Plantar Fasciitis: Tape or Arch Support?

December 31, 2010 by · 3 Comments
Filed under: Foot Care, Health 

Plantar fasciitis is a common condition involving foot pain and tightness, and many plantar fasciitis sufferers seek massage therapy for relief. New research shows using a medial arch support helps manage pain and pain-related disability associated with plantar fasciitis. The medial arch is on the inside of the mid-foot.

The study compared effects of the arch support with supporting the heel and foot using a taping method commonly called “Low-Dye” taping.

Medial arch support

Medial arch support

Thirty patients with unilateral (one-sided) plantar fasciitis were randomly assigned to the arch-support or tape groups, according to an abstract published on www.pubmed.gov. Both groups were assessed before and after the study for pain and foot function. The study group was made up of 23 men and seven women.

Both groups received nine sessions over three weeks consisting of ultrasound and calf-muscles stretching, the abstract noted. They were instructed to maintain supportive
intervention (arch support or tape) throughout this period.

The pre-post comparison showed reduced pain and improved function in both groups; however, there was “significant” improvement seen in the arch-support group.

“Results indicate that a medial arch support is more convenient for short-term management of pain and disability in patients with plantar fasciitis than taping,” the researchers noted.

Source: “Low-Dye Taping Versus Medial Arch Support in Managing Pain and Pain-Related Disability in Patients With Plantar Fasciitis” was published in Foot & Ankle Specialist. (2010 Dec 1.)

Heel Blisters at the Gore-Tex TransRockies – Part II

December 26, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

Last week I wrote a post about the horrific heel blisters I had seen at the 2010 six-day  Gore-Tex TransRockies Race. If you have not read that post, or want to read it before going on to this Part II, here is the link.

To refresh your memory, here’s a brief description: The heel blisters covered the whole bottom of the heel side-to-side, and were 1 ½ to 2 ½ inches in length, towards the mid-foot. In most runners, the forward most edge of a blister had torn and opened up across the whole bottom of the foot. The blister’s roof is thick, at least four layers of skin. Most runners with these blisters had them on both feet.

This post will describe how I patched these deep and torn heel blisters.

As usual the first steps are to clean the blister and surrounding skin with alcohol wipes. Then drain the blister. Normally, needles holes will seal back up on themselves, so make sure you move the needle side-to-side to make a larger hole. If you use a scissors or clippers, make a V cut in the edge. Make several cuts. I would make one on each side at the forward edge and back edge. Expel as much of the fluid as possible.

In most blister patching jobs, I would then apply a dab of zinc oxide to the blister and then tape over this. The zinc oxide works to dry out the skin – just as when it used on a baby’s bottom. These deep heel blisters required more care.

Injecting zinc oxide

# 1 - Injecting zinc oxide

I filled a 5cc syringe with zinc oxide and attached an 18-gauge needle. Using the holes made to drain the blister, or the torn skin, I inserted the needle as much as possible into the center of the blister, and squeezed the zinc oxide into the blister cavity. This is shown in the first photo. Then I used my fingers to massage the zinc oxide around to fill any open space in the blister cavity. Any excess zinc oxide can be pushed out the openings. All you need is a thin layer of zinc oxide inside the blister.

After injecting the blister with zinc oxide, and pushing out any extra, I cleaned the skin with another alcohol wipe, applied a coating of Compound Tincture of Benzoin, and applied tape. I used two-inch Kinesio Tex tape.

The first strip of tape

# 2 - The first strip of tape

The first strip went around the back of the heel, side-to-side (the second photo).

The second strip of tape

# 3 - The second strip of tape

The second strip went under the foot, side-to-side, to anchor the blister’s roof to the foot (the third photo).

The last strip of tape

# 4 - The last strip of tape

I used two strips under the foot. Whether using one strip or more, the strips should be applied starting towards the mid foot, then work backwards so the last strip covers the edge of the strip going around the back of the heel (the fourth photo). Apply a slight stretch to the tape as it is applied. Round all corners of tape. Squeeze any overlaps sections of tape and use scissors to cut them flush. Kinesio Tex tape should be rubbed gently for 30 to 45 seconds to warm the tape so the adhesive bonds to the skin. At the TransRockies, I patched many runners’ feet with these heel blisters. Because they were running for six days, often times the runners came back the next day for a repatching.

I used the zinc oxide in side of the heel blisters too. I saw one runner, a lady from Germany, five of the six days. She had terrible side of the heel blisters. Her insoles were really thick in the heel and the edge rubbed her foot in the same spot every day, creating new blisters daily. These often were blood filled. After the third day, I started injecting zinc oxide into the blisters. I was amazed at how it would flow into all parts of the blister. Several times, because of the zinc oxide going into the blister, I could see blister under blister.

