Foot and Ankle Injuries on the Trail
Foot and ankle injuries occur quite often on the trail. They usually happen all of a sudden and you don’t have time to avert them. However, you can treat most injuries (sprained ankles, for example) immediately - while still on the trail. Such a treatment can significantly reduce the pain and recovery time.
Foot and Ankle Injuries
Sprains occur when the ligaments that connect bones within a joint are forcibly stretched beyond their normal range, leading to stretching or tearing. Sprains vary from minor to major depending on the amount of ligament tissue that is damaged. A full-thickness tear of a ligament is often referred to as a complete ligament rupture; these usually require prolonged immobilization or surgery to repair or reattach the separated ends of the ligament.
Signs and symptoms of a sprain
- Possible bruising or discoloration
- Pain on joint movement
Ankle injuries are among the most common trail injuries. A sprained ankle (which is a mechanism rather than a diagnosis) is the most common injury to the musculoskeletal system for outdoor adventurers. It is important to differentiate between an ankle sprain and an ankle fracture. Most ankle sprains are the result of inversion or eversion injuries (rolling the ankle to the inside or outside). In order to withstand the impact of running, twisting, pushing off and landing, the ankle and foot must momentarily distribute the impact higher up the chain at the mid-foot. In addition, the very nature of changing directions places an inordinate amount of strain on the ankle region, as well as the velocity of the movement. Other methods of injury include stepping in a hole, stepping off a curb, or rolling the foot off the surface. Any of these can easily happen when you're hiking at night.
Pain, tenderness, and swelling are the common complaints resulting from an ankle sprain. They are caused by damage to the lateral ligaments.
Ankle sprains are graded into three grades (I, II, and III) based upon severity starting from partial tear of a ligament to complete tear of a ligament. Though generally minor, they need to be treated with care to prevent lasting damage. Treatment begins with RICE. Some hikers will need added support. A tape or improvised splint provides some support and helps prevent swelling.
The acronym RICE (rest, ice, compression, elevation) is helpful during care of orthopedic lower body injuries. Resting an injured extremity prevents further damage, while ice, snow, or cold water (such as from a stream) can help reduce swelling and pain. Compression can help to reduce swelling of some injuries and provide support for others, while the elevation of the extremity above the heart can also assist in reducing swelling.
On the trail you will need to improvise, so stay off the affected foot while soaking it in a cold stream or lake. Your boot, or an ace bandage you carry with you, will provide the compression, and you can elevate your leg onto your backpack while you sit against a tree or rock. Obviously, some sprains could be severe enough to cause you to abandon the trail. Give your body a chance, though, and you might be surprised by how quickly it recovers.
Plantar fasciitis is inflammation of the fascia (connective tissue) that connects the heel of the foot to the toes. It is a common problem for runners, but can also be troublesome for hikers, backpackers or mountaineers who routinely hike long trails.
This condition commonly occurs when running or jumping repeatedly on the forefoot or when using poor shoes on hard surfaces.
Pain rarely occurs during activity, but instead begins afterward, usually in the morning or after prolonged periods of sitting or rest. It emanates near the medial side of the heel. This pain can also be significant when “pushing off” for a step or stride.
Initially try orthotics to support the foot arch, which provides improved shock absorption the insertion area combined with stretching of the calf muscles. Deep tissue massage may also help, while steroid injections and surgery are rarely needed. NSAID or local cortisone injections can give short-term relief. Surgery is seldom indicated.
Rest will not help so allow all kinds of sporting activities, with well-fitting shoes. If there is a pain on impact, suggest low-impact alternatives such as cycling and swimming.
Though the chances for full recovery are excellent, it is not unusual for symptoms to last for a long time.
Achilles tendinitis, a common injury among runners, can also happen to hikers and mountaineers. For these athletes, carrying heavy loads uphill elongates the Achilles tendon and can cause inflammation. This often occurs among those new to hiking or those who have a typical desk job and decide (without proper preparation) to go uphill. The tendinitis occurs from the elongation of the Achilles tendon beyond normal limits. The change from a sedentary lifestyle to highly physical activities can create the perfect scenario for Achilles pain.
The structure of some hiking shoes can also put pressure on the Achilles tendon and cause pain. The tight fit presses on the Achilles tendon, and with repeated movement and long-term wear can cause inflammation. This can be resolved best by changing shoes.
Pain in the heel leading up to the calf is the principal symptom of Achilles tendinitis, especially in the morning or with increased activity. Stiffness sometimes accompanies this morning pain, and some backpackers complain of pain the day after a hiking trip. Swelling also occurs and often increases throughout the day.
Achilles injuries are difficult to treat and often entail months of rehabilitation. The first step in treatment is to decrease or halt the activity that is causing the inflammation. For example, rather than running, try an elliptical machine or stationary bike. Such activities, or others such as swimming, can maintain cardiovascular fitness without exerting strain on the Achilles.
Icing the Achilles tendon with a reusable ice pack or foam ice cup for 20 minutes multiple times throughout the day (RICE) can aid in inflammation control. NSAIDs can also be beneficial in reducing inflammation but should be used cautiously, and preferably only for a short period after the initial injury.
Stretching with a focus on the calf is key in helping to prevent further injury. Other treatments include physical therapy, eccentric strengthening exercises (slow release of lengthening muscles while under load), steroid injections, orthotics, and surgical intervention.
This often chronic ailment may respond to conservative treatment in early stages, including modification of training and calf muscle strengthening exercises that can be tried over three months. If this regime is not successful surgery may be necessary to release any constrictions and adhesions between the skin and excise abnormal parts of the tendon. Cortisone injections should be administered only in rare cases, due to the high risk of later tendon rupture. Indeed, a cortisone injection and frequent use of NSAID are possible causes of this ailment. Surgery is followed by a few weeks’ partial immobilization and rehabilitation before resuming sport.
Several steps can reduce the incidence or severity of an injury. These include the use of appropriate footwear and physical conditioning.
Physical conditioning is one of the strongest defenses against injury. Unfortunately, the foot and lower leg are often neglected. Lack of flexibility can predispose an individual to certain injuries. For example, a tight Achilles tendon has been shown to predispose an individual to plantar fasciitis, Achilles tendinitis, and lateral ankle sprains. Exercises should focus on ensuring a normal range of motion and may be performed alone or with a partner. Strengthening exercises for the intrinsic and extrinsic muscles of the region are essential in injury prevention. Foot strength can be improved by picking up marbles or dice with the toes and placing them in a container close to the foot, or placing a tennis ball between the soles of the feet and rolling the ball back and forth from the heel to the forefoot.
The demands of a particular activity require adaptations in shoe design and selection. In individuals with arch problems, the shoe should include adequate forefoot, arch, and heel support. Choose stiff footwear that provides adequate ankle support and forget about soft shoes or boots. In all cases, individuals should select hiking shoes based on the demands of the terrain and weather. You can read our post about hiking footwear here.