Learning Foot Care from the Heat

July 31, 2011 by · Leave a Comment
Filed under: blister care, Foot Care, Health 
Alene at Badwater 2011

Alene at Badwater 2011

This guest post comes courtesy of Alene Nitzky, Ph.D., RN

I ran Badwater as a rookie in 2008 with two years of crewing and pacing experience and several training runs across the valley. I’d never had foot or stomach problems before, but in the race, I suffered from an array of the usual problems runners have there: blisters, swollen ankles, not peeing enough, vomiting, nothing tasting good, and not getting enough calories.

While working on the medical team at Badwater in 2009 and 2010 and watching runners in some of the hot weather races I’ve run, I noticed the difference between runners who took cool down breaks and those who didn’t. Some dunked themselves in a cooler of ice water; others stopped and sat down in the shade of the van or sat in the air conditioning of the vehicle, while others seemed to reject the idea of stopping at any cost, as if it were a 5K road race.

What I also noticed were the number of runners who came to us in Stovepipe Wells, in various stages of dehydration and heat exhaustion, and the amazing turnaround they’d experience by spending an hour inside the air-conditioned medical room. They’d come in unable to urinate, nauseated or vomiting, unable to keep down any food or fluids. They’d lie there on a cot while their crews watched them anxiously.

We didn’t have to do too much for most of them. They’d cool off, sip fluids, and soon they’d be jumping up to urinate, the nausea was gone, they kept food and fluids down, and were on their way with their relieved crewmembers. Most of the time we wouldn’t see them again until they were at the post-race party being recognized for their finish.

What was happening?

Most of your blood flow goes to your skin and major muscles while you’re running in the heat. That means little blood is available to the GI tract, kidneys, and other organs. Low blood flow can rob these organs of oxygen and nutrient-carrying blood and make it hard to digest food and process fluids. This can lead to the puffy hands, bloating, sloshy stomach, nausea, and vomiting, and blistering, especially if you’re not getting enough sodium.

By taking a break, you allow some of the blood to be returned to the organs that allow your normal functions to resume. The blood flow that was going to your skin to keep you cool can go to the kidneys and GI tract again, so you process the fluids and start urinating again.

Here’s how I avoided a downward spiral?

Hydration and electrolyte replacement

Managing hydration and swelling

Managing hydration and swelling

I experimented with different products for electrolyte replacement. The one I used in 2008 didn’t have enough sodium for the extreme heat of Badwater. In 2011 I used S caps. I had tried them in the heat and humidity of Florida and South Dakota and they worked. I watched my hands for swelling routinely, made it a habit to look at my hands every time I got a new water bottle. If I was puffy, I had to think about what was happening. Usually it happened in the evening as the temperatures cooled down, when I needed less sodium. Then I’d back off. I also noticed that when my hands were puffy, my feet hurt more because they were swelling too.

Cool down breaks

I thought, it makes a lot more sense to take cool downs BEFORE you get overheated. I began trying this in my training. I’d sit for 10 minutes, put my feet up, put a little ice on my neck and legs, and soon, food started to taste better. When I got up to run again, I felt fresh.

I planned 10 minute cool down breaks every 60 to 90 minutes in the stretch between Furnace Creek and Stovepipe Wells. This year it was a lot cooler than previous years, and I often felt like I didn’t need it, so I’d go 90 minutes, but then I made myself stick to my plan. I used these breaks to my advantage to elevate my feet, check my tape, shoes and socks for moisture, get some calories in, and drink more. I had ice wrapped around me in a towel, on my neck, armpits, and thighs.

When I’d get up I usually needed to urinate. Then I’d get moving and I felt fantastic. I ran a lot more of this stretch than I anticipated, and even got into Stovepipe well ahead of my predicted time. The time I spent cooling down paid off.

Learned to work on my own feet

In 2009 and 2010 I watched Denise and John working on runners’ feet as they came in. Ugly, painful blisters, big chunks of skin peeling off their toes and heels. So many of the runners’ feet looked wet, like they’d been taking a bath.

