In the summer of 2017 I decided to go for a little walk –  a little 500 mile walk. 

If you read my last blog about cycling you’ll know that pre-planning my adventures is not my strong-suit. This story will continue that theme. 

To give a little background, I was wrapping up grad school and mending a pretty gnarly injury to my meniscus from about 5 months prior. Of course, I knew that this would be a good time for a strenuous backpacking trip. I set out to hike the Colorado Trail which is an absolutely stunning, 500 mile traverse that stretches from Denver to Durango.

Being in Colorado, the trail hosts some significant and steep daily elevation gains. Not to mention, it rained the whole first day and I think I may have gotten trench foot. I spent more than a day off trail to lance and nurse a golf-ball-sized blood blister on my foot. But, once that dried up I was blessed with several days of beautiful hiking and camping. 

When it Rains it Pours

As my mileage increased I started to notice another problem. I had some pain in the front of my foot. It would start at around 15-20 miles and make the last few miles of every day miserable. I would limp into camp, lay down and try my best not to move for the rest of the night. Not ideal.  

This time I had enough education to know why I was hurting and what I could do about it. Metatarsalgia, which is a fancy Latin term for “pain in the front of my foot” was to blame. The cause of metatarsalgia is limited flexibility in the ankles, specifically the motion where the foot is moved towards the shin (dorsiflexion).  

Thanks to evolution, humans need around 15-20 degrees of motion in order to walk effectively. I was hanging out at a solid 5 degrees. When the appropriate range of motion isn’t there, the body has to over compensate. This can happen in multiple ways. My personal compensation means an increase in pressure to the bones in the front of my foot as I walk. 

In my normal day to day life this doesn’t bother me very much. However, walking 20 miles up a mountain with a 30 pound pack was not my normal day to day.

My knowledge from PT school and the tips below allowed me to complete and enjoy the rest of my adventure. 

Quick Tips

Obviously, the trail doesn’t boast a plethora of options for those in need of addressing this sort of injury. If you are an avid hiker or trail runner with similar issues here are some things you can try:

Metatarsal pads – These are little inserts you put into your shoe that are designed to offload the pressure to the front of your foot and transfer it to another area. 

Heel lift – If the source of the problem is poor ankle mobility (dorsiflexion) then adding a little heel to your shoe can help give yourself an artificial increase in dorsiflexion.

New shoes – Shoes have a measurement called a heel drop which is the difference between the depth of the back of shoe versus the front of the shoe.  You can buy a shoe with a larger heel drop which, similar to the heel lift, can give you an artificial increase in dorsiflexion. 

Stretch Often – For long term benefit in this situation, the best fix is going to be increasing the mobility in your ankle which means stretching the calf muscles. Lots and lots of stretching the calf muscles. 




Tyler Matherne

Tyler is a Louisiana born transplant to the Asheville area. He received his Doctorate of Physical Therapy from Western Carolina University and completed a year-long orthopedic residency program at UNC. He is also a Certified Strength and Condition Specialist. Tyler likes to use all the skills he has learned from these experiences to assess his patients' movement patterns, identify the biochemical reasons for their pain, help them work towards addressing those deficits and give them the tools to help themselves. In his spare time he enjoys all of the wonderful hiking and camping that the Asheville area has to offer. You might also find him cycling on the park way, running around town, or knee deep in a river trying to get some trout. His favorite quote is “A ship in harbor is safe, but that is not what ships are built for.” - John A. Shedd Doctor of Physical Therapy Board Certified Orthopedic Clinical Specialist #56605 Certified Strength and Conditioning Specialist (CSCS)