Trekking socks, blisters and foot care for Nepal

The NHS advice for avoiding friction blisters is the best summary of foot care for a Nepal trek: wear comfortable, well-fitting shoes, wear new shoes for short periods until they are comfortable, wear thick moisture-wicking socks and change your socks frequently if your feet sweat. In practice that means breaking in your boots before you fly, choosing socks that fit them, carrying enough pairs to change every day and treating any hot spot the moment you feel it. A blister on day two of a twelve-day walk will shape the rest of the trek, and it is one of the few problems that is almost wholly preventable. This guide covers boots, socks, what to pack, how to handle a hot spot on the trail, and what the NHS says about caring for and treating blisters.

We are not a medical service. The care advice here follows the NHS blister page, linked in the sources. For infections, diabetes, circulation problems or anything that worries you, see a doctor or travel clinic before you go.

Why trekking blisters happen

According to the NHS, blisters develop to protect damaged skin and help it heal, and they are mostly caused by friction, burns and skin reactions. On a trek, friction is the issue. A day on the Everest or Annapurna trails can mean thousands of steps downhill on stone stairs, each one pushing your foot against the front of the boot. Add damp socks, sweat, a pack that is heavier than the day before and boots that do not quite fit, and skin begins to rub. Blood blisters, which the NHS says look red or black and fill with blood, appear when blood vessels in the skin have also been damaged, typically from a pinch rather than a rub.

Descents are the sharpest test. The Everest Base Camp route page recommends poles for the long descent from Namche to Lukla, and Poon Hill and Annapurna Base Camp both include long staircases. The foot slides forward on every step, and the toes take the force.

Boots first, socks second

The sock is only as good as the boot it sits in.

• Fit. Try boots in the afternoon, when feet are largest, with the socks you will wear on the trek. Your toes should not touch the front when you walk downhill, and your heel should not lift when you walk uphill. Some trekkers go up a half size for thicker socks and swelling feet.
• Break-in. The NHS says to wear new shoes for short periods until they are comfortable. For a trek that means several weeks of walks, including hills and a full day with a loaded pack, before the flight. A pair bought in Thamel the day before you leave is a gamble. If you must buy or rent in Kathmandu, see renting gear in Kathmandu and renting gear in Pokhara, and plan a short walk in the new boots first.
• Lacing. Learn two or three lacing patterns that stop the heel lifting and ease pressure on the toes. A heel-lock lacing and a loosened forefoot lacing for descents help many people. Your boots will feel different after two days on the trail, so retie them at lunch.
• Insoles. Replace a flat factory insole with a supportive one if you need it, and test it before you go.

Socks: what to wear and how many to pack

The NHS names thick, moisture-wicking socks. For trekking, that translates into wool, merino or synthetic socks rather than cotton, which holds moisture against the skin. A sock that is too loose bunches up; one that is too tight squeezes the toes. Seams over toe joints can rub, so look for flat seams.

A reasonable packing plan for a classic teahouse route:

• Three or four pairs of trekking socks, so you can change daily and rotate.
• One pair of light socks or liners to wear under thick socks if you like a two-layer system, which lets the layers slide against each other instead of against your skin.
• One clean, dry pair kept for sleeping and for the evening, because a warm, dry foot recovers.
• A spare pair in your day bag for emergencies, in a plastic bag.

The NHS also says to change your socks frequently if you get sweaty feet. In practice, take a pair off at lunch, let your feet air for ten minutes, and put on a dry pair. Hang the damp ones on your pack to dry in the sun. Rinse a pair each evening and hang it in the dining room, where the stove helps, but do not put socks on a hot stove. In winter, damp socks can freeze overnight, so keep tomorrow's pair in your sleeping bag.

Hot spots: the five-minute rule

A hot spot is a warm, tender area that is not yet a blister. Treat it immediately.

1. Stop. Do not keep walking on a hot spot to the next village.
2. Take off the boot and sock and dry your foot.
3. Cover it. A soft plaster, padded dressing or tape that sticks well on dry skin reduces friction. Smooth out wrinkles.
4. Fix the cause. Change socks, adjust the lacing, remove a pebble or fold, or move the insole.
5. Check again at the next break.

Carry the supplies in your day bag, not in the porter's duffel. Hot spots need attention when they happen, not when the porter arrives at the lodge.

What the NHS says about treating a blister

The NHS advice for self-care is clear and cautious. Blisters often heal on their own within a week. To protect one and help prevent infection:

• Keep the blister as clean as possible; gently wash the skin and pat it dry.
• Cover it with a soft plaster or padded dressing.
• Wash your hands before touching a burst blister.
• Allow the fluid in a burst blister to drain before covering it with a plaster or dressing.
• Do not burst a blister yourself.
• Do not peel the skin off a burst blister, and do not pick at the edges of the remaining skin.
• Do not wear the shoes or use the equipment that caused the blister until it heals.

On a trek you cannot always stop wearing the boots, so the practical answer is to reduce friction with padding and dry socks and to ask your guide to shorten the day if needed. The NHS says a pharmacist can recommend a plaster or dressing and that a hydrocolloid dressing, a moist dressing, can protect a blister, reduce pain and speed healing. These are easier to buy in Kathmandu or Pokhara than on the trail.

When a blister becomes a problem

The NHS says not to ignore an infected blister: it can be hot and filled with green or yellow pus, and the surrounding skin may look red, although this can be harder to see on brown or black skin. Without treatment, it could lead to a skin or blood infection. It advises getting medical advice if a blister is very painful or keeps coming back, if the skin looks infected, or if several blisters appear for no reason.

On a trek, that means telling your guide or partner early, not hiding it. Your guide can arrange a rest day, a lighter day or help to reach a clinic. The Himalayan Rescue Association runs clinics in Manang and Pheriche, covered in our guide to the HRA clinics. An infected-looking foot is a reason to stop, rest and get it seen, not to push on.

Other fit problems

• Toes hitting the front of the boot on descents are a fit problem, not a health one: trim toenails short before you go, tighten the lacing on the way down and make sure your boots are not too small.
• Feet that swell over several days make a snug boot tighter, so loosen the laces at breaks and consider boots with a little room.
• Cold or damp feet call for dry socks in the evening, a pair kept for sleeping and a change of footwear: carry light sandals or camp shoes to give your feet air.
• Medical conditions that affect the feet, such as diabetes or circulation problems, are a conversation for your doctor or travel clinic before the trek.

A foot-care kit

For a typical trek, pack: a roll of tape that sticks to dry skin, a few soft plasters in different sizes, a hydrocolloid dressing or two, a small pair of scissors, a safety pin, antiseptic wipes, a spare insole if you use one, sandals or camp shoes, and nail clippers. Add your socks and liners. The kit weighs little and is the cheapest insurance in your bag. For the wider picture, see the Nepal trek packing list.

Sharing and planning with a partner

A partner can help you spot a hot spot you cannot see on your own heel, and can carry shared supplies, but each person should carry their own plasters. Agree a rule: if one of you has a foot problem, you stop, treat it, and shorten the day, with no sulking. Our guide to what to do if your partner cannot continue covers harder situations. If you are looking for someone to walk with, the Everest Base Camp partner page and the Poon Hill partner page list trips. For other kit, return to the gear and packing hub.

The short version

Break in your boots weeks before you go. Wear well-fitting, moisture-wicking socks and change them often. Treat a hot spot the minute you feel it. Do not burst a blister yourself, and cover it with a soft plaster or hydrocolloid dressing. Get medical advice for a very painful, recurring or infected blister. Most blisters are made in the first week, and most are avoidable.