Scott Webb (Host): Hiking is a popular form of exercise and exploration, but hiking health and taking care of our feet is essential so that we can stay on the trails and enjoy ourselves. And I'm joined today by Dr. Hayden Hoffler. He's a Foot and Ankle Surgeon with Orthopedic Associates of Central Maryland, and as a hiker, surgeon, and Eagle Scout, he's got a lot of hiking tips for us today.

 Welcome to A Bone to Fix from Orthopedic Associates of Central Maryland Division.

I'm Scott Webb and I've Got a Bone to Fix With You.

Doctor, it's nice to have you on again. We've spoken before, and today we're talking about hiking health and all things hiking, if you will. Before we get to that, though, just want to have you introduce yourself, explain your background in podiatry, especially as it relates to outdoor activities such as hiking.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: So first and foremost, my name is Hayden Hoffler. I'm a Foot and Ankle Specialist with the Orthopedic Associates of Central Maryland. My background in podiatry ranges from general, just routine care, clipping toenails and calluses to complex reconstruction. And that definitely relates to the topic we're talking about today and especially feels at home with my background being an Eagle Scout as well.

So I've done a lot of hiking and can relate to some of my patients, if not all of them who have had hiking and outdoor injuries or are not comfortable.

Host: Yeah, I never made it to Eagle Scout. That's probably a separate podcast about, you know, I got distracted and didn't finish, but good to hear that you finished. And yes, of course, in the Scouts, lots of hiking. Let's just talk broadly about the foot health and why foot health is particularly important for hikers.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: It's definitely important and it's important for all types, whether it's day hiking, overnight backpacking or just hiking throughout a whole trail. Historically hiking present challenges, even to just the healthiest feet.

And the reason why is, the amount of weight that you can carry, whether it's a water bottle all the way to a backpack can actually change not only the weight through the lower extremity, but also change the center of gravity, which ultimately affects your gait, and your walking ability as well as the different terrains that you're encountering as well.

Host: I have to confess, I've never purchased hiking boots before. I've purchased a lot of footwear over the years, Doctor, but never hiking boots. Work boots, that kind of thing, snow boots. Let's talk about hiking boots and how to select the right hiking boots and maybe what are some of the key features.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Sure. Absolutely. Hiking boots and definitely shopping for them can be overwhelming sometimes because there's plenty of them out there.

Host: Yeah.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: The biggest thing is choosing the right fit. Unfortunately, there's not a certain gadget that measures hiking boots because boots can be made differently. Brands are designed differently. The biggest things you're looking for, obviously good ankle support. If you're looking for a boot versus a trail shoe, which I'm sure we'll get into. Obviously the right length, you don't want it to be multiple fingers longer inside, allowing for you know, severe traction and friction in between the shoe.

Sometimes a breathable material if it's hot outside. Sometimes the height of it can affect which actually boot you're, you know, wanting to buy, what type of terrain you're doing. The biggest things though are ankle support, , some sort of traction on the outside or bottom of the boot, the weight of the boot. And ultimately the biggest thing and a lot of thing that people pay attention to is actually if it's waterproof, because you're going to encounter water somewhere or another, most likely on a hiking trip.

Host: Yeah, for sure. Yeah. And, those of us of a certain age can remember, going to a shoe store and having people there who could help fit you for shoes. And, you know, you put your foot on the thingy and you adjust it, you know, that thing, that foot shape thing, but when it comes to actually like fitting yourself, if you will, cause that seems to be how it goes now, we all sort of help ourselves at the stores when it comes to doing that, are there any specific measurements or techniques you advise when we're trying to fit ourselves with hiking boots?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: I think the key feature for fitting into a hiking boot is trying them on at the end of the day. You know, naturally your feet swell throughout the day. So trying them on at the end of the day will be the most accurate fit. A couple of different features; number one, you want them to be generally snug. You don't want them to be loose. You don't want your heel slipping out. Just like I mentioned previously, about a finger's width of space at the front of your toes, with a heel firmly placed at the back, for some general support. And the easiest way to actually check and see if they fit and feel right is just walk around the store, walk down the block, just to make sure they feel okay.