I got a copy of John’s Fixing Your Feet book as soon as the 5th edition came out. I began doing my own weekly pedicure sessions, soaking my feet, working on reducing the calluses. I practiced the taping techniques John shows and found one that works for me. I built a well-stocked foot and first aid kit so I’d have everything I needed. And I kept my feet dry on the run.

Despite over a dozen “foot checks”, cool down breaks, and a few naps, I still managed to better my time from 2008 by over an hour and a half. I was extra cautious with my feet this time because I knew that in order to turn around and run back to Badwater, I was going to have to have my feet intact. On the way back, I followed the same strategy.

When I arrived at Badwater, after 270 miles, the only blister I had left was the one I had at 80 miles. Other than the general soreness that comes from 5 days of running on asphalt, the blister wasn’t really an issue. I used only two pairs of shoes, one for the race and one for the return trip. I never had to go to a larger size because my feet stayed dry and my feet didn’t swell much.

I thoroughly enjoyed my double and ran comfortably the whole way. When you take care of the basics like feet and hydration, everything else tends to fall into place.

Alene Nitzky, Ph.D., RN lives in Fort Collins, Colorado. She has been running ultramarathons since 1991. Check out her blog Journey to Badwater.

Alene Nitzky’s Foot Care Lessons From Badwater

July 24, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

Alene Nitzky is a veteran ultrarunner from Colorado who two weeks ago completed Badwater, and then turned around and made it a “Badwater Double” – going back on the course to the start. She had successfully run Badwater before and spent several years working on the medical team. Her Double this year was a success in many ways. Her stomach held up well and her feet cooperated. Here is a report from Alene’s blog about what worked for her feet.

You have to remember that whatever is going on in your hands is also going on in your feet. Avoiding the swelling that comes with fluid/electrolyte imbalance means your feet are not going to swell causing friction against your shoes, the layers of skin and tissue in your feet are not going to swell and separate, which means you avoid blistering.

My biggest problem in 08 was the blister under my left foot. I had a blister in the same spot but over the past year I read John Vonhof’s book Fixing Your Feet and learned how to tape properly, and how to reduce the callus in my problem areas. In 08 the blister was so deep John was unable to drain it with a scalpel, he taped it the best he could to prevent further blistering, and the blister finally popped from repetitive trauma on it’s own at mile 127, which hurt like hell.

Alene's boot w blister at the base of the big toe

Alene's boot w blister at the base of the big toe

This year, it was easy to access the blister pocket and drain it, which was much less painful and much easier to manage. Other than that blister, I developed only a few small, minor blisters, which I was able to easily drain as soon as they developed, and they never became a repetitive problem. At the end of 270 miles, I only had one blister left, the big one under my foot, which didn’t get any worse after 80 miles.

Keeping your feet dry is another requirement. Checking your feet for moisture is critical. I use Drymax socks exclusively and they do very well, but no sock is blister-proof. There are seams, movement in the shoe, and moisture builds up eventually no matter what sock you wear.

My tape job on Alene's blister

My tape job on Alene's blister

Changing your socks frequently is important, and you have to be very careful not to disturb your tape job. Don’t let your crew mess with the lacing on your shoes or pull your socks and shoes off unless they know exactly how to do it right. The runner is better off doing this is they can.

Speaking of shoes, I run in Brooks Addictions and I used only two pairs of shoes, one during the race and the other on the return. I never needed to change shoes or go to a bigger size because my feet never got very swollen and they stayed dry.

We can learn from Alene did. She gets five starts for a well planned and executed race. She ran a good race and with her insights from running it in 08, and years of working on the medical team, she put what she learned into effect. Her Lessons Learned blog post contains great information on hydration, food choices, stomach, and more. I encourage you to check it out. Congratulations Alene on a successful Double.

If you don’t have a copy of Fixing Your Feet, check it out at ZombieRunner.

