FIXING YOUR FEET E-zine – Blisters with Blood, and Staph and Cellulitis Infections, and a lot more

July 20, 2007 by
Filed under: Foot Care, Footwear, Health, Sports, Travel 

FIXING YOUR FEET E-zine


Volume 7, Issue 7, July 2007
John Vonhof, Footwork Publications
Copyright, July 2007, All rights reserved
 


THIS ISSUE IN SUMMARY

This is a huge issue – almost 14 pages before formatting. However, in the seven years of publishing this newsletter, I think this is the
most serious and important issue yet. It has in-depth focus on
infections as a result of blisters. First read my editorial, Blisters
Can Lead to Serious Infection
, and then the feature article, My
Infected Blister – Almost My Life!
I think you’ll agree with Denise
Jones, the Badwater Blister Queen, who told me, “This is indeed
sobering and shocking (literally). I think people need to see this
because I do not think they take blisters very seriously!
” I urge you
to fully digest the articles, then read the articles on Blood Blisters and
Infections
, Staph Facts
and Cellulitis Facts.
     This issue also has several foot care products, a link to a video
of my lancing a huge toe blister on YouTube, a Bad Feet photo and
story, and reader feedback.


PURPOSE

The Fixing Your Feet E-zine is published monthly to inform and educate
athletes and non-athletes about proper foot care skills and techniques,
provide tips on foot care, review foot care products, and highlight
problems people have with their feet.

EDITORIAL: BLISTERS CAN LEAD TO SERIOUS INFECTION
By John Vonhof

Athletes have told me, “It’s only a blister.” as they don’t want to take the time to patch it properly. Well, this issue focuses on blister infections. I have seen and heard stories of what a simple blister can do. Remember the movie Million Dollar Baby? Hillary Swank had a blister from her intense training. She ended up being hospitalized because the blister became infected.
     The feature article this month is the story of Cari, a long distance thruhiker on the Pacific Crest Trail. A simple blister, with the right combination of exposures almost took her life. Read her story, see the photo of her infected blister, and be amazed.

I have a few quotes below that should help you realize that infections can happen to any of us. What I want you to take away from this issue of Fixing Your Feet is 1) a healthy respect for blisters, 2) an understanding of how prevent infection, and 3) the warning signs of infection. After Cari’s story are in-depth articles on Blood Blisters and Infections, Staph Facts, and Cellulitis Facts.

At Raid the North Extreme last month, I patched the feet of an adventure race who was later extricated out by helicopter due to a medical condition. By the time he was rescued, there were red tracers going up his foot and ankles. His blisters were infected. The doctors said it was the beginning of cellulitis. He told me what happened and I will share more next month. There were several contributing factors. The patches I had applied held in spite of all the water and unbelievable terrain.

In response to Cari’s story, a hiker, Caithlin wrote in Cari’s blog, “I am horrified by your experience with septic poisoning and said a prayer of thanks to God that Manynames and Marmot were in your path to help you. I had no idea one could get septic poisoning from a blister until my friend’s wife told the story of how she almost died from exactly the same thing as you. She lanced a blister, it got wet in a river and within a day or two she was a very, very sick woman.

Shane Sampson, MD and an experience ultrarunner and Badwater finisher wrote about Cari’s story, “That is one wicked infection. Sounds like a combination of risk factors acting in concert to make her more susceptible. She was hiking long distance. She probably had some degree of dehydration and malnourishment/nutritional imbalance. She was probably sleep depraved. She may be a carrier of staph nasally (as the ID specialist suggested), or she may have become colonized, or she became exposed to an exceptionally virulent strain of staph, which would not likely respond to Neosporin. Bactroban would be much better. Also, if you combine all of these factors, she had everything working against her immune system. And without the immune system, we can’t really fight off bacteria. She didn’t say anything about sterilizing her hands or the foot. In retrospect, there can be a huge difference in the number of bacteria present in a wound when we alter variables such as the initial bacterial load/dose and the % bactericidal level of various cleansers, and the concentration of these cleansers. Looks like everything was on the side of the unicellular organisms. Hand washing, effective cleansers, effective antibacterials, good health and nutrition, timely sterilization of hands and wounds, and NOT picking your nose after caring for someone’s blister are all important points to follow.

