Bob Fox - Author

What Ails You

Long-distance hiking on the Appalachian Trail has many risks. The worst of which Bill Bryson’s hiking friends reminded him of before he left which included bear attacks among other wild things. There is also the risk of falling and breaking a bone or worse. Fractures among A.T. hikers surveyed in 2003 were relatively rare at 4% and bear attacks are very rare. The more common issues are less remarkable but are more likely to be encountered by the average hiker. The top 15 from this study are presented below.

15. Skin Rash

Reported by 16% of hikers.

14. thru 11.

Four-way tie at 20% between:

Muscle Cramps

Most likely caused by dehydration or electrolyte deficiency. Water and certain dried fruits or powdered sports drinks can help avoid this.

Achilles Heel Pain

Likely due to overuse or a heel fracture from walking on hard surfaces. Either of these sound like something a long-distance hiker would be doing.

Poison Ivy

Sets of three pointy leaves with the outer two being mitten-shaped. If you know you’ve been exposed wash off the area within 10 minutes and you may have no reaction. If this isn’t possible use Calamine lotion, not sure how long this will stay put on a sweaty leg, antihistamines, or if severe enough an off-trail trip to the doctor.


Trail guides will help you plan how much water to carry. It’s better to carry an empty bottle if you don’t need it than run out of water when you do.

10. Chronic Joint Pain

Reported by 22% of hikers. Keep the Ibuprofen or Naproxen Sodium handy.

9. Back Pain

Reported by 23% of hikers. Same as above.

8. Tick Bites

Reported by 24% of hikers. 3% Reported contracting tick-borne illness. Lyme disease: check the CDC’s website for a full list of symptoms, especially later symptoms some of which are severe. Early signs are fever, chills, headache, fatigue, muscle, and joint aches, swollen lymph nodes, rash in 70-80% of infections which begins at the site and expands up to 12 inches or more and may be warm, itchy, or painful. This rash may look like a bull’s-eye and may appear anywhere on the body. Starting with Virginia northward is where most cases along the trail occur.

7. Sunburn

Reported by 26% of hikers.

6. Numbness

Reported by 28% of hikers.

5. Lost Toenails

Reported by 30% of hikers. May be unavoidable in shoes. Keep laces tight so your toes don’t bump inside the front of the shoe. Good arch support to help keep your feet in place. Keep toenails cut short and have shoes that account for your feet taking up more volume.

4. Acute Joint Pain

Reported by 36% of hikers.

3. Skin Chafing

Reported by 51% of hikers. Depending on location compression shorts can help guys avoid unmentionable problems with the unmentionables. Also, wear moisture-wicking fabrics.

2. Diarrhea

Reported by 56% of hikers. Filters are used by most with iodine or boiling the less preferred water treatment methods. Rinsing cookware in cold water increased the chances as well as not washing hands after bowel movements. Drinking unfiltered water from surface streams or ponds also increases your chances but drinking from springs doesn’t. Those who reported having diarrhea had about 1 episode per month lasting 0 to 7 days each.

1. Feet Blisters

Reported by 64% of hikers. See the link below for preventing and treating these.


Boulware, David R., William W. Forgey, and William J. Martin. 2003. "Medical Risks of Wilderness Hiking." The American Journal of Medicine 114 (4): 288-293.