Disclosure: I have an affiliate relationship with Zombierunner.com and earn a few pennies when you buy though this link.

A Perfect Foot Taping Job

July 18, 2011 by · 8 Comments
Filed under: blister care, Foot Care 

A question I am often asked is how to tape one’s feet. This is not a simple question. Some people are better at taping than others. Some can’t self-tape because of the hard to reach areas of their feet. Some simply don’t have the patience for it. Others have the wrong tape, or

Denise Jones with Shannon's taped feet

Denise Jones with Shannon's taped feet

have not read the how-to’s that I and others have written on the topic.

Today I want to share two pictures from Badwater. The lady pictured is Denise Jones, and I consider her one of the best at taping. She loves helping runners and has loads of patience – both of which are important. It can easily take at least 1 1/2 to 2 hours to complete a full tape job that includes heels, balls of the feet, and toes. It can also be a backbreaking job.

The feet shown here belong to Shannon Farar-Greifer. Denise did the tape job on Wednesday – after Shannon cut her Badwater run short due to hydration/stomach issues. The taping was in preparation for Shannon’s run on Saturday at the Vermont 100. The tape held and Shannon completed Vermont.

A bottom view of Shannon's feet

A bottom view of Shannon's feet

A well-done tape job will hold for several days. The second photo shows the tape job from the bottom of the feet. You can see the detail in taping the toes. Denise is a master at taping.

For those wondering how to tape, I am working on creating a DVD showing many of the things I teach in my foot care clinics. Stay tuned here for details as I work on this project over the coming months.

The tape used is Kinesio Tex tape with a strip of Hypafix between the toes. A good tape job involves cleaning the skin, prepping the skin with Compound Tincture of Benzoin, then cutting and layering the tape in a specific order, rubbing the tape to activate the bonding character of the tape’s adhesive, applying a light power to cut and remaining stickiness of the benzoin, and finally, rolling the socks on the foot. You can shop for tape and other supplies at Zombierunner.com.

Foot Care Advice from Denise

July 8, 2011 by · Leave a Comment
Filed under: blister care, Foot Care, Health 

One of the runners doing next week’s Badwater 135 Mile Ultramarathon recently emailed Denise Jones with questions about managing his feet at this grueling race. Denise cc’d me with her response. I liked what she wrote and decided to use part of it here because it is important information.

[Denise talking about feet getting wet]. How you avoid getting your feet wet is that you avoid getting water sprayed on your legs. It’s your core that needs the cooling anyway. If you are sprayed on the legs, i.e., quads, you have to have it wiped off, then you wipe sunscreen off too. You can survive quite well without getting sprayed on the legs (honest). And, very importantly, you make mental notes about how your feet are “feeling” and address any hot spots BEFORE they grow!

As well, you make sure your crew knows by giving them strict instructions NOT to get you wet below your waist, and if anyone does (they DIE…just kidding). Really. The water that hits your legs runs down the legs into shoes. Depending on how hot it is, which is not looking very hot this year, the water that is sprayed often evaporates. However, if you get those feet wet, then one of the factors that come into play is blisters, i.e., heat, moisture and friction. You can’t avoid heat and friction, so you try to avoid moisture. The tape, as you know, acts as another layer of skin. But honestly, if you do get wet feet, and they blister, then it the athlete either is sucking it up and running anyway with those blisters, which has been done, or drops, which I doubt is on your agenda. Since you are fast, I imagine you are going to be pushing hard and those front-runners can definitely suck it up. When I see their feet afterward, I remark how much better they would have done if they had not allowed their feet to get wet or if they had figured out what works. Certainly socks, sometimes two layers, if you have trained with them and lube, and or powder can work well. Injinji’s often work with a sock over them, with lube and powder under that. The leg sleeves that have become popular now, which I really like, are a culprit I think because they allow water to drizzle into the shoes and socks. While they prevent sunburn, they do act as a catalyst to carry water that is in excess seeping down the legs onto the feet and shoes. That is DEADLY!

