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Hi All,

I have a patient who is planning to climb Everest next March she has suffered from nasty blisters on previous climbs and has even been hospitalised from infections in blisters from these climbs.

She has poor microvascular status and difficulty in finding shoes to fit as she has a narrow heel and very planus foot with mechanical issues which I will be treating with orthotics. I am also planning on using a diabetic covering system on the devices to hopefully resolve the blister issues she has suffered from.

I would like to make contact with others who have had experience with mountain climbers and their specialised footwear equipment i.e. Therm-ic Volcano Step-in Footbed.

Many Thanks

__________________
Mark Egan
Absolute Podiatry
331/33 North St
Spring Hill, Qld
4000

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Hey Mark,

Has this girl been to serious altitudes before? There is a huge difference between 14000' and 29000' - air pressure will do all sorts of nasty things to circulation, then there's the cold and the humidity effects both around the pt, then the moisture control within the footwear.

The final push (as they call it) is a 20 hour day that depletes the body of every last bit of energy. Plus the adrenaline allows climbers to ignore symptoms.

You need to check ALL the footwear she intends to bring from approach shoes, base camp shoes, high altitude boots and the crampons. The HA boots are a difficult issue for you. At sea level they should be about 2 sizes too big as the higher you go, the more the lining foam expands causing pressure issues to the tissues (pressure sores, gangrene, IGTN) so fitting with CFO will be a headache.

I would suggest if you still need CFO then make a one piece of dense EVA or HD PZ that could be trimmed with a sharp knife if needed and educate your pt to fit

Mark, I could bore you for hours on this topic.

She really is not a good candidate for high altitude! Talk her out of it - please!

THe HA boots come in different versions, some are a double boot comprising of a "boxer" type inner which gave some better friction control (or not) or the foam lined version as described as before.

She also needs to gice you an indication of how much extra weight she'll be carrying - often as much as 50% of body weight. Depends whether she will be guided/ non-guided and with/out personal Sherpa. Each climber needs to carry at least 5kg in thermos of tea per day, then ropes, extra eqpt, food, tent, bag, mat, clothing, personal stuff, cameras, batteries, etcetcetc.

The terrain also varies greatly; first it's rocks/ boulders, ladders (very difficult when you have small feet as you don't span the rungs), low gradient trail (up and down several trips) then once you hit the col it's steep with front point kicking - nasty foot injuries. Check out some Everst Blogs, season is over for this year.

And finally (does she ever stop???)...

I cannot give you any advice on the properties of orthotic materials at low temps and low air pressure. It can be minus 30 INSIDE your tent never mind outside so I don't know if polypro can crack, warp or whatever else. Climbers may nap with their boots on, but tend not sleep with them on. It gets to -40 where I live but I've never done anything daft with my CFOs + they are either on my feet or in my warm house.

Is it possible to give her a glorified insole with poron or EVa additions? Silipos?

BListers can end climbs. Trying to patch wounds at 20000' when your feet are infected/mangled/soggy is just miserable. The Drs are all down in base camp.

My experience with this type of climbing is if you are not born perfect/superhuman, then take up knitting or something. You endanger other people when you are not cut out for it yourself

Dear Fraoch,

Thank you so much for your replies much appreciated as this is well out of my experience levels being in sunny and warm and flat queensland.

You have raised some very valid points of concerns which I felt for this patient straight away.

She is wearing sportiva hiking boots and ascent boots which have been moulded to her feet and have the ther-mic inlays. She is going to NZ to climb and get her levels up and will be taking the boots and the CFO with her. I have spoken to the lab I use and they are going to research the limitations of the matierials they use. Following your points I am starting to lean towards a EVA device covered with diabetic trilaminer cover.

She is a well educated person with an allied health background she claims to have climbed in Mt Blanc ??? and will be climbing with a group for Everest. Am I naive to think that groups attempting to climb Everest would be thoroughtly assessed before they go and someone with her issues might be ruled out ? Or does money overrule this???

I shall let you know how it goes and would welcome your thoughts and experiences as with any others who might have some expereice with this type of activity.

Cheers

__________________
Mark Egan
Absolute Podiatry
331/33 North St
Spring Hill, Qld
4000

I wish you and your client all the best. All you can do is monitor how she does on these next couple of climbs

The Thermic inserts should be good for warmth ( I have similar telemark boot liners) and NZ (guessing Mt. Cook?) will probably give a decent idea how things will work out for her. Mt Blanc I'm afraid is a bit of a walk in the park depending which route you take and not much indidcation there.

As you rightly pointed out - there is NO selectivity for the business of Mt. E. Money rules. More people go and flash the greenbacks, can't blame the locals for wanting more. You can pay someone to literally drag your sorry ass up there and back - it's called short roping. Not to take anything away from people who have gone and done this mountain, horrible effort, declining conditions, not for the faint hearted.

Good first aid kit + blister kits - no worries!

Fraoch