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Home , Hiking, Hiking boot, La Sportiva, Mountaineering boot

SPORTS PODIATRY

The and 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 . “how-to” primer to familiarize you ing 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 ? 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- interface, or the added biomechanical demands placed on the lower extremity as a result of terrain, and addi- tional weight from that can sometimes weigh over 60 pounds. It is important, therefore, for the sports medicine podiatrist to Lightweight, midweight, heavyweight and 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- packs with food Ice climbing is a form of climb- and water for ing that involves ascending frozen short excursions or ice formations using to expedition- ice axes and 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 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. . 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 on 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- 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 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 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. The outsole but will provide greater stability may be laminated separately to the and help reduce leg fatigue when midsole or may be incorporated carrying heavy packs or hiking on into the midsole itself. The method technical terrain. The rigidity of the of adhering the outsole to the shank can sometimes be offset by upper of the boot can some- times allow for resoling of the Upper boot if the out- sole becomes ex- cessively worn.

Midsole The midsole is a very impor- tant component of athletic shoes especially in sports such as Lining and tennis where Cut away boot shock attenua- tion is important. As in other types incorporating a slight rocker bot- of athletic footwear, the midsole is tom configuration to the outsole to incorporated between the outsole make walking easier. and the upper of the boot or shoe. In hiking and climbing, the use of Upper shock absorbing midsole materials The upper is the part of the is not always as crucial as in high boot above the outsole/midsole. impact sports, where the outsole Continued on page 74 www.podiatrym.com SEPTEMBER 2004 • PODIATRY MANAGEMENT 73 Hiking & Climbing... significant amount of stability on challenging terrain but have become The materials used for the upper in- popular due to their lighter weight. clude full-grain leather, split grain leather, Nubuck leather, and syn- Lining thetic fabrics. Full-grain leather is a The upper material of a hiking full-thickness leather that is more or climbing boot is usually lined durable but harder to break in. with material to provide a smooth Split-grain leather is leather that protective layer between the upper the inner part of the hide has been and the foot and ankle. These pro- stripped from, leaving the support- prietary liners offer not only pro- ive, water-resistant leather intact. tection but help increase the water- This upper material does not repel resistance of the boot and can also water and is not as durable as full- provide a wicking mechanism to re- grain leather, but is easier to break duce moisture from the foot. This in. Nubuck leather is full-grain can aid in reducing blister forma- leather that has been abraded to tion as well as playing a role in give it a suede-like appearance. keeping the feet warmer in colder Synthetic uppers, such as Gore- environments. Tex and other proprietary materi- als, have become more popular in Categories of Hiking and climbing and hiking boots because Climbing Boots of their lighter weight, water resis- Hiking and climbing boots are tance and breathability. often categorized by their intended The height of the upper also use. As in other types of athletic helps determine the ideal use for a footwear, these categories can over- specific boot. Above-ankle or high lap. From a sports medicine per- top boots generally provide in- spective, knowledge of these cate- creased stability for the foot and gories can help guide your patients ankle, especially when on uneven towards the proper boot based on or rough terrain and when carrying their planned activity, foot type a heavy . These boots, and any underlying biomechanical however, usually take longer to or foot morphology concerns. Fac- break in and can present fit prob- tors to consider include the appro- lems around the malleoli. priate boot design based on func- Ankle-high or mid-cut boots end tional requirements including their just above the ankle, keeping the foot anticipated use, the construction of and ankle more secure than a low-cut the boot, and the fit criteria set or below-ankle boot. The advantage forth by each manufacturer. The ul- of this boot height is the lighter timate decision on the best boot to

Light-weight hiking shoe and boot

weight and easier break in time. use, however, still depends on en- Low-cut boots are similar in suring the best possible match of height to running shoes and other the foot to the boot. below ankle athletic shoes. The stabil- ity is these shoes is usually provided Lightweight Hiking Boots/Shoes for by the midsole/outsole, the upper Lightweight hiking boots also in- material, and the shoe counter. These clude hiking shoes. These shoes or types of boots/shoes do not offer a Continued on page 75

