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See https://mymacedoniablog.wordpress.com/ for more info about sightseeing and hiking in Macedonia
I have been wanting to do this hike for years, because both Mount Vodno with the Millenium Cross and Lake Matka are two great places that we visited separately in the past, so why not combine them in one hike?
The reason that we did not do this hike before is that we were told that especially the end of the hike, when you reach Lake Matka, is badly marked. Therefore the general advice is not to try this hike without a local guide. In retrospect, I think that when you have a good look at the map, in combination with the sparse marking of the trail, it should be possible to do it without a guide, but you may go wrong here or there...
This year however (2011), I bought an outdoor GPS and downloaded a track describing this hike from internet. Almost foolproof and no local guide needed!
We went by car to the parking at Middle Vodno (Sredno Vodo), which is halfway the top of the mountain. Then, we took the new cable car lift to the top of Mount Vodno and the Millenium Cross.
Alternatively, you can walk all the way to the top, from the foot of the mountain or from Middle Vodno, but that adds a pretty steep ascent to this hike! Some of the last parts are rather steep downhill, so high shoes and walking sticks are recommended.
From the top of Mount Vodno the hike is only downhill, so it is not too hard on your condition. The scenery and the trail are both pretty diverse, the views of the Matka Canyon are amazing.
When you arrive at the bridge over the Treska river, you have to go left to visit the lake. There are several churches around the lake, as well as a bar/restaurant for well-deserved refreshments!
There is a mini-bus going back to Skopje, but you can also arrange for a cab of course. The buses stop near the bridge.
The hike from the Millenium Cross to the bridge at Matka is about 11-12 km long and took us 4 hours including breaks. From the bridge to Lake Matka behind the dam is an additional 1.5 km.