The Middle Fork East Trail is a 78-mile hiking trail that parallels the Middle Fork Salmon River through the Frank Church-River of No Return Wilderness, running from Boundary Creek to Big Creek Bridge.

The trail offers access to historic sites including Native American pictographs, abandoned mining operations, and homesteader cabins, with opportunities to view wildlife like bighorn sheep, bald eagles, and river otters.

Hikers can arrange raft support or air/river egress at the trail's end, and the trail is maintained for backpackers, hunters, and pack stock, though users should be prepared for elevation changes and check current trail conditions before attempting.