More on Shear and Blister Treatments

August 26, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear 

Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.

It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:

Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like?  Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.

That’s shear.

Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.

The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.

Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.

Applying power during an adventure race

Applying power during an adventure race

A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.

The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.

Next time, we’ll talk about  a fifth way to reduce shear – Engo Blister Prevention Patches.

In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.

Feet Tell a Story

August 15, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, toenails 

I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.

I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.

The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.

A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!

I believe that feet tell a story.

Hurting Toes

Hurting Toes

The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.

Here are my observations about the story behind these feet.

  • Almost every toe has something going on.
  • The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
  • These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
  • My bet is the shoes’ toebox was too short in length and/or too low in height.
  • The runner may have worn two pairs of socks, which could have made the fit too tight.
  • The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
  • These toes scream pain – especially if they are encased inside shoes.
  • It’s possible the toes received some degree of care, but it is hard to tell from their condition.
  • Four of the toes have major trauma.
  • We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
  • The left big toe has blood showing in the blister on the outside edge.

That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.

My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.

What story do your feet tell?

Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.

High Quality Feet Pre-Taping

August 1, 2013 by · 6 Comments
Filed under: blister care, Foot Care, Foot Care Products, Footcare 

Over my years of taping feet, I have seen techniques improve to where pre-taping is more helpful then ever before.

Often times, in the middle of a race, one cannot take the time necessary to do a high-quality tape job. Things may be rushed. The runner may be in a huge hurry to make a cut-off. The feet and skin may be wet. Conditions may be less than ideal – lightening, set-up, workable access/angle to the feet, supplies, etc.

Bad Tape Job

Bad Tape Job

However, before a race, a hike, or run, there is more time to do a high quality pre-tape job. It’s also the time to practice your skills and learn how to do a really good tape job. The first photo here shows a pretty poor tape job on toes. In this photo, the tape will probably peel off from sock changes and general wear. If any one of the pieces comes off, the now untapped toe will be subject to the roughness of the tape on the neighboring toe. It looks like Leukotape, which sticks well, but does not conform to the curves of toes and other places on the foot. It is possible to do a great tape job on toes with Leukotape – but it take time and practice. I must admit I like Leukotape for certain conditions and tape jobs.

Bogies taped right foot after 157 miles

Bogies taped right foot after 157 miles

 

A good, high-quality pre-tape job should hold up well, for several days if necessary, and cared for. In this next photo, you can see the right foot of Bogie Dumitrescu after finishing a solo, self-supported crossing of Death Valley followed by up and down to Mt Whitney. You can see how the tape has held for 157 miles in the extremes of Death Valley. It’s hot on the valley floor, but there are two long uphill’s climbs followed by long downhill’s over two passes. An 11-mile trail hike follows that up to and another 11 back down Whitney. The tape job held for 157 miles! In fact it looks perfect.

The tape is Kenesio-Tex on the heels, balls of the feet and big toes. Hypafix tape is used in a figure eight cut to anchor the tape at the forward edge of the ball of the foot, between the toes, and anchored again on top of the foot. This prevents the forward edge of the tape from rolling.

Bogie's feet after 157 miles!

Bogie’s feet after 157 miles!

The next photo shows Bogie’s two feet after the tape was removed. No blisters. One of the reasons the tape held is that Bogie managed his feet well. He kept them as dry as possible. This is important in Death Valley where often Badwater runners get their feet wet when they are sprayed or doused with water in an effort to cool them.

Bogie was fortunate to have his feet taped by Denise Jones, the Badwater Blister Queen. Denise is a master at taping feet and does a precision tape job. This is not a 30-minute tape job. It takes as long as it takes to do it right. Denise and I tape almost identically. If we apply a piece of tape and it looks or feels wrong, we remove it and retape. Our aim is to get the runners on the course and able to finish with good feet.

Danny's Feet Taped Before Badwater

Danny’s Feet Taped Before Badwater

The point of this blog post is to show a good tape job that can hold up over multiple days. The final photo shows Danny Westergaard’s feet that Denise taped for Badwater three weeks ago. Danny’s feet are taped perfectly. You can see the small strip of Hypafix that Denise wrapped around Danny’s big toes to further secure the tape edges.

I commend Bogie and Danny for their runs. Bogie completed his solo self-supported Badwater crossing the week before the official Badwater ultramarathon. Danny completed his 7th Badwater, went to the summit of Whitney and then reversed direction and went back to the start for his 7th Badwater Double.

And I commend Denise Jones for her care of runner’s feet.  She’s a class act. Thanks Denise.

Kinesio, Leukotape and Hypafix tapes, as well as Compound Tincture of Benzoin and other foot care supplies are available at Zombierunner.com.

Disclosure: When you purchase through this link, I make an affiliate small amount of each sale.

  • Subscription Form

    Enter your email address:

    Delivered by FeedBurner

  • Recent Posts

  • Categories

  • Recent Comments

  • Archives

  • Pages

  • Circulation

%d bloggers like this: