Patching Blood Blisters

October 30, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

Blood blisters are something every athlete should know how to treat. Whether on the heel, forefoot, or under a toenail, these ornery blisters require special attention.

There are two schools of thought about blood blisters.

The Conservative Treatment

The conservative treatment is to not drain a blister when it is blood-filled. Doing so creates the risk of a serious infection as bacteria is easily introduced into the dermis layer of skin and into the blood system. Pad around the blister with moleskin or adhesive felt. As the blister heals, the blood will turn from bright red to a reddish-brown.

When to Drain A Blood Blister

Blood blisters on toes

Blood blisters on toes

There are times when it is appropriate or necessary to drain a blood blister. Here are a few occasions:

  • If it is in a pressure point where it is likely to pop on its own.
  • If it will likely pop on its own if you continue on in a race.
  • If you can have it attended to by a medical team.

In these instances, clean around the blister with an alcohol wipe and lance the blister with a sterilized pin, scissors, or scalpel. After expelling the blood, apply a layer of antibiotic ointment, and then cover with tape or a blister patch.

Watch for Infection

Infection has set in

Infection has set in

Recheck all blisters daily for signs of infection. An infected blister may be both seen and felt. An infection will be indicated by any of the following: redness, swelling, red streaks up the limb, pain, fever, and pus. Treat the blister as a wound. Clean it frequently and apply an antibiotic ointment. Frequent warm water or Epsom salt soaks can also help the healing process. Stay off the foot as much as possible and elevate it above the level of your heart. If the infection does not seem to subside over 24 to 48 hours, see a doctor.

Studies have shown that StaphAseptic (www.staphaseptic.com) kills over 99.9% of staph and 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.

Cloudy or Hazy Blisters

Do not drain the blister if the fluid inside appears to be either cloudy or hazy. Normal blister fluid is clear and the change indicates that an infection has set in. If clear, the fluid can be drained, an antibiotic ointment applied, and a protective covering applied. Recheck the blister three times a day for signs of the infection. Each time you check, apply a new coating of antibiotic ointment and change the dressing. Early treatment can keep the infection from becoming more serious.

Open Blisters

An open and torn blister

An open and torn blister

Once a blister is open, using soap and water, and an antibiotic ointment or Betadine is important for avoiding infection. Though you may not use these on an open blister during a run or in the middle of the day while backpacking, at the end of the event or day, take the necessary time to properly treat the open skin. Applying an antibacterial topical ointment will help the open blister heal up to 40% faster. Check your local drugstore for a broad-spectrum antibiotic ointment like Neosporin or Polysporin that provides protection against both gram-positive and gram-negative pathogens. Brave Soldier Antiseptic Healing Ointment is an excellent all-purpose salve to have on hand for blister care.

Vibram FiveFinger Injuries

October 24, 2010 by · Leave a Comment
Filed under: Footcare, Footwear, Health 

I received a comment on a recent blog post about runners wearing Vibram FiveFingers. Debra Martin, MSPT, CLT, sent me a link to an article on “Injury Report from the Sump Jump.”

“It was thrilling to see almost 800 people run off from the starting line at this year’s Stump Jump 50Km event. Overall the injuries were few, considering the number of people out there. But there were a few patterns that were noteworthy, so here is a summary for you to learn from in preparing for your next trail race!

We actually had a line waiting for wound care after the 11 mile race due to the scraped up knees, with a few palm and finger cuts for good measure – just a matter of going fast on a technical trail here. I was very pleased that there were few twisted ankles throughout the day! I hope that was the result of trail runners working on their balance and ankle strength over the past few months and not just plain luck.

The toe injuries I saw came from people wearing – can you guess? Vibram FiveFingers shoes during the race. One person jammed their toe against a rock, twice, and has a possible fracture at the base of his toe. The other either dislocated or fractured his little toe when it split on the other side of a bush/tree.