Denise Jones, the Badwater Blister Queen says, “It is certainly sobering and scary. We just think we are immune to this stuff and yet we know that there are very resistant bugs out there these days.”

MA,a medic from Canada, shared some concerns about these staph and cellulitis infections, “Clearly in the case of my friend Mary (whose feet I worked on at Primal Quest 2007) there was no sign of infection – but two days later she had to be taken off course with cellulitis. Often there is no sign of infection seen at the time of working on the blisters – yet the staph can be present. My understanding is that it takes at least 48 hours to visually present itself, and often the patient shows other symptoms first. Is there a way to figure out if there is infection already present? It must be pretty deep down. How can we even tell out there on a race? Or is it just the luck of the draw? These infections are quite frightening, aren’t they?

Read the articles on Blood Blister and Infections, Staph Facts and Cellulitis Facts to fully understand the source of these two problems. Know how they are caused, how they present, and how to treat them. This is not solely my responsibility, not the responsibility of the aid station volunteers, or even the medical staff. It is also your responsibility to know how to manage your feet.

Please don’t tell me, I don’t get blisters, or it won’t happen to me. None of the people mentioned thought it would happen to them either. It can happen to a marathoner runner, a casual hiker, a walker, a tough adventure racer, ultramarathoner, and like Hillary Swank – an actress. What they all have in common is they all use their feet and are active.

For years when I have patched feet at events, I have told athletes, especially those with blood blisters, to watch for signs of infection. Then I tell them the warning signs of an infection and how a ruptured or lanced blood blister opens a pathway to the body’s circulatory system, and potential infection.
     In all likelihood, you’ll be fine. But rather than take a chance, learn how to protect yourself from a possible infection. Whether it’s a simple infection, a staph infection, or cellulitis, you can take steps to prevent it from happening. Use alcohol wipes or antibacterial wipes to clean the skin before lancing a blister. Learn proper blister patching techniques. In fact, learn how to take proactive steps to prevent blisters in the first place. Do not assume blisters are a natural part of your sport.

I welcome your opinion on this editorial. Send me an email.

FIXING YOUR FEET, 4th EDITION
The 4th edition of Fixing Your Feet can be ordered through my FixingYourFeet.com web site, ZombieRunner.com, or Amazon.com. Completely updated, it has three new chapters and lots of new sections. The new retail price is $18.95 but these days no one pays full price! So, whichever of the two sites below you choose, the price is comparable. 

LANCING A BLISTER ON YOUTUBE!
Toe_blister_still_shotLast year at the Badwater Ultramarathon, I lanced a huge toe blister. I handed my camera to one of the medical staff. As I lanced the blister, he shot the whole thing on video. So here it is on YouTube. A word of warning, YouTube has a number of videos that are questionable in nature. If you look at any other blister videos, they do not show good lancing techniques, much less good video or even language. Watch the others at your own risk. You must click on the link above to see the video.

SHARE THIS NEWSLETTER
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FEATURE ARTICLE: MY INFECTED BLISTER – ALMOST MY LIFE!
By Cari Tucker “Sandals”
Editor note: Thanks to John Shannon, M.D. for putting me in contact with Cari Tucker, trail name "Sandals", the Pacific Crest Trail thru-hiker whose story follows. I appreciate Cari’s willingness to allow her story to be told to help others. The story is taken from her blog.

Yeah, I’m alive!!!!
     At about 2:30 on Sunday, 4 miles out from Tehachapi-Willow Springs road, I started feeling a little under the weather. I thought it was just the heat, so I quickly found a shady spot and settled in, but within 15 minutes, I was feeling VERY ill and started vomiting. I rested, hoping it would go away. Instead, things deteriorated, with diarrhea and a complete inability to hold down even water. I was alarmed but not ready to call in the evacuation team. I carry a cell phone and had service if I stood up and walked up the trail to a high spot. I called my husband [Pete] and tried to update him, but lost the connection. I was by this point lightheaded, having difficulty standing and had started having chills. I got back to my nest, pulled out my sleeping bag and tried to rest.
     About 7 pm, Manynames Tom came by and called Pete to let him know he was with me. Tom essentially spent the night taking care of me. The plan was that if I was not better by morning and able to hike out, we would call for help.

