Foot care on a thru-hike as a diabetic.

[Smoky Spoon]

I am a diabetic and taking a thru-hike in 2016. I will be going NoBo. I normally do not have any trouble with my feet when hiking but realize that may change on a longer distance hike on the AT.

Presently before and when taking a hike I do these things: I break in all shoes or boots on the trail at least 50 miles before my hike. I change into clean socks everyday. When retiring for the evening I wash my feet and give them a good rub down. I take second skin and use it if I suspect any kind of blisters forming.

My questions are:

IS THERE ANYTHING ELSE I COULD DO OR DO BETTER?

WHAT KIND OF FOOT CARE AND PREVENTION DO YOU DO ON A THRU-HIKE?

DO YOU KNOW OF OTHER THINGS THAT DIABETICS MAY TRY ON A THRU-HIKE THAT WAS HELPFUL TO THEM?

Thank you for your help.

[Jordan's Dad]

I am also a diabetic hiker doing a nobo next year, so I am intensely interested in what others have to say on this subject. I do a visual and manual inspection of my feet every day, and I highly recommend the book "Fixing Your Feet" by John Vonhof. Best of luck to you, Smoky Spoon.

[Slo-go'en]

The AT is a very wet trail, especially in the spring. Hiking in wet boots (and therefore wet socks) promotes blisters.

I would strongly suggest using GTX lined (Gortex) boots. It can be impossible to keep your feet dry during an all day or heavy rain as it will run down your leg and into your boots, but a GTX boot will keep your feet dry when walking on a wet trail, crossing streams and grass which is just wet from dew. So long as the water does not top the boot (which can happen when the trail becomes a river during a heavy rain), your in decent shape.

Some will argue that a GTX boot takes a long time to dry once it gets wet on the inside, I have not found that to be the case. Later in the summer you might want to switch to a breathable boot or shoe as mostly you just have to deal with afternoon thundershowers.

The other thing would be to simply limit your daily mileage, especially in the beginning.

A few years back one diabetic hiker had to be taken off the trail not once, but twice by ambulance before getting 20 miles into Georgia. He was found passed out on the trail due to insulin shock.

I meet another diabetic hiker who had to leave the trail after a couple of weeks as he found he simply could not effectively manage his blood sugar level and he was a young kid in his 20's.

So be careful. Hopefully you will hear from other diabetics who were more successful in their blood sugar management.

[squeezebox]

Does compression socks to improve venous return make any sense?

[Smoky Spoon]

Jordans Dad, thank you for the book recommendation. I have never heard of that book and will see about getting it. I too do the inspection every day on my feet. More than once it has helped.
I hope we get some good feedback because our feet is the one thing going that can surely knock us off the trail. I try to do everything proactively but with diabetes you never know.

Thanks again for the book tip.

I am also a diabetic hiker doing a nobo next year, so I am intensely interested in what others have to say on this subject. I do a visual and manual inspection of my feet every day, and I highly recommend the book "Fixing Your Feet" by John Vonhof. Best of luck to you, Smoky Spoon.

[Smoky Spoon]

Not sure but plan on asking my foot doc that very question now that you mentioned it.

Thank you, I hope it can help.

Does compression socks to improve venous return make any sense?

[Elder]

Check out www.wrightsocks.com Guaranteed blister free by a patented sewn in liner. Wear out your socks, not your feet.

[Options]

Just discovered this thread. Sounds like you have a pretty good plan for foot care. I'm an insulin-dependent PWD who is contemplating a 2016 thru attempt. Good luck on the trail!!

[squeezebox]

Please wear one of those med bracelets or such, in case someone finds you passed out somewhere. Be safe! Enjoy!

[Options]

Please wear one of those med bracelets or such, in case someone finds you passed out somewhere. Be safe! Enjoy!

Agree with squeezebox. This item is a necessity as is communicating one's condition with other hikers.

[RockDoc]

Your biggest challenge on the trail may be dealing with the typical hiker's diet of carbs and sugar. There are ways to do it but you have to plan ahead.

[TheEngineer]

Sadly, uncontrolled diabetes causes loss of sensation in the feet. You'd get a blister and not feel the pain, so it only gets worse. Therefore, if you are in this condition, you must visually inspect often. One plan is to stop at noon, swap your socks out to a second pair. The first pair gets washed and hung on the back of the pack ready for the next day. At this time, inspect for any hot spots.

(You can manage to an A1C of 5.5 or so. I know people that do it. Then, if you get a blister, you'll feel the pain, and know to treat your foot.)

