Help with Foot and Knee Pain and Problems while Hiking and Backpacking

A journalist just contacted me asking for tips about keeping your feet and knees healthy and happy on the trail. My quick response is below.

Keep shoes on while crossing rough rivers. It’ll also ice your feet!

I’ve had significant previous problems with foot pain! I broke my foot in Lyell Canyon in the Sierra in 2002 and had to be carried out by a horse. I also walked much of the PCT with various pains, perhaps including undiagnosed stress fractures. And then, i’ve also worked in wilderness therapy, where we look, ask and touch each clients feet three times a day! I’ve also sold hiking boots and shoes…



I believe that I broke my foot partially due to wearing worn out shoes that had too little protection. I’m a big fan of trail runners, but now I look for ones that have at least some sort of rock plate. There is a spectrum of trail runners. Some are more like running shoes, some more like boots. I go in the middle.

The flexibility of trail runners is pretty important for avoiding foot problems. I believe that a fully rigid sole forces your ankle to roll, instead of having the shoe move around the rock that you stepped on weirdly. Big boots cause big blisters. Wear them only if your feet or trip really requires them.

I consistently go for shoes that are breathable, so no goretex. But I also aim for mesh that does allow sand to enter.

Change your socks frequently. If you’re having problems, change them in the middle of the day. Take your feet out and let them dry at lunch and breaks. This helps toughen the skin. Wet skin is more prone to “the funk”,  blisters, non-freezing cold injuries, amongst others.

Fungal infections lead to more foot problems. Use clotrimazole usp 1%.

Avoid cold injuries. Actually take your feet out and look at them. If your capillary refill is poor, you have white waxy skin, or other issue, stop and rewarm them. Then do something different.

Make sure you have enough room to wiggle your toes and that there is no chance that your toes will touch the front of your shoes on a downhill. People typically have too small shoes.
Hiking poles do wonderful things for your feet and knees. I’ve also had success using Glucosamine and Chondroitin.

A foot massage can go a long way towards helping beat up feet feel better. It also feels great to walk around barefoot for a while. Be careful with that though, you really don’t want to cut your foot ten miles from the road. It’s probably best not to walk around barefoot at night.

Toughen your feet before a trip by applying tincture of benzoin to problem areas like your heels.

Avoid and treat ingrown toenails by not rounding the nail when you cut them. Try to keep them cut “square”. If you have an ingrown nail, treat it in the field by cutting a ‘V’ into the end of the nail. This will open up some space for the nail to move back towards where it should go.

I try to avoid using medications, but if you’re experiencing swelling or severe pain, pop some “vitamin I” (ibuprofen). Beware of taking too much of it though, it can have serious health implications. Ibuprofen cream makes a lot of sense for knee pain and the like. Arnica cream works well for me too.

Knee braces.. use em if you need them! Learn how to properly tape a knee or ankle. It’s a good skill. Learn about your specific pain, not all braces are appropriate.

Walk less miles. Take more breaks. Rest with your feet in the air.

Most importantly, go light!

Reader, what works for you?


  1. Ryan

    I have found that liner socks make a huge difference. Not everyone I see hiking use them and had blisters and pain to show for it. Up to this point, I have never had a bad blister while wearing moderately heavy boots (need them for a bad ankle).

    BTW: I am really enjoying your updated blog!

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