Featuring insights from Dr. Jeff Hammond, DPM, Double Board-Certified in Foot and Ankle Medicine and Surgery
Feet are the unsung heroes of endurance performance. They carry athletes up mountains, across finish lines, and through the long training days that build strength and resilience. Despite their critical role, foot and ankle health often receive attention only after pain or injury shows up.
Dr. Jeff Hammond, a double board-certified podiatrist who works extensively with endurance athletes—from first-time hikers to multi-day ultrarunners—shared some evidence-based guidance with us to help athletes stay strong, resilient, and pain-free from the ground up.
This article outlines key principles in shoe selection, orthotic use, blister prevention, moisture management, and cold-weather foot care—practical knowledge every mountain and endurance athlete should know.
The Shoe Doesn’t Make the Runner - But It Matters
Questions about shoe drop (the difference in height between heel and forefoot) are among the most common in the endurance community. While zero-drop or minimalist shoes have gained popularity, there is no single “best” drop for every athlete. What matters most is what the body is adapted to—and how any transition is managed.
Most people grow up wearing shoes with some degree of heel lift, and their Achilles tendons and calf musculature adapt accordingly. A sudden switch to zero-drop footwear can overstretch these tissues, leading to issues such as Achilles tendinitis, plantar fasciitis, or posterior tibial tendon pain.
Zero-drop shoes can be highly effective when introduced progressively. Athletes can start by incorporating barefoot strides on grass—just 100 yards at a time—to build tolerance and mobility. Ultimately, comfort and adaptation are more important than the specific number of millimeters under the heel.
Orthotics: A Custom Tool, Not a Crutch
Orthotics often spark debate. Some athletes consider them essential, others unnecessary. The truth lies in understanding function: orthotics are tools designed to support efficient biomechanics, not rigid corrections to force the foot into an artificial “ideal.” Dr. Hammond’s take is that most people can benefit from a properly fitted orthotic—especially athletes.
Dr. Hammond emphasizes the importance of creating orthotics around an athlete’s functional neutral—the natural movement pattern unique to each foot. This approach enhances muscular efficiency, delays fatigue, and reduces overuse injury risk.
Over-the-counter inserts can serve as a temporary solution, but for athletes with chronic issues or high-volume training goals, custom orthotics provide precision support that can extend performance longevity and comfort over long training cycles.
Blister Prevention Starts Long Before Race Day
Blisters are not inevitable. In fact, with thoughtful preparation, Dr. Hammond has witnessed many endurance athletes complete 100- or 200-mile events without significant foot trauma.
Prevention starts with self-awareness. Identify friction-prone areas and tape them before they become hot spots. Sock choice also matters: thin, moisture-wicking socks work best in hot or wet conditions, while thicker, padded options offer protection during long descents or in cold weather. Rotating socks and shoes at aid stations or during multi-day efforts helps keep the feet dry and intact.
If a blister forms, prompt treatment is key. Draining the blister while keeping the overlying skin intact preserves a natural protective layer. Re-covering with moleskin or a barrier dressing helps prevent further friction and irritation.
Trench Foot is Real - and Preventable
Extended exposure to moisture—whether from rain, river crossings, or sweat—can lead to skin maceration and trench foot–like conditions. Once the skin softens and breaks down, deterioration happens quickly.
Dr. Hammond’s recommendations are simple but discipline is required: manage moisture proactively. Swap socks and shoes when possible, and avoid waterproof footwear in humid conditions where sweat cannot escape. Gore-Tex shoes are valuable in alpine or cold settings but can be detrimental in warm, wet environments because they trap moisture and heat.
A light dusting of talcum or antifungal (eg. Gold Bond) powder can help reduce friction, but overuse can create clumping and irritation – so less is more.
Cold Exposure: From Chilblains to Frostbite
Cold-weather athletes face unique challenges, including frostbite and chilblains. Both can end a race—and in severe cases, a season.
Layering is the best defense. Start with thin, moisture-wicking socks and add insulation as conditions demand. If frostbite is suspected, the goal is gradual rewarming—not rapid heating, which can worsen tissue damage. Frostbite acts like a burn, damaging tissue through loss of blood flow. Once affected, areas become more vulnerable in the future due to compromised circulation.
Chilblains are painful vascular spasms triggered by cold exposure, which are common in athletes with circulatory sensitivities or autoimmune conditions. Treatment is challenging, but a focus on warmth, gradual rewarming, and proper footwear fit to avoid compression can make a difference.
Foot Pain and Fatigue on Long Training Days
Foot pain and fatigue are common on steep or high-volume training days. Prevention lies in progressive loading—avoiding large jumps in duration or intensity. Increases of 15–30 minutes per week are sufficient to build durability without overloading the musculoskeletal system.
When fatigue does set in, early intervention helps. Anti-inflammatory creams, taping, or supportive inserts may help. However, persistent pain should be treated as a signal to adjust training load and address underlying biomechanical or footwear issues.
Final Thoughts
Every athlete’s feet are unique, reflecting personal biomechanics, training history, and terrain exposure. Foot care should be viewed not as maintenance, but as foundational performance work. Small problems left unaddressed quickly become bigger issues.
Attention to footwear, orthotics, and preventive care supports not just comfort, but long-term durability—the ability to train and compete consistently over years, not just seasons.
Whether you’re training for your first 50K, aiming for a PR at Cocodona 250, or planning a fast-packing adventure in the mountains, foot care is your foundation. Build it wisely.
Want more? Listen to the podcast episode with Dr. Jeff Hammond >>
Dr. Jeff Hammond is double board-certified in Foot and Ankle Medicine and Surgery. He’s based in Provo, Utah and works with athletes of all levels and both in-person and through telehealth consultations.
This article is part of Uphill Athlete’s mission to deliver science-based, experience-proven training and recovery insights for mountain athletes worldwide.