Pilgrim inluries

Las lesiones más habituales del peregrino son las que afectan a las articulaciones (esguinces y artritis traumáticas), y las que afectan a los pies (rozaduras y ampollas).

The most common pilgrim injuries are those affecting the joints (traumatic arthritis and sprains) or the feet (rubbing and blisters).

SPRAINS: This is the term given to an injury to a joint caused by the over-stretching or tearing of the ligaments. For pilgrims, the most common sprain is a twisted ankle (generally with the foot rolling inwards) caused by taking an awkward step. When this happens, you will feel a sharp pain on the outside of your ankle. Ankle sprains generally occur when walking over uneven ground, particularly downhill. If you are carrying a heavy weight, this will do even more harm to the ligament and may even cause it to tear, considerably worsening the injury.

Ankle sprains can be avoided by wearing boots that provide good ankle support and, of course, ensuring that your rucksack is as light as possible. If the ligament hasn't been torn, then it is generally sufficient to treat a sprained ankle by applying ice to the swollen area and resting your ankle for a day or two. It might also help to take an anti-inflammatory medication (Neobrufen, Quiralam, etc). With a grade II sprain (the partial or complete tearing of the ligament) you've no choice but to stop the pilgrimage and go home.

TRAUMATIC ARTHRITIS: Joint injuries caused, in this case, by carrying too much weight. Repeated micro-traumas to the joint finally lead to pain in the joint area which can force you to stop walking. It most frequently occurs in the knee after prolonged descents. Excessively long stages, prolonged descents (Triacastela!) and an extremely heavy rucksack all contribute to the appearance of these injuries.

You can try and avoid traumatic arthritis by planning shorter stages and limiting the weight of your rucksack.

The injury can be treated with an anti-inflammatory medication (Neobrufen, Quiralam) and the local application of a cold pack.

If you don't force yourself to do too much and with the right treatment, this type of injury shouldn't be too much of a problem, although it will make walking slightly more painful.

TENDONITIS: This refers to the inflammation of a tendon at any point along its path. Pilgrims are particularly susceptible to Achilles tendonitis; this injury is characterised by pain in the back of the heel and generally appears in the mornings when you take your first steps, it then disappears either totally or partially as you walk and returns more sharply during and at the end of your physical exercise, becoming increasingly more intense. The pain begins to last for increasingly longer periods of time and may even not go away at all, until it finally prevents you from carrying on.

There are several causes, however the ones of interest to us pilgrims are: the difference in heel height (particularly the case for women used to using high-heel shoes), the change to flat-soled footwear obliges the tendon to stretch in a way it is not accustomed to. The use of footwear with an excessively soft heel area, walking up slopes also causes the tendon to stretch excessively to the limits of its elasticity. Finally, the direct pressure of the footwear on the tendon, caused by ankle-high boots that are too tight at the ankle.

Achilles tendonitis can basically be prevented by choosing the right footwear. The  boot soles should be hard, with no soft cushioning for the heel area and ensuring that the back of the ankle support is lower. Almost all good boots now have a lower ankle support at the back specifically to prevent Achilles tendonitis. Women used to wearing high-heel shoes should do Achilles tendon stretching exercises, progressively increasing the exercise intensity, a few weeks before starting to walk in the boots to be used along the Way.

If, despite everything, you do get tendonitis, you should take an anti-inflammatory medication and apply ice locally.

Badly chosen footwear can prevent you from continuing with the Pilgrimage!

RUBBING: foot wounds or sores caused by footwear that is too tight or too short. Although not a serious problem, it can be painful. Footwear that is too tight can also cause nail problems (the famous "black nails") which will eventually lead to the nail dropping off. These injuries can be prevented by selecting suitable footwear that is not too tight. Also make sure that your nails are always cut short, and remember to include a good nail cutter in your toiletry bag. Keep sores caused by rubbing scrupulously clean to prevent them from becoming infected: clean with Betadine and protect with plasters or, better still, with a cicatrizant like Tulgrasum that promotes the sore healing. And, of course, throw away the footwear found to be too small! (better late than never!)

BLISTERS: Oh those blisters! Inevitable, hateful blisters. A pilgrim generally has a blister by the second day of the walk, or even the first day. They are the most common pilgrim injury and the one that is the most bothersome.

Consider how a blister is formed: when you walk, your footwear never fits snugly on the whole of your foot, meaning that there are parts of your foot that move slightly with each step. You're not immediately aware of this and so you start walking calmly along until you start to feel some slight discomfort somewhere on your foot. A blister is starting to form.