The zinc oxide worked well to dry the inside of the blister. It also eliminated much of the pain associated with blisters.

Blunt needles

Blunt needles

While I used an 18-gauge sharp needle, I would not recommend that for others. Typical needles, as you might imagine, have a point. Unless you are very careful, you can easily cause the point to penetrate into raw, new skin and tissue. You can purchase blunt needles that are much safer – and are easier to dispose of. Regular needles must be put into special “sharps containers” that most of us do not have access to. If you want to buy blunt needles, Amazon sells them, as well as syringes (the fifth photo). I would recommend a 16 gauge blunt needle. Because zinc oxide is like a thick substance, a large bore needle is needed to push it through. Several times I set the syringe in the sun to warm the zinc oxide so it would push easier. At night, I achieve the same results by rolling the syringe between my hands to generate warmth. If the zinc oxide is too thick (cold), no matter how hard you push on the syringe, it will not come out the needle.

There are several possible options to this extreme blister patching method. One can use Instant Krazy Glue or Gorilla Glue, or Compound Tincture of Benzoin. Be aware that these will sting as they are injected – but they seal the blister’s roof to the base.

Patching blisters using one of these options is best reserved for events where you have to run again the same day or the next day. Also, not everyone will have the syringes and needles necessary to inject blisters. If you are building a foot care kit for extreme events, these tools can help you care for the worst-case blisters.

And as usual, know and heed the signs of infection: redness, swelling, red streaks up the foot and leg, pus, fever, and pain. If any of these happen, seek medical attention.

Heel Blisters at the Gore-Tex TransRockies – Part I

December 18, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

This past August I worked on the most horrific heel blisters I have seen in over 13 years of doing foot care. The event was the running of the Gore-Tex TransRockies Race over six days in the Colorado Rockies. The daily distances ranged from 13 to 24 miles. The course was over trails and fire roads and many were steep. It was not a particularly wet course.

Heel blister with torn skin

Heel blister with torn skin

While there were many other blisters, heels and toes and ball of the foot, the heel blisters on many of the runners were impressive. In this first picture, you can see how the forward most edge of a blister has torn and opened up across the whole bottom of the foot.

Looking closely, you can see that the blister’s roof is thick, at least four layers of skin. It doesn’t mean that this is a blister under a callus. The second photo from a different angle allows you to see the blister covers the whole heel, side-to-side and to the back of the heel.

Photo showing the whole blister

Photo showing the whole blister

Up to that point, I had only seen this type of blistering on one runner. That was during the 2008 Badwater race in Death Valley. I attended to him at mile 21. He had bilateral heel blisters as shown in these photos. His history was interesting in that he had vacation in Tahiti on the beaches and just before Badwater had hiked down and back up the Grand Canyon. I theorized that the rough sand coupled with the heat on the beaches, followed by the friction of the steep ups and downs of the Grand Canyon, made his heels susceptible to blistering on the hot roads of Badwater.

Then I saw not one runner at the TransRockies, but more than 15 runners with these same blisters! The blisters were on men and women, of all body weights, and of all running speeds. They even affected a few of the race leaders.

A view of another heel blister torn on the side

A view of another heel blister torn on the side

The third photo shows a heel blister that tore on the side of the foot. I removed the torn skin because of the condition of the torn part. Leaving it on would have not provided any protection.

At the TransRockies, I talked to David Hannaford, a sports podiatrist from California who was running the race. He speculated that the footwear or the insoles could cause the heel blisters. My feeling is that the blister formed deep under several layers of skin due to a combination of steep downhill running and pressure/friction created when the runner landed on his/her heels. As the runners ran the steep downhills, with their full bodyweight landing on their heels, the added pressure and friction led to the blisters forming deeper then normal. While the coarse was not unusually wet, the feet have hundreds of sweat glands and the sweat typically generated while running could have also been a contributing factor. Many of the runners had these blisters bilaterally on both heels.

The next time I see these blisters, I will ask the runners what type of socks they were wearing. Socks with less moisture control will trap the wetness under the foot and can contribute to softened skin and blistering. I will also look at and feel the insoles. The surface fabric of some insoles is rougher than others and might be another contributing factor.