Host: And maybe if there's a rock climbing wall, just head on up there?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Yeah, I don't know about that.

Host: Yeah, probably not. There's probably some insurance issues. Alright, so you mentioned earlier about the trail running shoes, and I'm sure folks have preferences, be it trail running shoes or traditional hiking boots. Is there one that you favor more than the other?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: It all depends on what type of activity you're doing. You know, trail running shoes are designed for shorter and faster hikes. Most of the time they're more maintained trails, meaning there's not a lot of brush within the trail. It's clear. You kind of know where you're walking. A lot of times it's also with some of, we call them lighter days, meaning, the weight you're carrying, whether it's a backpack or an actual hiking backpack, they're actually lighter.

So speed's prioritized. Some races, trail running, which is popular out west. Most of the people wear trail shoes for that matter. And then also weather changes. So a lot of times trail shoes are number one, going to be lighter, but number two, going to be feeling a lot more comfortable when it's warm and hot outside.

The biggest thing with hiking boots is, you know, people who are going longer distances, more technically challenging trails, that might, you know, cause you to, get in and out, there's brush on the trail, there's roots causing uneven terrain, and then lastly is obviously the opposite of warmer weather is colder weather. You want something that's going to keep you not only warm, but also provide the protection for it.

Host: Yeah, I see what you mean. Like, it just depends what we're going to be doing. Most of us don't accidentally find ourselves hiking, right? So, whenever we head out the door or we're thinking about a trip or a vacation or whatever it might be, we'll have a pretty good sense of what the temperature, weather, the types of trails, and that kind of thing, right?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Absolutely.

Host: Yeah. Wondering, does the material of hiking boots matter, let's say leather versus synthetic, and does that have any impact on comfort and protection?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: A lot of boots nowadays are actually hybrids of both, you know, leather is actually designed to be more durable. And you know, deals with a lot of those, the roughage, you know, hikes that are for heavier loads, rough terrain. The problem with those though they're heavier. Sometimes they take a little bit longer to break in.

So if you have an upcoming hike, most people don't like those cause it takes a little bit longer. And they're also less breathable, Um, so they're potentially leading to, you know, sweaty and moist feet, especially when it's hot in the summertime. Versus synthetic, you know, they're quite opposite.

They're a little bit lighter, takes barely any time, if any, to break in. Obviously a little bit better in the summertime, but the problem is they're not as durable. You know, they're definitely going to damage a little bit easier than leather. And obviously support, they're just a little less supportive, than some of those leather mades.

But the good thing is a lot of the boots nowadays are a hybrid of both, so you have some components of both, to provide support not only and durability as well as flexibility with weather changes.

Host: All right, let's move to blisters. Anyone who's ever had a blister knows how annoying they are, be they on your feet or wherever. So, I'm sure that blisters are common among hikers, no matter whatever they picked, right? The trail shoes or hiking boots, whatever they picked, the best materials, the best laid plans, they probably still get blisters. So what are the main causes of blisters? And is there any way to prevent them?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: The main cause of a blister is just friction. And that could be due to poorly fitted shoes or socks. Obviously the combination of that with sweating leads to repetitive rubbing, which then leads to a potential hot spot. And then that further breaks down into a blister. So that could be a variety of factors, just like I talked about.

Sometimes terrain or the longevity of the hike. Or new shoes if they're not broken in appropriately can cause them. Now how you prevent them, you know, the complete opposite, obviously it starts with choosing the right shoe, which we kind of got into already, wearing socks, you'd be surprised how many patients say they hike without socks.

Breaking in shoes, trying to keep your feet as dry as you can, changing out socks, sometimes if you lace the shoes in different ways that can prevent friction or slippage in the shoe gear, and the last thing is just checking your feet and actually just taking care of them, um whether or not, sometimes padding as well.

Host: Yeah, take a look during the day maybe. Is it just a thing though? Should we just expect if we're breaking in new hiking boots that we're probably going to get some blisters or are there ways to avoid them even with new boots?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Yeah, I mean, there's ways to avoid it. Obviously padding the affected area. With it breaking them in the correct way and wearing socks are the main ways, but, you know, at some point, if they're forming, that's when you really have to kind of address them as soon as you can.