A blister consists of the accumulation of fluid between the epidermis and the dermis as a result of the surface layer of the skin sliding over the underlayer. This repeated sliding finally provokes a localised inflammation which leads to the accumulation of the fluid characteristic of a blister.

Blister prevention: every pilgrim probably has his or her own formula or system for preventing blisters from appearing. However, I'm now going to mention what I consider to be the best.

1. Footwear: your foot must not be able to move around. Footwear should fit as snugly as possible, without being too tight at any point (risk of rubbing and sores). The best thing is to get a good fit by using layers of socks, generally some fine socks in contact with the skin and then thicker socks on top. Socks can be made of cotton or, better still, polypropylene or another synthetic fibre. There is a very good brand of socks, called Quechua, which are specifically "anti-blister" and are on sale in most sports shop.

2. Before starting the stage: thoroughly clean your feet and spread Vaseline all over them, without being stingy; Vaseline all over your feet and between your toes. Then put on your socks, taking care that there are no folds or creases. If the socks have seams, then put them on inside out so that the seams are on the outside. Put on your boots and carefully tighten the laces, from your toe up to your ankle, ensuring that your foot is well supported but without the boot being too tight.

 3. Along the route. Try and stop every two hours to rest a little. Take off your boots and socks and air your feet a little. If you can immerse your feet in cold water, then even better. Examine your feet carefully for any redness or incipient blisters. Dry them thoroughly before putting your socks back on. If these are damp, then change them for a dry pair. You could rub your feet with rosemary oil again.

4 After the stage: As soon as you reach your lodgings, take off your boots and socks and spend some time on foot hygiene. It's a good idea to immerse your feet in cold water for some time (cold exerts an anti-inflammatory and an anti-oedema effect) and then rub your feet well with rosemary oil. Put on your sandals and have a rest.until the next day.

 I'm now going to deal with the first signs of a blister and what you can do. 

The first sign of a blister, when it's starting to form, is a slight feeling of discomfort at a specific point on your foot. I think all of us pilgrims have felt this at one moment or another. You get the impression that you have a bothersome crease in your sock. This is the time to stop, take off your boot and sock and carefully examine the area that hurts, only to discover with horror that a blister is forming. You need to take immediate action: if you've had the foresight to buy Compeed pads, put one on the blister, ensuring that it's big enough to completely cover both the blister and a small area around it. If you haven't got any Compeed, a wide strip of tape will perform the same function. Normal sticking plasters are no use at all once the blister has started to appear. The Compeed pad shouldn't be removed until it comes off by itself, generally after four or five days. In other words, you can have a shower with it on and walk perfectly easily with it on without any bother whatsoever. If everything's goes OK, when the pad comes off, the blister will have disappeared. If the blister hasn't completely gone, then put another Compeed pad on.

OK, you get to your lodgings and find that you've got a beautiful pair of blisters on your feet. So what can you do?

1. Firstly, you need to take your daily shower, paying particular attention to washing your feet.

2. Disinfect the blister and surrounding area with a piece of cotton wool soaked in Betadine.

3. Take a normal sewing needle, threaded with normal cotton thread, the one used for sewing buttons on. Disinfect needle and thread by wiping them with cotton wool soaked in Betadine. As is logical, first wash your hands carefully with soap and water. You don't need to dry them.

4. Take the needle and thread and, without a second thought, stick it through the blister from one side to the other (it doesn't hurt!) until you see the thread appear. Cut the thread leaving approximately one centimetre on either side of the blister. Disinfect the area again and Voilà! The job's done - you've now got an empty blister with a piece of thread coming out of each side.

The blister's gone for good, because the thread ends act as a drain, and no more liquid will accumulate in the blister.

Now you need to be particularly careful to ensure the blister (or rather ex-blister) doesn't become infected. So cover it with a dressing (a wide plaster is sufficient, provided that it covers the whole area) and disinfect with Betadine every day. You'll see that you'll be able to walk with no problem at all, even with the threads in place. If you remove the threads the blister will start to fill up again, and the problem reappears.

Well, I think that's sufficient to give you an idea of the treatments to be applied for the different injuries and sores and how to avoid them. If you have any doubts or need clarification on any point, well that's what the forum's here for. Ask and you'll get a reply. Or at least we'll try.

In any case, let St James protect us! And ENJOY THE PILGRIMAGE!

www.caminosantiago.com agradece la colaboración de Manu

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