In the morning I was even weaker, now barely able to move. Tom tried to call 911, but lost service with only a partial message being transmitted. He hiked 2 miles down and back and brought me water. In the meantime, Marmot appeared and stayed with me while Tom then hiked down to the road to be certain of getting help.
     Rescue was able to get a 4-wheel drive in, and I was taken down the mountain and transferred to an ambulance. The initial treatment was given at Tehachapi hospital. I thought that I just needed fluids and would be fine, but after 5 liters plus high doses of a drug to raise blood pressure, I just kept deteriorating and about 7 pm, I was emergency airlifted to a larger hospital in Bakersfield. At Bakersfield, I spent 5 hours being stabilized in the emergency room, and then was transferred to the intensive care unit, where I spent a total of 4 days.

It was finally determined that I had septic shock, a severe infection throughout my whole body, that was made worse by the dehydration. The source of the infection was probably a quarter-sized blister on my Caris_blister_2right heel that didn’t look any worse than anyone else’s blisters–in fact, it looked better than most except for a slight redness. The photo was taken in the hospital. I had lanced and dressed it, and in the desert, it looked OK, but over the first 5 days of being in the hospital, it blossomed into a 2 x 3 inch lesion with red swollen areas up into my ankle. The cultures came back as a Staph infection and I had to have some areas of dead and dying skin removed. As far as it getting into the bloodstream–I guess I’m just one of those unlucky statistics.
     The game plan from here is to return home (Dallas) to recoup and hopefully hit the trail again in a couple of weeks in Kennedy Meadows…with escort. Hmm, Pete seems reluctant to let me out of his sight. Lightening couldn’t strike twice, could it? This is, of course, subject to adequate recovery.

Editor: I emailed Cari and asked a few questions about her case. She was planning to get back on the trail mid-July but took the time to reply. Here is her response.

I had a foot injury on the left side and went to a podiatrist (about a week and a half prior to my blister). He gave me inserts with a metatarsal pad for suspected neuroma. But what he gave me was a size 7.5 – I had 8.5 shoes. I didn’t notice until I was on the trail; the blister on the right foot was caused by the insert ridge. I tried taping the ridge and my foot; it worked on the left, but the right side blistered anyway. If I’d made the final 4 miles to the road, my first chore in town was to find new inserts.
     Probably the most disturbing part is that I just found out last week that my left injury was actually a stress fracture–the doc here in Dallas X-rayed it when I said it hurt less without the metatarsal pad. It looks like it’s now pretty much healed even though I hiked almost a hundred miles on it before getting sick. Oops.

As far as shoes, just for the record, I was alternating between Montrail Vitesse and Chaco hiking sandals both with socks (toe socks with the sandals and liner socks with the trail shoes.)  I started using the sandals after the above foot injury since the combo had worked well for me in the past to help with tired feet. I’ve really never had blister problems before on this hike, I had only one other blister at mile 150 when I got lazy and did not do my usual foot care routine  (stop every two hours, massage feet, check for hot spots and change socks). That first blister healed with only a piece of tape over it; I did not need to lance it as I did for one that got infected.

Here’s how I treated the blister. I cleaned the area with soap and water, punctured the edge by nicking it with a sterile knife blade (run thru lighter flame), squeezed out the fluid  (clear fluid). I put Neosporin on it, covered it with Spenco Second Skin and then taped over with sports tape.
     What I DIDN’T do was redress it in the desert – it started hurting again the next morning (badly!), and I pulled the edge of the tape up enough to see that it looked Ok (a slight red border but no streaks or pus). I figured I would just deal with the pain until I got to town, which at that point was only another 20 miles or so. Unfortunately, I only got about 16 miles.

I WILL be redressing all future blisters–twice daily, with Bactroban! Actually, the infectious disease doc had me bathe in Chloraseptic daily for 5 days and use Bactroban on my nostrils with the thought that this would hopefully decolonize me of the toxic flavor of staph. I have to say that I’m a bit nervous of it happening again, eek.

A follow up from Cari:
1)  I don’t have a picture of the original blister, but it was a little thing by thruhiker standards – it didn’t show its true colors at first!
2)  The staph was identified as Staphylococcus Aureus, methicillin sensitive, not even the real resistant stuff. As far as I know, they did not test for the specific toxin, but I met the CDC criteria for confirmed staphylococcal toxic shock. I’m a neonatal/pediatric clinical pharmacist; my guess is that I was colonized in the hospital.

