BackgroundThe study aimed to compare the effects of medium hardness and high hardness arch-support insoles, with the latter modified by a soft forefoot pad, on foot pressure distribution and muscle activation during high-load carrying tasks in authentic mountainous trail environments. MethodsSixteen male mountaineer porters with experience in high-load carrying tasks participated in the experiments. They wore commercially available prefabricated arch-support insoles, specifically referred to as medium hardness arch-support material (MH) and high hardness arch-support material attached a 1-mm soft sponge pad to the forefoot area (HHSF) during uphill and downhill walking tasks with a 25-kg load. Foot pressure and muscle activation were measured using wireless pressure distribution insoles and a wireless surface electromyography system, respectively. ResultsThe HHSF showed significantly higher perceived comfort scores and reduced foot pressure in specific regions during downhill walking (p < 0.05). It exhibited increased peak foot pressure in the forefoot during uphill walking (p < 0.05). The MH showed greater foot pressure in the second metatarsal during downhill walking and a larger contact area in the midfoot during uphill walking (p < 0.05). Muscle activation did not differ significantly between the two insoles (p > 0.05). ConclusionThe study indicates that combining a high hardness arch-support insole with a soft forefoot pad may enhance comfort and potentially reduce foot injury risks, and improves foot propulsion and pressure distribution.