Host: Yeah, definitely don't, definitely don't ignore them because you know what's going to happen, of course. How about socks, right? I don't know if they make specific socks for hikers. I suspect that they do. The world is so specialized now. But are there any particular types of socks that you recommend more for hikers than others?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: So I actually do, when I hike, I wear two different types of socks. I wear an inside liner that's snug fit. And the reason why is that limits the amount of friction that you're actually having in the shoe. So that limits exactly what we just talked about. And then on the outside, which is the most common, if people are going to single layer, is what I call it, you're wearing socks that are made of wool.

And the reason why is that it creates a snug fit in the shoe if there's any slippage. And there's also the moisture wicking capabilities, you know, preventing that sweating, therefore the friction and breaking down, which therefore can cause some infections, blisters, and other issues.

Host: All right. So then broadly speaking, if we're going to, if we're already a hiker, we want to be a hiker, what are some of the most important foot care practices for hikers, you know, both before, during, and after a hike?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: So just to reiterate what we talked about, starting with footwear, choosing the right shoe, whether it's a shoe, boot, trail shoe, et cetera. Wearing socks. Like I said, you'd be surprised how many people don't wear socks. Bringing the right things with you, whether it's just powder for drying out or just making sure your feet are clean and dry. Some people get out of their shoes and get into ponds, streams, et cetera. You'd be surprised how many people put their wet feet back into the shoe.

Host: Hmm.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Trimming toenails, you know, that's another thing. Ingrown toenails are a common thing that I see after hiking. Just trimming them the correct way. And then the last thing, which I think is the most important, is actually just taking a break. Letting your feet air out, giving them a break from the actual repetitive activity that you're doing with hiking.

Host: Right. This is purely anecdotal, Doctor, but I feel like after multi day hikes that people get infections, feet or otherwise, so if that's true, maybe you can explain how foot hygiene helps maybe to avoid some of those infections.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: So a lot of the times bacteria and fungi thrive in those warm, damp environments. So that sweating that occurs, you know, with wearing closed toed boots and those thick socks can cause it. So just general, regular cleaning of the feet, drying of the feet, whether it's on breaks or at the end of the day, can help prevent some of that fungus that can form, whether it's athlete's foot, sometimes toenail fungus, the ingrown toenails as well.

Host: Yeah, and you know, I'm known to say probably just to myself, but at the end of a long day, when I've been on my feet a lot, I might say something like, you know, my dogs are barking, something like that. And I feel like after a long day on the trails, hikers that's probably the, maybe the most important time to care for the feet.

And you mentioned there about just kind of letting them breathe a little bit, get them out of those socks, out of those boots. Just wondering anything else you recommend, especially if it's things that we can bring with us to kind of help at the end of a long day.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Number one is get those shoes off, shoes and socks off. Whether you reach your destination camp, car, et cetera, remove them, wash them with soap and water. You can also soak them. I would prefer soaking in cold water and that's to reduce swelling, drying them out appropriately, whether that's, drying is what I call it using a towel, sometimes powder as well.

 Also elevating your feet. You'd be surprised how many people swell. So elevating your feet at the end of the day, that'll reduce swelling, as well. And then other just general foot care products work as well. The last thing I'll mention though, after coming at the end of a hike is I would try and avoid going barefoot as much as you can.

You know, if you're walking around a parking lot, campsite, et cetera, wear some just general camp shoes, that'll prevent any infections that you might get from not only walking barefoot, but it prevents any injuries that could potentially happen too.

Host: Yeah, I see what you mean. You make it through the day, you make it through the hike, and then you pick up something in the parking lot, right?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Absolutely. Yeah.