74 PODIATRY MANAGEMENT • SEPTEMBER 2004 www.podiatrym.com Hiking & Climbing... tect feet from rocky surfaces and provide good midfoot stability, but boots are designed for short day still retain flexibility in the forefoot hikes on maintained trails. The low- to allow for normal gait. When cut models may resemble running used for carrying backpacks with shoes but usually have stiffer soles, heavier loads, the mid-weight boot more stability in the upper, and bet- should be stiffer in the forefoot. ter traction than most athletic shoes. Mid-weight boots should also fit The upper of lightweight hiking similarly to a running shoe. When boots are typically made with fabric trying these boots on, make sure and leather combinations or syn- you utilize a with the same thetic materials. They are usually thickness as the one you plan to low-cut to mid-cut, but do not have hike with to help ensure proper fit. as much ankle stability as mid- Mid-weight hiking boots make up the largest cate- gory of hiking boots on the market today. Depending on the upper materi- al and midsole/out- sole construction, these boots are de- signed to function well when carrying backpacks weighing less than 35 pounds.

Heavyweight Back- packing Boots (lightweight moun- taineering boots) Mid-weight hiking boot Heavyweight weight hiking boots. backpacking boots are designed to These boots should fit similar to be used when carrying loads greater running shoes allowing around a than 35 pounds or when traveling 1/4 of an inch between the longest over rock, snow or ice. This catego- toe and the end of the boot. ry of boots also shares many of the Many people will use lightweight same features as mountaineering hiking shoes and boots for everyday boots. walking as well as on hiking trails. The uppers on heavyweight hik-

