Lisa de Speville, from Johannesburg, South Africa, is a friend I met at the Washingon state Primal Quest several years ago. She is a journalist and photographer in addition to an adventure racer. She’s pretty much a jack of all outdoor trades. I know I can count on Lisa for great bad feet photos. While you may not like the graphic images, they’re good to teach lessons. Check out Lisa’s website here.
Lisa recently wrote that she had just completed the 5-day, 200km RAW Namibia event. Here is a link to her blog where you can see some photos of the region and by clicking backwards on her posts, you can read more about the race.
She sent me an email saying, “It was fabulous! This one guy from the UK had BAD feet. Here are three sequential photos.
The first picture is after day 2. Day 1 was 41km. Terrain decent. He got grit in his shoes and didn’t deal with it at all. A heavy guy with an unnecessarily overloaded backpack (inexperience). By the end of day one, the foot looked like the photo I took on day 2. The doctor opened up the open part and bandaged him up. He got a dose of methiolate after day 1. Agony, as you know. His maceration was very severe already on day 1. I would have expected this kind of blistering – only later on – progressive. But he did it on the first 39km stage.
The piece of skin was cut off by the doc. I suggested that she leave it on but she took it off and padded the foot with bandages. Your comment on what to do – on or off – with this severity would interesting.
I think the primary problem was that he got sore feet during the stage, a bit of grit in his shoes and he didn’t deal with it then and there. I can’t remember now what shoes he was wearing… I’ll ask him to give you feedback. I have a sneaky feeling they were road shoes… on off-road terrain… I don’t know what socks he was wearing. And then you look at things like shoes being his normal road shoes and perhaps that half-size too small for long off-road stages in the heat; and also he wouldn’t have loosened his laces to accommodate swelling… Recipe for trouble.
Day 2 was about 40km. Also good terrain, mostly even footing. It obviously worked on the raw part of foot.
Day 3 was 44km. again nice terrain. This is picture 2. One river crossing so shoes got wet just over halfway. He was wearing quite thick socks from what I could see. He would have gotten his feet wet once mid-way through the stage. We had one river crossing and I think he went straight through it because even if he took off his shoes there would have been the bandages to deal with. That was the only water place the whole race.
If you look closely, you’ll see the dark spot under the skin under the middle toe. That’s sand inside the blister. How sore it must have been to be walking on the sand, which would have been rubbing on the raw flesh. Ow! I’m not that brave – I would have been out of the race after day1 – I just don’t know how these people manage to keep going with such injured feet!
Day 4 – 50km. Bit of sand. Hot as hell. He took a detour – went down the correct dry riverbed but didn’t get out of it to look for the finish. Must have been parallel to the finish. Turned around and started walking back to last waterpoint. He was found hours later (moving slowly). He didn’t want to be disqualified so they dropped him on the road and he walked to the finish. Almost 16-hour day for him! Picture 3 was taken in the dark, after he’d been out there for almost 16-hours!
He did start day 5 but when it got to climbing big dune he then withdrew. It’s obviously difficult to climb a dune when you can’t put pressure on foot. How he got so far past day 1 is beyond me.
Also check out the progression of the little piggy’s “toe-sock” syndrome.”
John’s comments: Thanks Lisa for sharing these great photos. The images show the destructive power of sand, the raw skin, the extreme maceration – and the worsening deterioration of the foot over several days. Lisa indicated there was only one water crossing so I suspect most of the maceration came from sweating feet. The heavy weight in his pack was a huge factor too as it adds stress to the feet. I don’t know if he wore gaiters. And be sure to check out the baby toe in pictures 1 and 3. You can see the progression of the maceration of the bottom of the toe. Lisa said she thought he wore road shoes in a desert race and that they may have not been large enough to allow for swelling. This too is a huge factor.
Regarding cutting off the skin, I am usually not in favor of doing this as the skin underneath is raw and very tender. I suspect he had callus at the ball of the foot and a blister formed underneath. The thick edges of skin where it was cut shows that the skin removed was not a single layer. I probably would have left the skin intact, applied a coating of zinc oxide and antibiotic mix, and covered it with Kinesio-Tex tape with an anchor figure eight piece on the side and between the toes.