Editor’s note:
1)  Bactroban is available only by prescription.
2)  Cari added, “By the way, I got your book last winter as part of my prep education; I was amazed at a whole book on feet but really enjoyed it – they are incredible devices, aren’t they?”

I welcome your feedback on this article. Send me an email.

BLOOD BLISTERS AND INFECTIONS
Comments By Shane Sampson, MD and an experience ultrarunner and Badwater finisher

In regards to the staph infections in blood blisters – one prerequisite condition is to have staph bacteria present on the skin (which is a very high likelihood for most humans); another is to have a sufficiently high concentration of bacteria on the skin, and this would follow from skin that was either insufficiently cleansed or not cleansed at all. Keep in mind that any chemical used to clean a surface has varying levels of ability to sterilize depending on the characteristics of the chemical, the concentration used, the temperature of the materials involved, the length of time of contact. A lanced blister is likely to have only a small opening to the outside. This reduces the opportunity for passage of bacteria inward – it also reduces the amount of material that remains in the blister as a culture media (and it reduces the internal Infectionpressure thus reducing the chance of enlargement of the blister).
     A big problem with blood blisters is that blood is a fabulous media for bacterial growth – so if bacteria do get in then watch out! Also, with a blood blister, the floor of the blister is into a deeper layer of the skin, actually communicating with the blood supply, and is therefore much more likely to result in bacteremia and a systemic infection.
     Of course, the typical ultrarunner is putting a tremendous strain on their immune system, making it even more difficult for their bodies to mount an appropriate response; and the physical forces on the local tissues make it more difficult for the body to initially form and then maintain the physical barrier to infection in the base of a blood blister – the clot at the ends of the capillaries. The probability of infection is directly proportional to the surface area of the wound (blister), which is a great incentive to treat them when they are small! So, to answer the question – Yes. Blood blisters are more likely to grow serious staph infections than serous blisters.

STAPH FACTS
Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. Sometimes, staph can cause an Staph_imageinfection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics (also known as antimicrobials or antibacterials). However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia). The image here is a staph infection on a hand.

How do infections and staph infections present?
Regular infections typically present with redness, painful, swollen, have some degree of pus, have streaks going upward towards the heart, and is warm to the touch, Skin infections caused by staph may be red, swollen, painful, or have pus or other drainage. You’re right, they present somewhat the same. Some staph (known as Methicillin-Resistant Staphylococcus aureusor – MRSA) are resistant to certain antibiotics, making it harder to treat.
     Staph infections produce pus-filled pockets (abscesses) located just beneath the surface of the skin or deep within the body. Risk of infection is greatest among the very young and the very old.
     A localized staph infection is confined to a ring of dead and dying white blood cells and bacteria. The skin above it feels warm to the touch. Most of these abscesses eventually burst, and pus that leaks onto the skin can cause new infections. A small fraction of localized staph infections enter the bloodstream and spread through the body.

Who gets staph infections?
Anyone can get a staph infection. People are more likely to get a staph infection if they have:
•    Skin-to-skin contact with someone who has a Staph infection
•    Contact with items and surfaces that have Staph on them
•    Openings in their skin such as cuts or scrapes
•    Crowded living conditions
•    Poor hygiene

How serious are staph infections?
Most staph skin infections are minor and may be easily treated. Staph also may cause more serious infections, such as infections of the bloodstream, surgical sites, or pneumonia. Sometimes, a staph infection that starts as a skin infection may worsen. It is important to contact your doctor if your infection does not get better.
     Skin infections from antibiotic resistant germs including methicillin resistant staph (MRSA) are growing at epidemic rates. These dangerous germs are of great concern to health professionals because they spread easily from person to person and can be misdiagnosed as spider bites and boils.

