clude cold weather and travel Ice climbing may result from these outdoor ad- over rock, snow, ice, and ventures. glaciers. These conditions necessitate ly shaped metal spikes that can pen- proper boot selection and an under- etrate ice or hard snow. Crampons Hiking and Trekking standing of the body’s response to can also be used for general moun- Hiking and trekking usually cold. Climbing expeditions can be taineering to allow better traction involve walking on trails that days away from specialized medical on hard packed or icy slopes. may range from well-main- care and therefore must be self-suffi- Continued on page 72 70 PODIATRY MANAGEMENT • SEPTEMBER 2004 www.podiatrym.com Hiking & Climbing... Footwear companies and vari- ous outdoor and climbing periodi- Rock Climbing cals have used several classifications Rock climbing involves ascend- in an attempt to categorize hiking ing vertical or near vertical rock for- and climbing boots. These cate- mations utilizing specialized gories provide the consumer, footwear that incorporates “sticky footwear retailer, and podiatrist rubber” to provide friction and vari- with a general guide for recom- ous design shapes depending on the mending and selecting a range of type of natural features on the rock boots that may be appropriate for being climbed. Techniques in rock the activity they are to be used for. As is the case with most athletic footwear, hiking and climbing boots may fall between two or more categories. The categories described serve as a practical guideline based on the construction of the boot and its recommended use. Once the use has been determined the ul- timate decision on what Outer sole Steel shank comprises the “best Outersole with embedded steel shank choice” is based on the boot that is best climbing include “smearing” in matched to one’s unique foot size, which a climber utilizes the rubber shape and biomechanics. on the outsole to provide friction and “edging” in which a part of the Anatomy of a Hiking Boot shoe contacts small features on the The innovations seen in hiking rock. As with other types of sports and climbing footwear over the last footwear, “hybrid” rock climbing several years have taken place in shoes may have more versatility to the construction, materials, and fit use on a variety of terrain. components of the boot. Basic boot Indoor climbing gyms have also design, for the most part, has not become popular over the last sever- changed dramatically, partly due to al years. These climbing facilities the fact that the biomechanics of have artificial walls that incorpo- the foot have not changed. The de- rate plastic footholds and hand- sign changes that have taken place holds in place of natural rock fea- are undertaken to allow the boots tures. The indoor climbing gyms to function more optimally in the have made climbing accessible to environment that are to be used in. more people and have helped in- To understand boot function, one crease the number of people partici- must first appreciate how the com- pating in the sport. In 2002 it was ponents of the boot relate to the estimated that 7.6 million people boot’s intended use. in North America have tried indoor rock climbing in over 600 public Last climbing gyms. The last is actually not a com- ponent of the boot itself, but rather The Importance of Proper the mold or shape that the boot is Footwear constructed from. The last is there- Appropriate footwear is the fore one of the most important most crucial piece of gear for any parts of the boot because it deter- hiker or climber. Proper boot selec- mines how the boot will fit on the tion requires not only an under- foot. Each footwear manufacturer standing of foot type and lower ex- utilizes a proprietary last that deter- tremity biomechanics, but an ap- mines the boot’s shape and vol- preciation of boot construction and ume, making it important for one how it relates to the anticipated use to try on boots from different com- of the boots. Continued on page 73 72 PODIATRY MANAGEMENT • SEPTEMBER 2004 www.podiatrym.com Hiking & Climbing... can contribute to some shock ab- sorption. One is more likely to find panies to determine the best fit for shock-absorbing midsoles used in a specific foot type. lightweight hiking boots, which are often used on a variety of terrains, Outsole including less forgiving surfaces, The outsole is constructed out such as asphalt and packed trails. of rubber material such as Vibram, designed to protect the feet and Shank offer a degree of shock attenuation. The shank of the boot can be The outsole can also provide stabili- incorporated into the outsole or ty to the boot along with traction midsole and adds further stability to the hiking boot. Mid- weight boots may have a half or full shank made of fiber- glass or nylon to allow some flexibility when hiking. Heavy- weight and mountaineer- ing boots usual- ly incorporate a Last more rigid full shank that adds on the surfaces they are used. Most more stiffness to the outsole/mid- hiking and climbing boots incorpo- sole. Full-length rigid shanks may rate various heights of lugged rub- impair walking comfort by limiting ber treads that help improve grip in the normal flex pattern of the boot dirt, mud and snow.