What I find is most important is that you have a Plan A – and then Plan B which comes into play if Plan A doesn’t work. Everyone is an experiment of “one”. About the time I think I have the magic combo figured out, someone proves me wrong. Case in point: KNOW YOUR FEET and what causes you problems and address that with a plan and then a backup plan if that fails. Then maybe you won’t need to use it once you are underway. All bets are off if you are pre-taped and those feet get wet because wet tape is not a good barrier. Duct tape is too hot and does not dissipate heat, though it can withstand moisture, often the feet macerate underneath.

Hopefully you do not have deep callus. That is also a “no-no” in my book in Death Valley because we cannot drain deep blood blisters because the callus can’t be penetrated.

Good advice from Denise – a pro about foot care in the heat. I’ll be back next week with a report from Badwater.

Foot Care Challenges at the 2011 Western States

July 3, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

Last weekend I worked the Michigan Bluff aid station at the Western States 100 Mile Run. The 2011 running of this amazing footrace over California’s High Sierras was different for several reasons.

This was a huge snow pack year, resulting in many runners with wet feet and footwear for long periods of time. The temperatures were particularly mild, resulting in the highest finisher rate since 1993.

As I worked the medical aid station, feet were my first responsibility. Somehow that’s the assignment I draw, and the rest of the medical staff are quite happy to let me do my thing. I don’t mind, it’s what I do. Push come to shove, many of them could do an acceptable job of patching a blister – but they are not knowledgeable with the best techniques.

So I set up my canopy, two chairs, stool, a card table with all my gear, my foot care kit, and several containers of extra supplies. I was ready. Over the course of the front-runner to the last runner, there was about an eight hour spread.

I didn’t count runners that I helped. I never do. I just move from one to the next as they come in for help. Strangely, this year I might have had one time when I had two runners in at the same time. Most years, there are runners waiting. And the runners I treated had less serious problems. So what did I see?

Two runners come to mind. I was amazed at how these two runners treated their feet. The first runner had come in for some minor blister repair. After I checked his feet and made a few minor repairs, I asked him whether he had clean socks. He pulled a pair out of his drop bag and handed them to me. One was fine. The other had a hole over the tip of the big toe. He laughed and told me they were his lucky socks, and asked whether I could put a Band-Aid over the hole. Really!

The second runner came and complained of heel problems. One heel had a quarter-size blister directly on the bottom and I cleaned and drained it, and then applied tape side to side under the heel. The other foot had no identifiable fluid or blister.  I asked about clean socks and he said he didn’t have any. So I powdered his damp socks and put them back on his feet. When I picked up his shoes, I was amazed to see that both insoles were worn through in the heels – exactly where he was having problems. The insoles had essentially fallen apart in the heel, creating a hole into which went the flesh from his heel. No wonder he had heel problems. I added an Engo Blister Patch on top of the indentation on each insole. After I had him set to go, he remembered he had extra socks in his drop bag, which he had forgotten about.

I saw several other things that could lead to problems.

For one thing, a majority of runners were not wearing gaiters. Those who know me have heard me preach the benefits of gaiters to keep junk out of shoes. Don’t use them and you take chances with small rocks and debris getting kicked up into the shoes, which can lead to hot spots and blisters.

Another huge issue was runners with wet socks. Failing to change socks for 65 miles leads to softened and macerated skin. More than one runner saw their day end because of this problem. When your feet hurt because of maceration, you slow down – and that leads to longer times between sia stations, and ultimately leads to missing a time cutoff. Some of these had gone through aid stations and not changing socks. Taking five minutes at an aid station to change socks can save you from slower and slower times when feet turn painful. Knowing ahead of time that snow would be an issue, failing to plan with additional socks, and even shoes, is puzzling.

Working at Western States is always an experience. I always come away having learned something new. This year I learned that no matter how many people I think I have reached and influenced with good foot care tips, there are still many who need to hear the message.

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