How do I keep staph infections from spreading?
•    Wash your hands often or use an alcohol-based hand sanitizer
•    Keep your cuts and scrapes clean and cover them with bandages
•    Do not touch other people’s cuts or bandages
•    Do not share personal items like towels or razors

Paul Auerbach, MD, an expert in Wilderness Medicine wrote: “Doctors are now seeing MRSA infections that are acquired outside of the hospital. These are known as “community acquired” infections. I have been made aware of a few infections that seem to have been acquired in the outdoors. In one case, it was almost certainly acquired from a wet suit worn by a surfer. Using an antiseptic ointment, such as bacitracin, on open wounds may not prevent a MRSA infection, but will certainly help prevent other Staphylococcus infections and Streptococcus (“strep”) skin infections.

How can I prevent staph?
Antibiotic-resistant staph infections, usually involving the skin, are showing up more often among healthy people. Here are some prevention tips:
•    Wash hands thoroughly and often with soap and water.
•    Keep cuts and abrasions clean and covered with a bandage until healed.
•    Avoid contact with other people’s wounds or material contaminated by wounds.
•    Do not share items such as razors, soap, ointments and balms, towels or washcloths, clothing or uniforms.
•    If participating in contact sports, cover cuts, scrapes and other wounds with a bandage.
•    If caring for someone with an infection at home, wash hands with soap after each physical contact and before going outside. Only use towels for drying hands once. Change and launder linens frequently, right away if they are soiled.
•    When contact with body fluids is expected, wear disposable gloves and wash hands after removing them.
•    See a physician promptly if you have a suspicious skin sore or boil.

How are staph infections treated?
Treatment for a staph skin infection may include taking an antibiotic or having a doctor drain the infection. If you are given an antibiotic, be sure to take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save them to use later. Severe or recurrent infections may require a seven to 10 day course of treatment with penicillin or other oral antibiotics. The location of the infection and the identity of the causal bacteria determines, which of several effective medications should be prescribed.
     Many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
     If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

What will I do?
To prevent skin infections caused by MRSA and other germs, it’s essential to treat your cuts and scrapes Staphasepticwith a good ointment. It’s an effective way to protect yourself and stop staph from spreading. StaphAseptic is one such ointment that I saw that many of the Canadian adventure racing teams had in their mandatory medical gear bags. Its greaseless, non-staining gel provides soothing wound care without stinging or irritation. The fact that is contains Lidocaine 2.5% for topical pain relief is a positive benefit. I have one tube, which I am taking to Badwater, and I will keep a supply in my foot care box. I will use it anytime I lance blisters in a multiday event and blood blisters.
     In vitro studies have shown that StaphAseptic kills over 99.9% of MRSA germs, preventing an infection without antibiotics. This new pain-relieving wound treatment should be used as part of a complete staph prevention program to provide protection from skin infections. An alternative ointment is Bacitracin. A prescription ointment is Bactroban.

Source: Drug-resistant staph infecting more people (Associated Press, 2004)
Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group
Source: The Centers for Disease Control (CDC) 

I welcome your opinion on this editorial. Send me an email.

CELLULITIS FACTS
Cellulitis is a potentially serious bacterial infection of your skin. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. Skin on the face or lower legs is most Saodull_arfeettop_sharoncommonly affected by this infection, though cellulitis can occur on any part of your body. Cellulitis may be superficial — affecting only the surface of your skin — but cellulitis may also affect the tissues underlying your skin and can spread to your lymph nodes and bloodstream.
     Left untreated, the spreading bacterial infection may rapidly turn into a life-threatening condition. That’s why it’s important to recognize the signs and symptoms of cellulitis and to seek immediate medical attention if they occur

How does cellulitis present?
Cellulitis may result in skin that is:
•     Red
•     Swollen
•     Tender
•     Warm

The changes in your skin may be accompanied by a fever. Over time, the area of redness tends to expand. Small red spots may appear on top of the reddened skin, and less commonly, small blisters may form and burst.

What causes cellulitis?
Cellulitis occurs when one or more types of bacteria enter through a crack or break in your skin. The two most common types of bacteria that cause cellulitis are streptococcus and staphylococcus.
     Although cellulitis can occur anywhere on your body, the most common location is the legs, especially near your shins and ankles. Disrupted areas of skin, such as where you’ve had recent surgery, cuts, puncture wounds, an ulcer, athlete’s foot or dermatitis, serve as the most likely areas for bacteria to enter. [Editor: and blisters]
     Certain types of insect or spider bites also can transmit the bacteria that start the infection. Areas of dry, flaky skin also can be an entry point for bacteria, as can swollen skin.