A good question is why some runners had these heel blisters and not others. It cannot be narrowed down to one thing. Here are my thoughts on possible contributing factors:

1.     The steep downhills

2.     The shorter day’s distances meant that runners could run fasted than those doing longer races, meaning the downhills were run faster

3.     The type of socks they were wearing

4.     The surface of their insoles

5.     How they landed (heels versus more on the whole foot or forefoot)

6.     How much their feet sweated

7.     Any pre-existing conditions as calluses or new skin under previous blisters

8.     The fit of their feet inside their shoes (allowing extra movement)

9.     The use of a lubricant on their feet, which can lead to softened skin

10.  A lack of training with enough miles on the feet to warrant running such distance on a back-to-back daily basis

So there the 10 factors I feel could cause such extreme blisters. As you might guess, any one, or several, of the above factors, could have caused these blisters. One person could have been affected by factors that did not affect another runner. Several of the factors, such as numbers 1 and 2, were more than likely factors in a majority of the cases.

My next post, Part II, will detail how I managed the blisters and show photos of the process of patching them, what I learned and how I would manage them the next time.

Has Nike Invented A Second Skin?

December 10, 2010 by · 2 Comments
Filed under: Foot Care, Foot Care Products, Sports 

The post by Steve Casimiro on Adventure Journal asked the question: “Has Nike Invented A Second Skin?” He wrote:

Nike Footstickers

Nike Footstickers

“These ‘Footstickers’ appear to be nothing more than concepts of potential Nike products, but the future they suggest is pretty darn intriguing. Three models are shown for yoga and dance, and how they’d actually stick to your feet isn’t explained, nor is the connection to Nike. But given the success and broadening line of Vibram Five Fingers models, it seems inevitable that more brands won’t experiment with the concept.

The idea of a simple paste-on makes complete sense for a pursuit like yoga, but probably wouldn’t stand up to the rugged outdoor world, where it’s easy to picture it peeling off at the first touch of hot asphalt. But once your feet have adapted to barefoot running, they don’t need much more coverage than a skin to protect from broken glass and other spiky hazards.”

Nike Footstickers

Nike Footstickers

According to a similar post on Behance: “There are many advantages of bare feet sporting: better motion control, more feeling in your feet and direct floor contact, etc. In this way you are more grounded and more aware of your feet and movements. It’s also a good training for stronger feet. But a disadvantage is the risk of injuries; you can easily twist or slip. The Footsticker improves the activity and keeps the bare foot feeling! The flexible material feels like a second skin. This Footsticker gives you more grip, support and protection.”

For this concept to work, I have questions.

  1. Will they be offered in various sizes for men and women’s feet?
  2. How about sizing for wide and narrow feet?
  3. How will they accommodate different toe lengths?
  4. How thick are they?
  5. How pliable are they?
  6. Can they be trimmed?
  7. What holds them on?
  8. How long will they last?
  9. What are they made out of?

The concept also adds something to a part of the foot that might be fine. That can be a problem for some people. I generally subscribe to the “less is better” theory. We will watch this and see if it ever makes it to market.

Thank you to Brian Schmitz for alerting me to this item.

Update on the 5th Edition of Fixing Your Feet

December 8, 2010 by · Leave a Comment
Filed under: Books, Foot Care 

The other day I received the following email from Ron from Nebraska:

“Great website! There’s a ton of awesome information there. I’m a beginner (although fat and 42…) and have just started jog/walking, but managed 3 marathons last year and 3 this year plus 2 50k’s and a 6hr trail run. Ok, enough of the boring history. I was just wondering if the new edition is on schedule or if it will be possible to get it any earlier? So far Glide/Vasoline and good socks have served me well and no issues, but I’m going to try a 50 miler in the spring and want to be ready (along with helping pace a friend in a 100 mile attempt and making sure HIS feet are good). Thanks again for all the info on the page.”

The New 5th edition of Fixing Your FeetGood question.

As I send this out I have the completed new edition, in paper form on my desk. My final job is to go through it page-by-page to check for any needed last minute corrections, and to create the new index. That’s 361 pages to review. My deadline is to have this back to the publisher by December 19th. It will go to press shortly after that. My understanding is that the delivery date is early February.

True to form, Amazon is already taking advance orders – and has it marked down by 33%! If you want to order it now for yourself or as a gift for a friend, here is my Amazon affiliate link:

You’ll notice this new edition has a new photo on the cover. I love this action shot, taken by Dan Campbell at one of the Primal Quest Adventure Races. It shows a true to life patch job – during a race.

Each new edition of Fixing Your Feet has gotten better and better. This 5th edition is the best yet. Am I biased. Sure. But I can honestly say that my goal has always been to help every athlete with their foot care problems. I believe I can do this by making sure FYF is accurate and up to date. And as always, I welcome and value your feedback.

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