Learning Foot Care from the Heat

July 31, 2011 by
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.

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