What are the risk factors?
Several factors can place you at greater risk of developing cellulitis:
•      Age. As you age, your circulatory system becomes less effective at delivering blood — with its infection-fighting white blood cells — to some areas of your body. As a result, skin abrasions may lead to infections such as cellulitis where your circulation is poor.
•      Weakened immune system. Illnesses that result in a weakening of your immune system leave you more susceptible to infections such as cellulitis.
•      Diabetes. Having diabetes not only increases your blood sugar level but also impairs your immune system and increases your risk of infection. Your skin is one of the many areas of your body that becomes more susceptible to infection. Diabetes may result in decreased circulation of blood to your lower extremities, potentially leading to chronic ulcers of your feet. These ulcers can serve as portals of entry for bacterial infections.
•      Chronic swelling of your arms or legs (lymphedema). Swollen tissue may crack, leaving your skin vulnerable to bacterial infection.
•      Chronic fungal infection of your feet or toes. Recurrent fungal infection of your feet or toes can cause cracks in your skin, increasing your risk of bacterial infection.

When should I seek medical advice?
If you have a rash that’s red, swollen, tender and warm — and it’s expanding — try to see your doctor the same day. If a fever or pain accompanies the rash, or the rash is changing rapidly, seek emergency care. It’s important to identify and treat cellulitis early because the condition can cause a serious infection by spreading rapidly throughout your body. Marking the outline of the area of redness with a pen can help medical personnel know how much and how fast the infection is spreading.

Can there be complications from cellulitis?
This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout your body.
     In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Flesh-eating strep, also called necrotizing fasciitis, is an example of a deep-layer infection. It represents an extreme emergency.

How can I treat cellulitis?
Your doctor may prescribe an oral antibiotic to treat cellulitis. You’ll likely recheck with your doctor one to two days after starting an antibiotic, which you’ll take for about 10 days. In most cases, signs and symptoms of cellulitis disappear after a few days. If they don’t clear up, if they’re extensive or if you have a high fever, you may need to be hospitalized and receive antibiotics through your veins (intravenously).
     Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. An example is cephalexin (Keflex). Your doctor will choose an antibiotic based on your circumstances.

How can I prevent cellulitis?
To help prevent cellulitis and other infections, follow these measures any time you have a skin wound:
•      Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
•      Apply an antibiotic cream or ointment. For most surface wounds, a single- or double-antibiotic ointment provides adequate protection.
•      Cover your wound with a bandage. This helps keep the wound clean and bacteria out. If you have draining blisters, keep them covered until a scab forms.
•      Change bandages often. Change them at least daily or whenever the bandage becomes wet or dirty.
•      Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.

People with diabetes and those with poor circulation need to take extra precautions to prevent skin wounds and treat any cuts or cracks in the skin promptly. Good skin-care measures include the following:
•      Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling.
•      Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
•      Protect your hands and feet. Wear appropriate footwear and gloves.

Promptly treat any superficial skin infections, such as athlete’s foot. Infections on the surface of the skin (superficial) can easily spread from person to person. Don’t wait to start treatment.

Source: MayoClinic.com
I welcome your opinion on this editorial. Send me an email.

BAD FEET PHOTOS
My son Scott, who started this whole foot thing by suggesting that I write a book on foot care (Thanks Scott!), recently sent me the following story of a coworker.
     “This is the toe of one of the guys here at work who was at the Manteca Home Depot and pulled a 4×8 sheet of siding off the shelf and attempted to slide it onto a cart. When the cart moved, he lost the grip Smashed_toein one hand as he tried to slide the sheet onto the moving cart and it dropped directly onto his toe and broke it in six places as well as lacerated it pretty good through his sock (he was wearing sandals). He said that blood was squirting straight up and within minutes, his sock was bloody toe to heel. He did make it through the register to pay and went into Target to find his wife before going to the hospital. They told him it was broken, put a Band-Aid on it and gave him two aspirin and sent him home.

Previous photos and their stories can be found in past issues of this newsletter (since July 2005). For photos before then, check here.
     Just think; your feet could be featured in this e-zine for everyone to see! Submit your photo or short story by email. Stories should be no longer than 250 words. Send them to me by email.