Mid-Weight Hiking Boots Mid-weight hiking boots can be used for anything from hiking on well-graded trails to trekking on more challenging terrain that may take you on rocky areas and uneven surfaces. These boots are often mid-height and may be made Heavy-weight hiking boot from fabric and leather combinations, synthetic ing boots are typically made of full- materials or split grain leather. grain leather that extends above The outsole or midsole may in- the ankle to serve as protection for corporate half-length shanks or the ankle and leg while providing semi-rigid plastic midsoles to pro- Continued on page 76 www.podiatrym.com SEPTEMBER 2004 • PODIATRY MANAGEMENT 75 Hiking & Climbing... increased support and stability on Lightweight Hiking Boots/Shoes rugged terrain. These boots have minimal seams to increase their Venture Mid water resistance and may incorpo- Montrail Storm GTX rate an insulated lining for use in Salomon Solaris Low cold environments. Scarpa Helium Heavyweight hiking boots usu- Vasque Sundowner ally incorporate full-length shanks or stiff nylon or composite midsoles Mid-Weight Hiking Boots to provide rigidity. As a result of this they can make full stride hiking La Sportiva Trango Trek a little difficult. Some boots in this La Sportiva Thunder category incorporate a rocker-bot- Salomon Mega Trek 6 tom outsole to allow a more natural Montrail Torre GTX gait and minimize heel slippage. Montrail Solitude (women specific) Many of the heavyweight back- Scarpa Vento packing boots also include modifica- tions in the outsole area to accept Heavyweight Hiking Boots crampons that are utilized when trav- (Lightweight Mountaineering Boots) eling on snow or ice. Crampons at- tach to the bottom of the boot with La Sportiva straps or bales, and utilize metal spikes La Sportiva Trango S to increase traction on snow and ice. Soloman SM Lite As a result of the inflexible outsole Montrail Olympus and more substantial upper materials, Scarpa VG20 heavyweight hiking boots often re- quire longer break-in periods. It is not Mountaineering Boots uncommon to develop blisters and ir- ritation over boney prominences while La Sportiva Nuptse (double-plastic boot) adjusting to these boots. Montrail Ice 9000 (double-plastic boot) Since heavyweight backpacking Koflach Arctis Expe (double-plastic boot) boots are often used in colder condi- Scarpa Inverno (double-plastic boot) tions, it is very important to fit these Salomon Pro Thermic boots with the one is wearing Scarpa Freney Pro La Sportiva Extreme while hiking or climbing. If you will be hiking or climbing above 6,000 feet one must also take into consider- ation the possibility of developing pe- cause of this concern, and the need usually fairly rigid. This is beneficial ripheral edema that occurs at altitude for mountaineering boots to be as when wearing crampons but de- and therefore allow room for foot insulated as possible, double plastic creases the boot’s sensitivity and swelling when fitting these boots. boots are the most common climb- makes it somewhat more difficult to ing boots used on snow and ice, es- walk in. The stiffness of the outsole Mountaineering Boots pecially in colder environments. also helps reduce calf muscle fatigue Mountaineering boots are spe- Double-plastic boots refer to two- when ice climbing on steep terrain cialized hiking boots designed for layer boots: the outer shell consisting that involves “front-pointing” cold temperatures and travel over of a molding plastic or composite which is the placement of the front ice and snow. Many heavyweight shell with a removable insulated points of a crampon directly into hiking boots can be used for travel inner boot. The inner boot usually the ice. To compensate for the out- in the mountains. These should be consists of closed cell foam such as sole rigidity, plastic boots uppers insulated, compatible with cram- EVA which is light and generally un- have become more flexible, allow- pons, and have an aggressive lug affected by moisture. The insulating ing the ankle to flex forward. Most pattern on the outer sole to provide materials in double-plastic boots double-plastic boots also incorpo- good traction. A significant disad- eventually compress down, reducing rate a rocker-bottom sole to allow a vantage to heavyweight hiking their ability to keep the feet warm. more natural gait when hiking. boots, however, is that when the Most boot manufacturers do sell re- leather and synthetic uppers be- placement inner boots. Fitting comes wet from either perspiration, The plastic outer shell offers no When fitting double plastic boots, rain or snow, they can take a cou- significant insulating capabilities but they should feel comfortable “out of ple of days to dry out. This can in- is completely waterproof, limiting the box” because due to their construc- crease the likelihood of developing moisture build up from the outside. tion, very little “breaking in” will lower extremity cold injuries. Be- The outsoles of plastic boots are Continued on page 78

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occur. Care must also be taken to allow ample room in the toe box to avoid cramping of the forefoot, which could result in circulatory compromise and subsequent frostbite. Most climbers tend to “oversize” their plastic boots when fitting to allow for peripheral edema that can occur at high altitude and they use two or three pairs of socks for insulation in colder weather.

Rock Climbing Shoes Rock shoes are designed to hold onto small ledges and provide fric- tion on natural rock features when climbing. Rock shoes usually con- sist of a flexible upper made of soft leather combined with a flexible sole made from various formula- tions of “sticky” rubber.Various shapes of lasts are used in manufac- turing rock shoes to match the spe- cific types of rock climbing for which the shoes are to be used. Rock shoes are fit very different- ly from climbing and hiking boots. Most rock shoes are designed to fit very snugly to allow precise move- ment when climbing. As a guide- line, these shoes tend to fit about one size smaller than athletic shoes. Experienced climbers typically fit their shoes tighter, even to the point of discomfort. This can result in irritation to boney prominences such as bunions, hammertoes, Haglund’s deformities and metatarsal-cuneiform prominences. In part 2 the author will discuss socks, orthotics, and common in- juries associated with hiking and climbing. ■

Perry H. Julien, D.P.M. is a past President of the American Acade- my of Podiatric Sports Medicine. He served as po- diatric coordina- tor for the 1996 Summer Olympic Games and is currently the co-medical director for the Peachtree Road Race and Atlanta Marathon. He is a member of the Wilder- ness Medical Society, The Explorers Club and has climbed extensively in the United States, including the summits of Mt. Rainier, Grand Teton, Mt. Whitney and Longs Peak.

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