Rock climbing injuries are common in the San Francisco Bay Area. In order to remain active and return to climbing as soon as possible after a foot or ankle injury, it is important to get the very best treatment as quickly as possible.
There a broad range of foot and ankle injuries that can happen when climbing. Climbing shoes themselves can lead to minor complaints like blisters, ingrown toenails, and thick yellow toenails. This is because the shoes (typically worn 2-2 1/2 sizes smaller than street shoes) severely cramp the toes. Of course this is necessary to allow a climber to edge on a tiny foothold. But when you wear these shoes all the way up the Royal Arches (and on the descent) you are asking for trouble.
Foot and Toenail Fungus
There is some speculation that climbers may develop athlete’s foot infections and toenail fungus more often than other athletes. This is really for two reasons. First, the shoes themselves have high rubber lasts that don’t breathe. The retained moisture and dampness in a climbing shoes creates the idea environment for fungus to thrive. And of course no one ever washes climbing shoes. In addition, many climbers at indoor climbing gyms will take off the painfully tight shoes in between routes. When you stand there in the gym tied to a belay anchor, you are forced to stand where every other climber’s sweaty bare feet have stood. When you do, you may pick up the fungus that causes athletes foot.
Some people recommend washing the shoes periodically to help reduce the amount of foot fungus spores in the climbing shoes. As a climber myself, I wouldn’t do that. If you wash your climbing shoes, they will never fit properly again. And we all know that the fit of the shoes is critical to climbing confidence. The best way to decrease the chances of getting athletes foot is to spray and antifungal powder in your climbing shoes. If you can, try to avoid standing barefoot when tethered to the belay anchors in the climbing gym.
When you stuff those feet into your painfully tight shoes, you can easily get an ingrown toenail. By taking some simple precautions, you can help prevent this from happening. Make sure you cut your nails straight across. The nails should be shorter than the end of the toe, but not too short. Cutting the nails at an angle is the best way to cause an ingrown toenail. If you believe you are starting to get an ingrown toenail after a climbing session, get help from a podiatrist immediately. The longer you wait to treat an ingrown toenail, the worse it becomes. If you get treatment right away, you can likely resume climbing within a day or two. But if you wait until it becomes painfully infected and severely ingrown, you might need minor toenail surgery. If this happens you won’t be able to climb for more than a week.
Blisters from Climbing
Blisters happen whenever there is both pressure and friction in one highly focused spot on the foot or toes. There is a lot of pressure in climbing shoes (because they are so tight). If the shoes fit correctly, there is usually very little friction. But when the climbing shoes don’t fit like a glove, the heel or the big toe may slide around while edging. In this case you can get some nasty blisters. If you repeatedly get blisters on your feet when you climb, its time to shop for a better fitting pair of climbing shoes.
If you do get a painful blister (and it isn’t killing you) don’t pop it until you are done with the climb. Blisters will heal fastest if drained and the top of the blister is allowed to adhere down to the underlying raw skin. But if you drain the blister and keep climbing, the roof of the blister will slide around in the shoe. Sliding around like that the skin can tear and the blister can become infected. If the blister isn’t painful, then definitely don’t pop it.
If you fall when when climbing, all bets are off. If the route is steep enough you could potentially fall a long way without hitting anything. But on low-angle routes and those with ledges, bad thing can happen. I have seen climbers with broken heel bones (also called calcaneal fractures), broken metatarsal, broken ankles and mid-foot fractures. In most cases a broken bone in the foot will keep you off the rocks for several weeks. When surgery is required to set the broken bone back in position, you can expect a two to three month recover period before climbing can resume.
If you fall when climbing and notice some swelling, pain and bruising the chances are goo that you broke something. Don’t assume that it isn’t broken just because you were able to hobble all the way back to the car. I have seen several climbers with broken feet that continued the descent and hike after after bad falls.
If you suspect a fracture or sprain it is important to see a foot fracture specialist as quickly as possible. Many of these fracture patterns are subtle and frequently missed in the Emergency Rooms. In fact, research shows that certain foot fractures are very likely to be missed and left untreated if evaluated in the E.R. and not by a foot specialist.
Of all the injuries sustained by climbers, sprained ankles may be the most common. Often the climber will roll the ankle on the descent. Hiking down a talus slope wearing a pack with a coiled rope swinging you off balance is a recipe for disaster. Popular “approach shoes” are light weight and have sticky rubber on the soles, but don’t provide much support for the ankle.
Sprained ankles need treatment to heal. The quicker you get that treatment, the better your ankle will heal and the faster you will be able to get back to climbing. Immediately after the ankle sprain, you should start ankle sprain first aid. You can remember this as P.R.I.C.E. Protect the ankle (wear a brace or fracture walker). Rest (don’t walk on it or move it if it hurts). Ice (apply ice to the painful area for 20-30 minutes of each area while you are awake the first 48 hours after the sprain). Compression (apply an ACE wrap or have a podiatrist apply a more effective type of compressive dressing to keep the swelling down). Elevate (keep the ankle above your hear for the first 24 hours).
And most importantly call for help from an ankle specialist. Some ankle sprains will heal just fine, but many sprained ankles have associated chip fractures in the ankle that can lead to arthritis and pain down the road. These subtle ankle fractures look a lot like a standard ankle sprain and are also know to be missed in the Emergency Room. Get expert care right away.
Climbing may be a dangerous activity, but to the seasoned climber the risk is well worth the reward. With a little prevention, you can avoid the minor foot complaints that plague climbers. If you do have a mishap and get a more serious problem, seek the best treatment you can find. You’ll be back out on your favoirte route in Yosemite or the Pinnacles in no time.
Dr. Christopher Segler is a foot and ankle fracture specialist in San Francisco. He is also a veteran climber who has climbed El Capitan, free-soloed the Royal Arches and has attempted new alpine routes in Alaska. He was awarded a grant from the American Alpine Club to carry out the largest research project ever undertaken on lower extremity climbing injuries. He also won two different awards from the American College of Foot and Ankle Surgeons for his research on diagnosing foot fractures and ankle fracture that can happen in climbers, but might get missed in the Emergency Room. He now practices surgical podiatry in the San Francisco Bay Area. He makes emergency house calls for injured climbers so they don’t have to try to negotiate traffic and find a podiatry office. If you have a question about a climbing injury, it is best to reach the award-winning expert directly by calling (415) 308-0833.