FEATURED FOOT CARE PRODUCT
Inov-8, the shoe company, has introduced a combination sock and gaiter called Debris Sock. This unique Inov8debrissocksorsm061anatomically designed single piece gaiter sock is designed to prevent dirt and grit from entering the shoe when running. Choose between fast wicking and quick drying Coolmax or Merion wool with padded areas giving extra cushioning and protection. The socks come in small, medium, large and extra-large sizes.
     BackpackingLight.com says : At 1.3 ounces, no combination of sock or gaiter comes close to this weight and simplicity. Even the most breathable stretch gaiters are warm and sweaty; the Debris Socks offer far superior breathability- they are nearly as breathable as normal socks.
     The GearZone.com writes: The Debris Sock has a low profile elastic cuff with an integrated stretch Inov8debrissocksorsm062gaiter. Custom length, replaceable, gaiter fasteners run underneath your shoe to keep everything nice and tight. Grippers at the back of the gaiter and a hook that attaches to your front shoe lace makes sure the gaiter stays down.
     The Debris Sock is ideal for adventure racing, trail running, backpacking, hiking and mountain biking. Prices range from $18.00 to about $22.00 depending on the fabric. Zombierunner carries these unique socks.

MY HAPPY FEET BLOG
If you like to stay informed about foot care issues and information – on a more regular basis than this monthly newsletter, check out my blog, Happy Feet: Expert Foot Care Advice for People Who Love Their Feet. This is different from this ezine. The Happy Feet blog will have a new short topic every other day. It’s at http://www.vonhof.typepad.com/happy_feet/

READER FEEDBACK AND COMMENTS
Joe Lugiano of Cary, NC wrote: “Thanks for all your contributions to the sport. Without your advice a lot of newbies would certainly find a miserable experience. Over the last 30 years, I’ve been able to find the happy medium for my foot problems that keep me fairly blister free. Ironman Triathlon socks, shoes that have a larger toe box and slightly oversized, and trail gaiters to keep out the debris seem to make a big difference. Having that knowledge can save you from many years of pain and discomfort from trial and error experiences. I know people today who still have problems with their feet and consider it a normal part of running the distance and don’t learn. I’m sure that your efforts are greatly appreciated by those whom receive your help.”

Melissa Griffiths, an adventure racer, wrote: “A million thank you’s for all your help during the Raid the North Extreme race. I am delighted to report that I didn’t get a single blister, which is unprecedented for me. I think it was a combination of careful taping and thorough nail filing. You were very generous with your advice and time, and both myself and the Dirty Avocados  [Melissa’s team] appreciated it.
     Our time on the mountain was certainly soul searching. We were up there for 57 hours, 48 of them with no food so it was definitely "Extreme"! It’s hard to describe the feeling of traversing a 45-degree snow cliff in running shoes with no tread, or watching your team mate sliding down a glacier with no ice axe, or bush whacking through dense forest for 8 hours and moving 4 miles. The highlight for me was the incredible teamwork and courage we all displayed. Many teams would have fallen apart but the Dirty Avocados put on a very proud show and maintained a sense of humor when all we wanted to do was crumple into a heap and burst into tears. I know it’s not just me who felt like that!
     Now that it’s over and we’re all recovering, I’m already looking forward to the next one. I’ll probably do Primal Quest next year and maybe Baja. Hopefully I’ll get to see you at some of them. Thanks again for all your help
.”

Reader feedback to this E-zine and its articles is welcome and encouraged. Please email any foot care ideas or tips that you have tried and would like to share with others, or ideas for an article for the e-zine.

HAPPY FEET BOOKLET   
My booklet, Happy Feet! Foot Care Advice for Walkers and Travelers is in stock and ready for the walkers in your life. This booklet is 3.75 x 8.5 and 36 pages in length. In an easy read format, it gives advice on biomechanics and gait, buying footwear, fit, lacing, insole and toenail tips, skin care, powders and lubricants, blister care, sprains, foot care kits, and more. It’s on sale at 20% off for $4.00. Click here to read more.

GOT A STORY TO SHARE?
I am always on the look out for stories to share about their adventures with some type of connection to feet. If you have something to share, please send me an email.

PRIVACY INFORMATION
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CONTACT INFORMATION
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