You can find my notes on barefoot running/wearing Vibrams on the wall of this Facebook page. Yes, wearing these shoes can build strength in your ankle and foot.  However, racing in them on technical trails… well, these injuries can happen. The bad part is that you will need to keep moving with a toe swelling up in it’s little compartment, and it will be used to help you push off and “grab” the terrain for the rest of the race. Just something to keep in mind when choosing footwear for your next race!”

Injury Report from the Sump Jump

Comments

I suspect this is a foretelling of injuries to come. Sure, runners get injured all the time. But when one changes their footwear to Vibrams, they need to be aware of the trail even more than other runners wearing shoes.

Barefoot and Minimalist Footwear Advice

Take the time to learn how to “read” the trail. Learn how to react to rocks and roots and other common obstacles. Learn how to change your stride mid-stride to avoid turning an ankle. Learn to be patient and don’t do too much too soon.

When venturing barefoot onto trails or even on pavement, you should take a few precautions. Start slowly with short barefoot excursions to give your feet time to adjust. Your feet are used to the support and cushioning of shoes, and going without will make a sudden change. Be attentive to the conditions of the path underfoot. Your feet can be cut or punctured by debris on the road or trail. If you want to run barefoot, start by walking.

Walking and running barefoot can be an excellent way to condition your feet in order to prevent blisters when you do wear boots or shoes. Your skin will be tougher and you may develop calluses. Yet, be forewarned: this is no guarantee that you will not get blisters. Remember that when it is raining, the moisture will soften the skin on your feet. That’s a good time to switch to one of the minimalist shoes.

Aside from the possibility of cutting your feet on glass or metal, if you have any cuts or open skin on your feet you run the risk of picking up an infection. Another concern is skin that calluses over. These calluses can split into fissures, or cracks in the skin. This opens the inner layers of skin to a greater risk of infection. If you step on something sharp and get a puncture wound, seek medical care. Puncture wounds typically close up and this seals any debris, germs, or contaminants inside the wound. If you choose to go barefoot it’s smart to take care of your feet. There is no point in getting an infection through carelessness.

After reading about all the possible injuries from going barefoot, you may be worried. Going barefoot may be the goal of many athletes, but in reality, wearing minimalist shoes will provide protection and enhance the “barefoot” experience. Tellman Knudson likes FiveFingers, especially for people who:

  • Don’t want to deal with the pain of running barefoot
  • Want to minimize the risk of stepping on something that could hurt them
  • Run on hot surfaces where their feet would roast without protection
  • Are in the process of transitioning from running in “normal shoes” to running barefoot

Remember that switching to barefoot running or minimalist footwear does not mean you can’t ever run in shoes again. Many athletes employ a combination of barefoot or minimalist and shoes. Running minimalist helps focus on good form, and for many, will reduce injuries. If you want or need something more substantial than FiveFingers, consider using one of the minimalist shoes such as Inov-8, Nike Free, Newton, New Balance 800, or Terra Plana. These replicate the free and natural flexible motions of your feet better than the usual running shoe.

The above advice is part of the new chapter on barefoot running in the January release of the fifth edition of Fixing Your Feet.

Bunion & Big Toe Blisters

October 15, 2010 by · 10 Comments
Filed under: blister care, Foot Care, Foot Care Products 

I have seen a lot of bunions over 13 years of patching feet. Some are minor while others are more pronounced. Any of them can cause problems. I’d say that until you have had bunions, you don’t realize the problems they can cause. This post is about bunions and the blisters caused on one runner’s feet.

Today I received an email asking for help. Not unusual. I get a lot of these.  This one came from Andrea. She lives in Tampa and wrote:

I am an ultrarunner and completed my first two 100 milers this year! I love the distance, and am starting to ‘get it,’ if that’s even possible! But my biggest problem is my crazy beautiful feet.

