The Pesky Little Toe Triangle

July 24, 2010 by · 1 Comment
Filed under: blister care, Foot Care 

Quite some time ago I wrote about the “Little Toe Triangle.” Working recently at Badwater, I was reminded again about this little appendage. A runner had completed the grueling 135-mile Badwater race through Death Valley and had come into the medical room for foot care.

Split open blister on a pinky toeHe really had pretty good feet. With on exception – his little toe on his right foot. A callus on the bottom of the toe had evolved into a substantial blister that had ruptured. The skin was movable from the bottom of the blister all along the inside of the toe to near the top, where the blister ended. There was no quick fix. The image here is not this runner’s toe, but very similar.

Removing the skin was not an option. I pulled the skin into place, added a dab of antibiotic ointment, and wrapped it with Coban self-adhering wrap.

Unfortunately, this runner was planning on running a 100-mile race this weekend. He and I talked about his options and I gave suggestion on how to manage the skin. I would doubt his ability to finish a 100 miler with this severely blistered pinky toe.

The number of problems with these little appendages has impressed me. “What problems?” you might ask. It’s all about that little triangle of skin where most problems occur.

If you look at your little toes, your toes may be well rounded and soft. Or they may have the often-typical triangle look where the skin on the bottom of the triangle is hard and callused. The skin on the bottom of the toe forms the point of the triangle. The problem is that on many of our little toes, this bottom point is hard and callused skin. The hard skin is prone to blisters forming underneath as pressure creates friction. Often this hardened skin is partially under the skin of the next toe, another pressure area. The outside of the foot, the little toe area, is often more wet and damp than the inside of the shoes, leading to macerated skin. Once softened, this skin can easily blister underneath, or worse yet, the skin can separate, leading to major skin problems.

One of the best ways to tame the callus on the bottom of the little toe is the Heel Smoother Pro. I reviewed this great tool last November.  It comes with two tips. The smaller one is shaped like a little Christmas tree. The curved sides are perfect for toes. This is the best callus tool I have ever seen.

The little toe is so small that it is hard to patch well. The use of Micropore or Kinesio tape is a good choice. Even better, in my opinion, is reducing the hard callused skin. Injinji toe socks can also be helpful. Good shoes are vital too. Shoes with a good toebox that allows the toes room to wiggle are good. Once the skin has blistered, 2nd Skin is good to use as a patch. Cut it to fit the blister. Too much and it becomes bulky and rubs on the neighboring toe.

During a race or hike, be watchful of your little toes. This small but potentially troublesome triangle of skin deserves special care.

Don’t Do This to Your Feet!

July 17, 2010 by · 1 Comment
Filed under: blister care, Foot Care, Health 

This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.

For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.

At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.

She should have.

After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.

What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.

An enormous blood blister

An enormous blood blister

There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.

We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.

What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.

I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.

It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”

See You at Badwater?

July 10, 2010 by · Leave a Comment
Filed under: Foot Care 

Sunday I will arrive at Furnace Creek in Death Valley for the Badwater Ultramarathon. For those unfamiliar with Death Valley, it is a beautiful place. And, contrary to most people’s imagination, it is not flat.

My role is to serve on the medical team and assit the 80+ runners as they start in three waves Monday morning: 6:00, 8:00 and 10:00 AM. The route is 135 miles through the National park and into Lone Pine, before starting the long road up to the Whitney Portal. This is a very extreme event and all runners and crews have my support. They are allowed 60 hours to finish.

Here is the link to view the webcast:

And the link for Twitter updates:

Catch the webcast if you can. Maybe you’ll see me. I expect to patch quite a few feet and many of my best patching jobs and the worst feet I have seen, have been at Badwater.

When I return, I will share what happened and what I learned about feet. I wish all the runners and crews a good and safe experience.

Toenails at Western StatesTo tide you over until my next post, here’s a photo that I shot at Western States two weeks ago. The runner came in for a bit of foot care and his, yes, his, toenails surprised me. I complemented him on his colors.

Foot Care – What Were You Thinking?

July 3, 2010 by · Leave a Comment
Filed under: Foot Care, Health 

Continuing our story of working on feet at Western States 100 last weekend, I have to share this story. Tonya and I were working side by side as runners came over for our help. She was a quick learner and asked a lot of questions – which was good. Twice, she seemed perplexed, as I was also.

The first time was with a runner who had stubbed her toe, which lifted the big toenail off the nail bed. There was blood under the nail. We noticed more than blood. There was also a large build-up of residue from toenail fungus. I drained the blood blister but could do little to reduce the angle of the nail. It stuck up quite a bit. Putting pressure on the nail to try and get it to lay flatter didn’t work.  It hurt her too much. There was too much nail fungus build-up under the nail. That is common with nail fungus. I ended up running a strip of Kinesio-Tex tape from the top of the toe over the tip and underneath. Then a wrapped a length of tape around the toe to help hold the nail down. I talked to the runner about her toenail fungus while I worked. She was aware of the fungus, but hadn’t done anything about it.

The second case was a runner who came in with macerated feet. We cleaned his feet and looked them up and down for anything to patch. Tonya pointed out a bunch of opened skin between his toes. Not a couple of tiny tears, but a lot of open skin around several toes. The skin was soft and wet, and had torn open. It looked pretty painful. It was Athlete’s foot. As I worked on his feet we talked to the runner. He worked in a running store. The advice I gave him was to get out of shoes during the day and let his feet air. And to start taking a proactive approach to medications to rid his feet of Athlete’s foot.

Both cases were interesting in that they knew that had a pre-existing problem condition with their feet. And both had chosen to do nothing, Ignore the problem. Maybe it will go away on its own.

The problem was that these two runners had entered this 100 mile run, and paid a large amount of money for gear, travel, crew and pacers, and spend a lot of time training – without thinking about their pre-existing foot condition. Toenail fungus in the first case and Athlete’s foot in the second.

Each condition was not run ending on a normal day. However this is a 100-mile run. The trail was wet and full of rocks, roots, sand and dirt, and in a race where things “happen.”

A stubbed toe led to a raised big toenail that now pressed even more on a toebox. It must have hurt – especially on the downhills. The Athlete’s foot led to easily opened and torn skin between the runner’s toes. The wet conditions had made it worse. That open and raw skin must have hurt too.

I hope the runners finished. I did not write down their numbers so couldn’t find out.

As I worked on their feet, I talked to each and told them they needed to take care of their conditions. I really wanted to say, “What were you thinking?” Truth be told, I wanted to yell it at them, “What were you thinking?”

Both runners had made choices that jeopardized their finishing. When you invest all that money and energy into a race, why not make sure the two feet that are responsible for getting you there are in the best shape possible.

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