Maceration

June 23, 2011 by
Filed under: blister care, Foot Care, Health 
A BAD case of maceration

A BAD case of maceration

This weekend is the running of the Western States Endurance Run, a 100-mile race from Squaw Valley to Auburn, over the California Sierras. While around 375 will start the race, the finisher’s numbers will probably fall between 200 and 250.

The main reasons for not finishing will include being under trained, stomach issues, simply missing cutoffs, and injuries.

Injuries are big. There will be sprained ankles, cuts and scrapes from falls, possible wrist injuries from falls, tons of blisters, and this year – a lot of problems from maceration. With higher than normal snow levels, and this week’s hot temperatures, runners will be in the snow more than normal. Plus runoff from the snow will affect trails and stream crossings. These wet conditions will affect many of the runners – leading to maceration.

The picture above shows a severe case of maceration. With maceration this bad, the runner usually cannot continue because of the pain.

Maceration at Western States

Maceration at Western States

So, what is maceration and what can you do about it?

Dermatology.about.com give the following definition: Maceration of the skin occurs when it is consistently wet. The skin softens, turns white, and can easily get infected with bacteria or fungi. The photo, taken at the Western States finish line years ago, shows a good case of maceration. The runner’s son asked me to look at his dad’s feet because he had huge painful blisters on the bottom of his feet. There were no blisters – only the skin as shown.

Wet conditions can have a negative effect on our feet. Blisters may go from being minor inconveniences to major problems. Maceration can happen. In severe cases, trench foot can become a real medical issue. When these conditions set in, you will be at the mercy of your hurting feet.

So what happens when your feet are wet and cold and how can that affect your racing? As your skin becomes wet, it softens and becomes more susceptible to blisters. If a blister forms, it is more likely to rupture. The skin then separates further. Maceration happens when skin becomes soft and wet for long periods of time. When you take off your socks and find your feet look like prunes, this is what has happened. The skin is tender and can fold over on itself, separating and creating problems. As layers of skin separate, blisters spread, the skin becomes whitish in color, and it can split open and bleed. It is very hard to patch feet when this has happened. Feet become so tender that every step is painful. The first photo shows such a case.

Many athletes with macerated feet feel as if the whole bottom of their foot is blistered, as I mentioned above. In fact, there are often no blisters. The skin is so soft and tender that every step is painful. Many times the skin had folded over on itself or has lifted to form deep creases. These feet need to be dried as much as possible by removing them from the moisture source, applying drying powders, and exposing them to air. There is no quick fix for macerated feet.

Tips for maceration

Maceration of the skin can cause a great deal of pain and interfere with walking and running. These steps should be taken prior to exposure for the best effect:

  • Apply a beeswax and lanolin preparation such as Pro-Tech-Skin from Atsko or Kiwi’s Camp Dry, or Hydropel Sports Ointment, which is used by many adventure racers because of its moisture-repelling capabilities.
  • Coat your feet with Desitin Maximum Strength Orginal Paste.
  • Reapply the skin protectant at frequent intervals or when changing socks.
  • Warm your feet when stopping, resting, or sleeping.
  • When resting or sleeping, remove footwear, dry your feet, and allow them to air.

Tips for moisture

  • For high-intensity, fast-paced sports, lightweight and fast-drying shoes are the best bet.
  • If you wear shoes with a Gore-Tex fabric, remember your feet will sweat and create moisture inside the shoe-therefore moisture-wicking socks should always be worn. Note: Once a Gore-Tex fabric shoe has water inside from a stream crossing or other water source, it will stay wet inside for a long time.
  • Treat your shoes with a waterproof spray to protect the shoes from the elements and, in turn, keep your feet warmer.
  • If your shoes have a breathable upper, layers of duct tape over the upper can keep the wind and moisture out.
  • Wearing shoes that do not have adequate draining capabilities will subject your feet to extended periods of moisture. Use a heated nail or a drill to make a few small holes where your upper attaches to the lower part of your shoe or boot. Make one on each side of the heel and one on each side of the forefoot. Some athletes prefer holes in the sole of the shoe for faster draining.
  • Wear socks that are have moisture-wicking capabilities. Whatever socks you wear, change them frequently and dry the old socks.
  • Consider wearing waterproof socks. The best choice is SealSkinz socks.

Wet and cold feet can lead to long-term and even permanent disability. Even at temperatures above freezing, the combination of cold and moisture can lead to serious injury. Trench foot can occur even in mid 60-degree temperatures. The care of your feet in wet and cold weather is crucial.

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Comments

One Comment on Maceration

  1. Mark Richardson on Thu, 23rd Jun 2011 4:38 pm
  2. I used to use the Seal Skinz socks and they work great but they are a bit like Goretex shoes. If your feet get hot and sweaty (mine always do) they will get damp inside and to keep feet dry they need to be changed several times during the event. On the positive side, they dry quickly when inside out. They are also thick and may impact how your shoes fit.

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