Bunions causing big toe blisters

Bunions causing big toe blisters

I have had bunions my entire life. They’ve been checked by docs who’d love to cut on them, but they really cause me no (or minimal) pain, so surgery is unnecessary, as far as I’m concerned.

The problem is that during every ultra I end up with huge blisters on my big toes. I have your book and have tried many different things, from lube to second skin to taping. But nothing works. I just ran Arkansas Traveller, and my toes are a mess!

I wear men’s shoes in a double-wide to accommodate my bunions.  I’m not sure if that’s the problem, or if there’s a remedy. But I figured if anyone knew…it would be you! Do you think you can help me?

Well Andrea, yes and no. As you and my readers can see, these are pretty pronounced bunions.

First, let’s understand bunions. Bunions are one of the most common deformities of the forefoot. A bunion is a bump caused by enlarged bone and tissue at the outer base of the big toe where the joint angles inward toward the other toes. A displacement of the first metatarsal bone toward the midline (center) of the body and a simultaneous displacement of the big toe away from the midline (and towards the smaller toes) cause this bump to appear. Over time, the big toe can come to rest under, or occasionally over, the second toe. The bony bump is a form of arthritis. The medical term for bunions is hallux valgus.

So, what can we do for Andrea?

The blisters on the outside of the big toes show friction caused blisters. My guess is that Andrea’s shoes are being stretched at the widest point of the bunions. As the big toes are angled inward, they are rubbing at the sides of the toebox. This pressure and friction creates blisters. The image shows blood in all the blisters. The skin appears to have blistered in the same places before.

Andrea says she has tried different lubes, 2nd Skin, and taping. Here are my suggestions.

1.     Depending on the shoes, I’d try to open the toebox up as much as possible and insert an Engo Blister Patch into the area touched by the side of the big toe. This may take several tries to get the patch in without creases. Cut the patch to the size and shape needed. Use either the large ovals or the rectangle size patches.

2.     Run a strip of tape from the inside of the big toe, around the tip and down the side past the bunion. For this, I would cut a piece of 2-inch Kinesio-Tex tape to a width that works for the size of the foot and covers the affected area. I like Kinesio-Tex for this because it conforms to the curves and shape of the toe and side of the foot.

3.     Experiment with different types of tape until you find one that works. A slick and smooth tape like duct tape would be nice for this but is hard to shape to the toe. I would not use Elastikon because it s too thick and rough.

4.     Check the inside of the shoe for any rough areas or seams – and eliminate them – or switch to other shoes.

Now, the reality is that Andrea has pretty severe bunions. While they are not bothering her in everyday life, they are interfering with her running – which she loves. This is the “No” part of the answer. There may come a point when she will have to make a decision to have surgery.

Common Bunion Treatments

Be sure your shoes are wide and deep enough in the forefoot and toebox. If you overpronate, try an arch support or orthotic to reduce the overpronation. Bunion discomfort may be relieved with wider shoes, pads between the big and first toes, arch supports, and warm soaks.

Bunion Surgery

When conservative measures don’t provide relief, surgery may be necessary in extreme cases. A bunionectomy removes the bony prominence. In severe cases, an osteotomy procedure realignes the toe joint. In these surgeries, screws, plates or wires hold the bones in position while they heal. A new procedure, developed by Dr. Goerge Holmes, MD, a Foot and Ankle Surgeon with Rush University Medical Center, offers new hope. The procedure, called the Mini Tightrope, a hole is drilled through the bone leading to the big toe and another through the bone leading to the second toe. A special type of wire, called FiberWire, is fed through the holes, with tiny buttons on each end keeping the wire from slipping out of the bones. The wire is tightened, pulling the outer bone toward the second bone – into a better alignment. Holmes then rebalances the associated ligaments, tendons, and nerves in the toe. Because no bones are cut, healing is faster and with less complications.

For my money, if I had severe bunions, I’d try this.