Overall, everyone should test the shoe/boot and sock combination on a mountain. Here in NH, I'm planning on going up Monadnock with each combination. Trying this on the AT trail the first day is suicide IMHO. If you come off the mountain, and your toe nails are bloody, you boots are too small. On the way down, your foot can slip forward. Get one size larger shoe/boot and try again.

Carry a diagonal toe nail clipper and keep the nails as short as possible. Long nails will dig into adjacent toes.

Carry some 1.5" surgical tape to cover hot spots. Moleskin and Molefoam can also be used. I'm currently testing Leukotape, but the jury is still out. (Put the tape on, stand in a bucket of water for 15 minutes, then try to get the tape off. If it comes off easy, it is rejected.)

Carry a roll of 2 inch gauze for any wound care. It can be cut into pads if you need them, but you can't turn a pad into rolled bandage.

Get a prescription and carry Bactroban antibiotic ointment for wound care.

Test out various foot balms. I'm currently trying Bag-Balm made in Lyndonville, VT. If anything, the Vasoline in the product will help keep the foot tissue drier but I don't know yet if I'd carry it.

As for socks, there are two schools. One says use two nylon socks with a non-water proof boot/shoe. They get wet but dry quicker. The other school says go with wool whatever you do for a boot. Wool keeps its warmth when wet and won't smell as bad as nylon. Hikers report gortex boots don't keep your feet dry anyway so skip the weight and expense. Others swear by them. (Me, I've been up on Mt. Washington, NH when the wind is howling at 40 mph, with fog and light rain and you just have to push on. Anything but heavy wool socks, wet or not, are clearly unacceptable. I had a choice of wet and cold (nylon) or wet and warm (wool) and I chose warm.)

One recommendation is to carry one pair of wool socks just for sleeping. Keep them in the sleeping bag and they will keep your feet toasty.

Gaiters can be worn to keep rocks out of your shoes. Others don't like the weight and just stop from time to time to remove the stones.

Every pound you remove from your shoe/sock combination is the equivalent of six pounds off the pack, so you want to get the most comfortable lightweight shoes you can.

[RangerZ]

Sadly, uncontrolled diabetes causes loss of sensation in the feet. You'd get a blister and not feel the pain, so it only gets worse. Therefore, if you are in this condition, you must visually inspect often. One plan is to stop at noon, swap your socks out to a second pair. The first pair gets washed and hung on the back of the pack ready for the next day. At this time, inspect for any hot spots.

(You can manage to an A1C of 5.5 or so. I know people that do it. Then, if you get a blister, you'll feel the pain, and know to treat your foot.)

Overall, everyone should test the shoe/boot and sock combination on a mountain. Here in NH, I'm planning on going up Monadnock with each combination. Trying this on the AT trail the first day is suicide IMHO. If you come off the mountain, and your toe nails are bloody, you boots are too small. On the way down, your foot can slip forward. Get one size larger shoe/boot and try again.

Carry a diagonal toe nail clipper and keep the nails as short as possible. Long nails will dig into adjacent toes.

Carry some 1.5" surgical tape to cover hot spots. Moleskin and Molefoam can also be used. I'm currently testing Leukotape, but the jury is still out. (Put the tape on, stand in a bucket of water for 15 minutes, then try to get the tape off. If it comes off easy, it is rejected.)

Carry a roll of 2 inch gauze for any wound care. It can be cut into pads if you need them, but you can't turn a pad into rolled bandage.

Get a prescription and carry Bactroban antibiotic ointment for wound care.

Test out various foot balms. I'm currently trying Bag-Balm made in Lyndonville, VT. If anything, the Vasoline in the product will help keep the foot tissue drier but I don't know yet if I'd carry it.

As for socks, there are two schools. One says use two nylon socks with a non-water proof boot/shoe. They get wet but dry quicker. The other school says go with wool whatever you do for a boot. Wool keeps its warmth when wet and won't smell as bad as nylon. Hikers report gortex boots don't keep your feet dry anyway so skip the weight and expense. Others swear by them. (Me, I've been up on Mt. Washington, NH when the wind is howling at 40 mph, with fog and light rain and you just have to push on. Anything but heavy wool socks, wet or not, are clearly unacceptable. I had a choice of wet and cold (nylon) or wet and warm (wool) and I chose warm.)

One recommendation is to carry one pair of wool socks just for sleeping. Keep them in the sleeping bag and they will keep your feet toasty.

Gaiters can be worn to keep rocks out of your shoes. Others don't like the weight and just stop from time to time to remove the stones.

Every pound you remove from your shoe/sock combination is the equivalent of six pounds off the pack, so you want to get the most comfortable lightweight shoes you can.

All excellent advice. Along with all of the LD hiker's problems and prep, diabetic hikers have got to understand and manage their BGL. Working their A1c down before a hike is as important as any gear shakedown.