Host: For sure. You know, I know it's important for all of us in any sort of medical topics, and today we're talking about hiking and feet, to just listen to our bodies, right? Our bodies usually don't lie, right? So when someone's dogs are barking, if you will, when we think about foot pain and fatigue, what do you recommend?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Absolutely. It's definitely important. You got to listen to your body. Not only for pain, but fatigue as well. I mean, that could, you know, lead to serious injuries, whether it be the foot or the rest of the body. The biggest thing is when something doesn't feel right, take care of it. That's what I always tell patients.

Don't get it to the point where that hotspot is becoming a blister or you have pain in your foot that becomes suddenly a stress fracture, or a tendon doesn't feel like and now it's tendonitis. Um, so being proactive, not only with just general foot care, but general pain that you have. And that's why I recommend just taking breaks in between hikes, whether it's a short or long, not only to check your feet for those common issues that we talked about, but just to maintain your energy level and keep your energy up. Not only so you feel better, but also to make your hiking experience ultimately better.

Host: Yeah, you don't want to be in pain, you know, and feel fatigued, especially your feet all the time, but I'm sure that's an issue with hikers and maybe even runners as well. Let's talk about for those who really do experience chronic foot pain or issues, but they just have to keep hiking, right? What adjustments would you recommend to their respective hiking experience?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: There's a couple different things, you know, obviously it can start with shoe gear, changing shoe gear or, changing sock gear to allow your hiking boots to fit, you know, correctly. Sometimes orthotics help improve not only foot pain, but your biomechanics as well.

 Increasing or decreasing your hiking distances, whether it's a day or an overnight backpacking trip. I think one that's overlooked is actually stretching before and after a hike. And then obviously taking those breaks, like we talked about as well, to monitor for all those things.

Host: How about some of the most common foot related injuries? We've kind of been, you know, scattered them throughout the podcast here, but just in one answer here, what are the most common things that hikers experience and maybe the best practices for recovery?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: I see anything from ingrown toenails and blisters to stress fractures and tendonitis. And the biggest things, for treatment for some of those, obviously for blisters is accommodating it, whether it be padding, offloading, switching shoe gear, et cetera. For those ingrown toenails, you can do anything from trimming the toenail the correct way to actually removing a border, and soaking them as well.

And then we get into some of those fractures and tendonitis. A lot of it's just decreasing activity. Immobilizing, performing some exercises, and then obviously the trauma and related injuries, there's potential surgery, um, if something serious happens.

Host: Yeah. Worst case scenario. Of course. It's been good stuff today. I told you before we got started, I'm like, I have a lot of questions for you, you know, cause I don't know a lot about hiking, not being a hiker. So I'm sure for me, obviously, and for everybody else, lots of good information here.

Just wondering if listeners want to learn more about foot care for hiking or anything else, and they want to connect with you, how can they find you?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Absolutely. So I'm one of the Foot and Ankle Specialists at Orthopedic Associates of Central Maryland. I'm at four different offices around the Maryland area, and I am located on our website at mdbonedocs.org, so you can find us there.

Host: Yeah. Give you a chance here at the end. Always a good guest. If you had to boil it down to three top tips for maintaining healthy feet while we're trying to enjoy the outdoors, hiking, whatever it might be, what would they be?

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Yeah, I think the biggest thing, number one is, properly fitting shoe gear, whether that be boots or shoes. Just like we talked about it starts from when you walk in the store to when you walk out. You want to make sure they're correctly fitted, and obviously wearing socks with them as well.

Number two is having dry socks and dry feet, you know, wet, anything is not a good thing. So not only having waterproof boots, but having socks and even a backup pair of socks in case that primary pair gets wet. And then the last thing is just general hygiene, you know, taking those breaks, checking your footwear and your socks to make sure if they're wet or damaged, elevating your feet, sometimes just wiggling your toes and letting them air out. Inspect them before, during and after your hike. And then at the end of the hike, obviously having that clean or dry pair of socks to put on and some just general powder for drying if needed.

Host: Well, that's perfect. Like I said, a lot of great information today for hikers and maybe, you know, just weekend warriors. So thank you so much. Appreciate it.

Hayden L. Hoffler, DPM/Foot and Ankle Surgeon: Absolutely. Thanks for having me.

Host: Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb and That Was a Bone That's Fixed.