Resources for this Post

http://www.goengo.com – Engo Blister Patches

http://www.zombierunner.com/fixingyourfeet – carries Engo Blister Patches, Kinesio-Tex tape and other foot care supplies.

Disclosure: I receive samples of Engo patches from Engo and a small  amount of compensation for sales made by ZombieRunner through my link.

Vibram FiveFingers at the Gore-Tex TransRockies

October 10, 2010 by · 5 Comments
Filed under: Foot Care, Footwear 

You may recall that in August I was part of the TransRockies Race, a three day and six-day footrace through the Colorado Rockies. I was impressed with the athletes. Most were very prepared for the rigors of covering 115 miles through the demanding Rockies.

I had contact with many of the runners each day. I would see them at breakfast and dinner, and of course, when they came for foot care.

Vibram FiveFingers

Vibram FiveFingers

One of the runners impressed me every day. John Cutroneo wore Vibram FiveFingers for the full six days. I saw him on at the end of day one. He also wore Injinji toe socks. Here’s a photo of his FiveFingers. His feet stayed relatively clean.

John came into the race with a few scrapes that bothered him. One was on the top of his foot, a bit back from the big toe on his left foot. It had been rubbed raw by one of the seams or creases on the FiveFingers. I taped that several times.

After each day’s run, I asked him if he was going to run in his FiveFingers the next day. I expressed surprise that he could run the rugged and rocky course day after day. He assured me he was doing fine.

Many runners were coming in with heel and bottom of the heel blisters. Toe blisters were common. The worst problem he had was heel blisters. I treated these and he continued on the next day.

John Cutroneo's FiveFingers

John Cutroneo's FiveFingers

I saw John most mornings and he always wore his FiveFingers and Injinji socks. He told me he had been running in FiveFingers for about 10 months. While that is not a long time to build a FiveFingers base, it worked for him. Running in these takes patience and a slow build-up to longer distances.

In spite of the FiveFingers’ lack of cushioning and support, he finished all six days. The photo here was taken at the finish line. The sole of his FiveFingers look no worse for the wear.

Yesterday I worked an aid station at the Dick Collins Firetrails 50 Mile Run. I saw two runners wearing FiveFingers. If you choose to wear FiveFingers for trail runs, be sure you have put in the training miles to avoid injury.

Fixing Your Feet, 5th edition coming soon!

October 3, 2010 by · 3 Comments
Filed under: Books 

I received word from my publisher that the 5th edition of Fixing Your Feet will be out in January 2011. This is an exciting revision.

Fixing Your Feet, 5th edition

Fixing Your Feet, 5th edition

I added a new chapter on Barefoot and Minimalist Footwear that was fun to write. This is an evolving subject but the material I wrote will be helpful to those wondering whether this is for them. Lots of tips.

Another new chapter is providing Foot Care for Athletes. This chapter is geared for those working on medical teams at races or as crew to athletes. I came home from this year’s TransRockies six-day race and knew this was a needed chapter. It will be useful for anyone wanting to learn how to provide foot care, whether for one or 200.

I fully revised the Taping for Blisters chapter. Many of my taping techniques have changed over the years and this chapter incorporates what I have learned. Photos show how to tape. The Blisters chapter too, has been fully updated to reflect what I have learned over the past years.

Virtually every chapter has been updated. I listed to comments over the past years and have made changes based on feedback. All product information and websites have been verified and updated. There lots of new products too.

The 3rd and 4th editions had the same cover, with a main color change. The cover image here is the first look at the new cover. I keep hoping for a different photo on the cover.

I am excited with this new edition. Not many books make it to this many editions. Each revision has made it better.

My publisher has pulled down the Kindle version of FYF since it was the old 3rd edition. When the new 5th edition is released, I expect it will also be available on the Kindle. For those with smartphones or an iPad, you can get the Kindle application for your device and then read FYF on it. The world is changing.

I will keep you posted when I get an exact release date. I hope to give away a few copies through this blog. Stay tuned.

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