Maceration and Blisters

September 23, 2010 by · 3 Comments
Filed under: blister care, Foot Care, Foot Care Products 

Tonya Olson and I met at Western States this summer. She worked with the medical team and was really interested in learning foot care. A few weeks ago she asked for advice on how to manage foot care and supplies at the new Pine to Palm 100 last weekend. Here is her report.

The inaugural Pine to Palm 100 mile endurance race in Ashland, OR this weekend exhibited some rather atypical weather for the runners. It rained for 30 hours straight. Not so many blisters to address but plenty of macerated trench feet. Here are a couple of photos.

Severely macerated foot with open blood blister

Severely macerated foot with open blood blister

The first was the result of 30 hours of running in the rain with blisters starting at mile 27. He didn’t get help from me at 65 and his wife put moleskin across the bottom of his foot, which adhered to the macerated skin and blood blister, you can see a little dark patch of the remaining moleskin that I was able to remove using a scalpel. I didn’t see this runner until after the race so, I removed the moleskin and counseled his wife who is a nurse practitioner on how to care for the feet when he got home and showered.

The other photo is after the race as well and is a nice heel blister.

Let’s evaluate the photos.

The first photo shoes a badly macerated foot. No surprise there. Skin folds on the bottom of the foot can lead to huge problems. These folds are painful. The one her in the center of the arch developed into a blood blister, which then split open. A blister this low in the mid-foot is probably caused by the insole and shape of its arch. It could also have grown worse because of the maceration and folds, leading to a split, where under normal condition, it would have been fine. The photo shows what appears to be dirt inside the blister. This could easily lead to infection.

Prevention and treatment of maceration can be difficult. In this case, with as much rain as the race had, it is hard to keep feet dry. Probably the best bet is to use a drying agent to keep moisture under control. Once the skin is macerated, drying can be accomplished through powder, exposure to air, and dry socks and shoes. The skin folds will return to normal – over time. There is no fast cure. Here are a few more tips:

  • Apply a beeswax and lanolin preparation such as Pro-Tech-Skin from Atsko or Kiwi’s Camp Dry.
  • Coat your feet with Desitin Maximum Strength Original Paste.
  • Reapply the skin protectant at frequent intervals or when changing socks, making sure to clean the feet first.
  • Make sure your footwear drains moisture out of the inside of the shoe.
  • Warm your feet when stopping, resting, or sleeping.
  • When resting, remove footwear, dry your feet, and allow them to air.
  • Consider wearing waterproof socks. You have two choices. SealSkinz socks are designed to keep water out. Seirus StormSocks are made from neoprene and are designed to hold warmth in, but some water can get inside.

Back of heel blister caused by maceration

Back of heel blister caused by maceration

The second photo shows skin peeled back from a back-of-the-heel blister. The maceration softened the skin and rubbing in the shoe’s heel counter caused the blister.

An ENGO patch in the heel counter would have helped prevent the rubbing. Taping before the race could have helped.

Something to try before an event where rain is expected is to pre-tape the bottom of the feet. A carefully done tape job, with Compound Tincture of Benzoin to make the tape adhere better, could help reduce the occurrence of skin folds.

Thanks Tonya for sharing these photos.

Toe Blisters at the Gore-Tex TransRockies

September 10, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

Toe blisters at the TransRockies were a huge problem. We saw many of the same runners day after day during the six-day race. One lady kept coming in every day after her run. She finally told me she was removing all the tape from her toes before running the next day. Bad idea. I informed her tape would act as a skin protector for the day’s run and not to take the tape off.

Every day we saw all kinds of toe blisters. Big ones and little ones. Ones filled with clear fluid and others filled with blood.

Most had the usual blisters between toes and after draining these were patched with Kinesio Tex tape first wrapped from bottom to top and then a second strip from side the side. The second strip going side to side prevents there being a seam hitting on the neighboring toe.

Draining a blister under a toenail

Draining a blister under a toenail

Blisters under the toenails were very common. Many were blood filled. In the photo you can see the thin edge of a blister at the forward edge of a toenail. When possible, I drain the blister there. Since the lifted skin is dead, there is no pain associated with this method. I always use a scalpel or needle and give a test ople to make sure the runner can’t feel the point. If the can’t, it is safe to make the drain hole there. If they can, I have to go through the nail.

Drilling through a nail is pretty straightforward. I use a nail drill but you can also use a needle or even, in a pinch, a paper clip. Hold pressure on the drill or needle as you spin it back and forth until the nail is penetrated. At the TransRockies I drained four or five blisters with my nail drill.

Once the hole is through the nail or a hole is made in the skin, pressure will expel the fluid and the pain and inside pressure will be gone.

Covering the tip of the nail with a strip of tape will help prevent it from catching on socks.

Toe Blister Causes

In my experience, toe blisters are typically caused by too long or rough toenails, and poorly fitting shoes. When toenails are too long, the socks catch on the long nail, or on a rough nail, and are pushed into the quick of the nailbed. A blister forms underneath the nail and pain starts. The answer is to trim nails short and then file them smooth so when you run your finger over the tip of the toe, no edge of a nail is felt.

Of course, toe blisters can also be caused by shoes that are too narrow or too short in the forefoot, overlapping toes, old and worn socks, downhills, and rough fabric on insoles. At the TransRockies there were long steep downhills.

With a bit of forethought and planning, you can avoid painful toe blisters. The best way to start is to do good toenail care.

Summary of Gore-Tex TransRockies Run

September 3, 2010 by · Leave a Comment
Filed under: Travel 

Last week I had the opportunity to spend six days working medical at the Gore-Tex TransRockies Run in Colorado. This was truly a positive experience.The Colorado Rockies are fantastic.

About 50 individuals did the three-day race and 110 teams did the six-day. We saw a significant amount of foot problems. Toenails and heels were the main issues. We had between 10 and 14 runners who presented with large heel blisters. Toenails were an issue mainly because of poor personal hygiene and runners being not understanding the potential of under the toenail blisters and toe blisters. There were only a few runners with ball of the foot blisters. The next few posts will highlight what we saw and treatments given. I have some great photos. Those of you who know me know you can count on some photos that will make you cringe!

Tim and Doone finishing day four at the Gore-Tex TransRockies

Tim and Doone finishing day four at the Gore-Tex TransRockies

The photo is of Tim and Doone Watson finishing day four at Redcliff.

This year the runners covered 115 miles in six days. Stages ranged from 14 to 24 miles. The route was from Buena Vista to Beaver Creek, going over Hope Pass into Leadville, and then later through Vail. Great swag for runners, all inside a huge duffle bag – a Gore-Tex WindStopper jacket, Timex watch, hat, shirt, a trail running book, ceramic mug, Peet shoe dryer, energy food stuff, WindStopper stadium blanket, WindStopper gloves, and more. Good meals, masseuses available every afternoon, ice baths, mobile showers, and tents put up and taken down for you. Awards were presented every night for that day’s stage category winners and overall winners. Videos were shown each evening of the day’s race. It was a real social event too. Gore-Tex and Salomon each had areas for runner relaxation for the runners every afternoon.

The staff and volunteers are there to make the event as fun as possible for the runners. I can honestly say the runners every need was taken care of.  We worked hard but were treated well. We also received swag, in fact more than any other race I have worked.

For those looking for a late summer experience, the TransRockies is a first rate race.  I encourage you to consider the race for 2011. Teams can be two guys, two ladies, or a guy and lady – or do the three-day race solo. The link is http://transrockies.com/transrockiesrun/news/

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