Helping Our Patients Succeed in the Great Outdoors, Part II: Addressing Foot and Ankle Pathologies for Hiking

This is part II of our series discussing common problems hikers may encounter out on the trails, with an emphasis and focus on our patients with conditions such as hemiplegia, diplegia, spasticity, co-contractures, and deformity of the ankle and foot that could increase the chance of injury. In part I, we focused on the ankle and hindfoot, providing tips for addressing ankle pathologies and stability as well as preventing issues from developing in our patient population due to their increased propensity for injury on uneven terrain. Now we delve into the midfoot and forefoot to continue the theme of providing the best tools for our patients to be able to enjoy outdoor activities with experiences such as hiking and getting out there with confidence.

Plantar Fasciitis

Plantar fasciitis is a common source of foot pain many individuals experience, especially those that are active.¹ Pain is located in the anteromedial portion of the calcaneus and is usually worse at the beginning and end of the day.¹ The plantar fascia is a structure of connective tissue that extends from the calcaneal tuberosity to the metatarsal heads.^1-2 Plantar fasciitis, more accurately called plantar fasciopathy as it is not inflammatory, is a degenerative overuse condition.¹ This condition is caused by excess repetition through prolonged loading on the medial arch through activities such as running, walking, hiking, or jobs that keep you on your feet, which creates microtears in the contracted fascia.³ Risk factors include a high body mass index that causes additional load to the plantar fascia, pes planus, pes cavus, limited dorsiflexion, or excess plantarflexion.^2-3 Patients with cerebral palsy or diplegia are at risk as they often have tight Achilles tendons with limited dorsiflexion.