Most of the pages on this site are about things external to you: the trail, the weather, gear, maps, and so on. But the other ingredient in any long trek is you, for it is both a physical and mental challenge. I’m not a qualified medical person, so you cannot rely on what I say here, but I can speak from my own experience, and this seems common enough to that of others.
You will almost certainly get blisters. That’s the bad news. But the good news is that you will stop getting them after about a month, when your skin has hardened into calluses at friction points. What’s more, with a bit of care you could aim to be entirely blister free, and certainly prevent them making hiking a misery.
There is quite a lot written about blister prevention and treatment, but much of it is from the point of view of runners. Their solutions are not necessarily applicable when you are active for long periods of time and doing so day after day.
Lets start with prevention. Blisters are caused by rubbing. That is, rubbing where the skin is held more or less in one place by pressure while your foot moves. The inner and outer layers of skin eventually separate. One website compares this to holding your thumb on a peach and moving it back and forth while not allowing it to slide over the skin surface. Eventually the outer skin of the peach will separate from the flesh inside. So to prevent that happening the thumb needs to move over the skin easily and not stick to it. Or have the peach and thumb move together.
So shoe/boot fit is the first place to start: not too loose and not too tight and no rubbing points. It is unlikely you will be able to figure out any rubbing points in the store, so you should really hike long distance for a couple of days or more in your footwear well before the TA to see if you get any blisters. If so, then you will have time to let them heal and will know in advance the problem areas to deal with.
Second is allowing your skin to be slippery. Some runners use liquid lubricants or powders, but these don’t last long. Another running trick is electricians tape on known blister points because it is very slippery and cheap. However, it doesn’t stick well to skin for long periods of time. Duct tape, which you may be carrying for repairs to equipment, is stickier and slippery but not as elastic as some strapping tapes (see below).
When you use tape you need to think of the movement against it to avoid the ends coming free. If you get heel blisters, for example, and want to prevent them, then a short bit of tape around the heel will quickly get rubbed loose as your heel goes up and down. It needs to go from under your heel to above the shoe/boot top, and should be rounded at the corners to prevent it being rubbed off at those points. Toes are another area: you need a piece of tape that goes the length of the toe underneath and wraps up and along the top. And then another piece around the circumference of the toe.
Some socks are advertised as anti-blister as they have two or more layers. These rub between each other rather than against your skin. I haven’t tried one of these but a cheaper alternative that works well for me is a thin inner sock, preferably a slippery one. I use bamboo dress socks (which are actually just rayon). Then I put on my regular sock over that.
You’ve probably heard that wet skin is more vulnerable to blisters forming. Anyone doing the TA is likely to have feet wet for days at a time on some stretches where there are a lot of river and stream crossings, so it is worth having some strategies to deal with this risk to blistering. Even on dry terrain, your feet can get sweaty walking, so it is often recommended to take your footwear and socks off at lunch break to let your feet and socks dry out.
Toes seem to be a blister trouble zone. They can rub against each other, get impacted by the front of the shoe, or simply move around a lot. There are a number of options to stop them rubbing together. Socks with toes in them such as Barefootinc or Inji work for me. I have also sewn a divide between the big toe and the next one in a regular sock and that was effective in preventing those two toes rubbing together. I’m a fan of gel tubes that you cut to length and push over the toe. They do more than stop toes rubbing against each other, and help cushion both nails (which can develop blisters underneath and fall off) and the underside of toes. Hikers Wool can be used for this too. It is sheep wool that you can buy in some tramping stores. It sticks quite well to socks, so stays in place. It can be used to cushion any area of the foot. You can always save some money and pick sheep wool off fences yourself, though you might want to wash it before use. At a real pinch I have found that strong, glossy leaves can prevent rubbing, but they don’t last too long of course.
Whatever the case, and this can’t be emphasised enough, as soon as you feel the beginnings of a blister you should stop right then and deal with it. Far, far better to stop one developing than to deal with it already formed and a subsequent week or more of healing time. Don’t wait until your lunch stop.
OK, so much for prevention, what about treatment and the question of whether to pop or not. Opinion seems divided. If the blister is not causing pain and you leave it alone then you have a ready-made sterile covering and cushioning provided by the blister. You just need to ensure it doesn’t get worse by cushioning it or stopping the rubbing against it. Otherwise, relieving the fluid pressure can reduce pain. Make sure the area around it is clean, then use a needle sterilised in a flame, or with alcohol, and make a hole at the lowest edge so fluid can drain with gravity as it develops. I think more than one hole is best, as they plug up easily with dried fluid. If you have antiseptic cream, smear this around the hole, or if the outer skin has detached or is half off, over the raw skin. Alcohol can be used, but may sting.
Then you need to prevent the popped blister rubbing. Some medical dressing, cotton wool, or even toilet paper over it can absorb more fluid and give a bit of cushioning. Then you can tape over this. Make sure the tape is not sticking to the now loose skin (you can stick some tape in reverse to the covering tape to provide a smooth surface over the blister). Duct tape has been mentioned, but preferable is strapping tape. You can buy this in supermarkets, pharmacies and sporting stores. Get the stretchy version. It usually has small holes for the skin to breathe, sticks well, but also comes off easily when you want it to without leaving a residue behind, unlike duct tape or bandage tapes. And it is quite elastic, which helps it stay on. Rub it to warm and soften the adhesive once you have applied it to make it stick better. You can always run duct tape over the top of it too, as it provides a good base for adhesion. Whatever tape you use, to get a good stick you should make sure your foot is really clean, grease-free and very dry before taping. If you have some methylated spirits for cooking that is great for drying the skin and removing skin oil.
Quite effective, both to prevent blisters forming and to cover existing ones are the Compeed or Scholl blister cushions. They are not cheap, but not much is when it comes to blister treatment. As with tape, make sure the skin is super dry and oil free before sticking one of these down. Once in place they are very hard to remove and generally just wear off over time.
Things I have not tried are rings of moleskin, which allow you to put tape or a dressing over a blister without it touching the blister itself, and tincture of benzoin, which has antiseptic properties, toughens up skin, and makes an excellent base for adhesive tape to make it stick better. Reskin blister protection patches (available in running stores) a bit like Compeed and Scholl patches but reusable are another product I haven’t tried but which sound good.
Lastly, before starting the TA, you can work on building up the calluses mentioned at the beginning by walking around in bare feet on pavements and other hard surfaces to toughen the skin under your feet.
Joints, muscles, tendons
You will be giving your lower body a good thrashing, so you should make sure that nothing becomes a show stopper and you don’t develop a permanent injury. A niggle that develops during a two or three day tramp can easily become much more serious after 30 or more days of walking and could become a long term problem in later life. This is another reason why you should get some practice in before you start, so you can diagnose potential problems and get some advice on how to prevent them getting worse. You can try and work out problems and solutions yourself with a bit of reading on the internet, but it’s much better to get specialist advice from a podiatrist and/or physiotherapist or sports doctor. And if you are young and think that aches and pains are old peoples issues, well that may be so, but you will be there yourself one day and might regret the lack of care you gave your body earlier. A doctor said to me: ‘You know, those professional rugby players, when they retire at age 30 they have the body of a 70 year old.’
You might want to throw away the insole that came with your shoe or boot and get a better one. Even the must expensive footwear tends to have poor quality insoles. But before you do that, you could check to see if you under or over pronate, or have flat arches, as you can buy off-the-shelf insoles for different types of gait and foot alignments.
There is the whole debate about a minimalist approach to footwear, with the argument that your feet were designed for walking and should be allowed to do their work, vs the alternative of giving them as much cushioning and support as possible. I can’t get into this here, except to observe that as you get older and develop foot problems you might want to go the latter way. I love my Hoka walking shoes which have good cushioning and a remarkably stiff last (foot bed), giving the stiffness of a tramping boot without the weight.
Going down long stretches of hill can be tough on the toes. Cut your toe nails as short as you can to prevent nail damage as they strike the front of your footwear (and to help lengthen the life of your socks). Re-lace your footwear to stop your feet slipping back and forwards. You can tie the laces at the half way point as well as the usual place further up, allowing you to retain low pressure over the forefoot, but have tightness on the upper foot to stop it moving forward. And you can always try gel pads in front of the toes, though keeping them from moving out of position can be difficult.
It could be worth doing exercises to strengthen your ankles before you start your walk, as rolling over and twisting an ankle is going to put you out of action for a while. There are some you can do with elastic fitness bands, though my physiotherapist suggested just spending lots of time walking over uneven ground. If you do twist your ankle, then the recommended treatment is RICE: Rest, Ice, Compression and Elevation. So you want to take the pressure off the ankle at first, and reduce swelling by keeping it cold, applying a compression bandage, and raising it above your body.
The drug Voltaren can help reduce swelling too. Voltaren cream is recommended by some as a safer alternative than the pill version, as it only goes to the problem area, rather than circulate through your whole body. But the active ingredient is only absorbed so far below the skin, so the cream is best for surface tissue inflammation and pain. The painkiller ibuprofen has anti-inflammatory properties, so is a good choice of a painkiller to take on a hike, though apparently aspirin is the best pain killer for joint and muscle pain.
I always take a length of Tubigrip when tramping. You can buy cut lengths from a pharmacy, and it comes in different diameters. You roll it over an injured area and it applies compression to help prevent swelling and reduce what swelling you do have. An alternative is an ankle sleeve or ankle brace, and while these may provide more support, as well as compression, they are heavier to carry and you can only use them for an ankle injury (ditto for a knee sleeve or brace), whereas Tubigrip can be applied in many ways.
Athletic strapping tape will also provide support to prevent too much movement of the injured joint, but you need to know how to use it properly. You need the non-elastic type here, not the sort I’ve mentioned above for blisters. And duct tape can be used as well. It will be unpleasant to remove, but you can always apply a more comfortable under-bandage.
Getting sore knees when you go downhill is common, especially as you get older. To minimise the pain you need to lower the load on the knees. That means not having a heavy pack, using walking poles, making a zig-zag route downhill, and taking small steps. Maybe a knee sleeve can help, though it needs to have a hole for your knee cap. You should also work on your body beforehand. There are different types of knee pain with different causes, so if this is a recurrent issue you should get a professional diagnosis, but commonly pain just above the knee is caused by the knee cap not tracking correctly. This in turn is because your leg muscles are not strong enough to guide it the way it is supposed to move. Stiff muscles don’t help because they are not functioning fully either. Pronation of your feet can also contribute (see above). So there are leg exercises such as leg lifts, wall sits, calf raises, inner thigh leg lifts, etc. you can do as part of your training. And stretches. Ideally you should be doing these before you set out each day (well, actually after ten or fifteen minutes when your muscles are warmed up) and when you have finished walking. A good supplement or replacement for stretching is massage, either with the hands or by using one of those rollers you roll your tense muscles over. Unfortunately these are bulky to carry hiking, though they don’t weigh too much.
If you find your pack is giving you an aching back you could of course try lightening its load. Exercises that strengthen your core muscles (the ones deep below the surface around your middle) will probably be helpful as well. Then there is the Aarn pack that is said to spread the load between front and back and avoid stressing the spine.