Foot Care – Whose Responsibility?

May 10, 2014 by
Filed under: blister care, Foot Care, Health, Sports 

The other day I was looking around the website for the Western States 100 and came across the picture below. It’s pretty brutal. The feet have been pounded to death and been wet – probably the majority of the race. I see torn blisters; blisters on the heels, bottom of the heel, ball of the foot, the crease by the toes, side of the big toes and the toes; and macerated skin. I have no idea if the runner finished the race or was helped off the trail, but my guess is that he gutted it out to the finish line. Click on the image for a larger picture.

Feet at the finish line of Western States

Feet at the finish line of Western States

My point in showing you this photo is to remind you, as strongly as possible, that there is only so much that I or any other medical person can do to repair your feet and get you to the finish line. You are the one person responsible for your feet, not your crew or anyone on the medical staff. Here are 15 questions you have to answer about your feet:

  1. What are the best shoes?
  2. Will you have additional shoes in a drop bag – the same kind, what size, and where?
  3. What are the best socks – one pair, two pair, double layer, Injinji toe socks, and what brand?
  4. Will you change socks – where and when, the same socks?
  5. Will you wear gaiters?
  6. Do you need lubricant – what kind, where on your feet, how much, and when to reapply?
  7. Have you trimmed your toenail and filed them short and smooth?
  8. Have you reduced your calluses?
  9. What is your plan for managing your feet during the race?
  10. If you get blisters, what will you do?
  11. How will you manage the inevitable water in your shoes and socks?
  12. Do you have a foot care kit?
  13. Do you and/or your crew know how to use the materials in the kit?
  14. If you go to medical for foot care, can you describe what you want them to do?
  15. Have you put the training miles on your feet necessary to run 100 miles?

These are not hard questions – but each is important – and together they make up your plan for your feet. The runner whose feet are pictured above made some wrong choices about his feet. As did many other runners. It happens every year and at races across the country. It’s not just a Western States issue.

The best time to ask these questions is in the months before the race. Then develop a plan. Just like you make up drop bags, find a crew, plan your food, a plan for night running – you need a plan for your feet. I emphasize “You.”

I cannot stress this enough. The medical staff at races cannot fix every big and little problem each runner has. At most races there are too many runners per medical or podiatrity people. And not enough supplies. And not enough time to get everyone patched up to continue on and make the cutoffs. Yes, we are there to help you and we do the best we can.

At Western States there are eight aid stations with medical staff. Each station usually has someone who is in charge of feet. These people have varying degrees of skill and supplies. Did the person above seek help at any of the eight aid stations? I wish I knew. If he did, what did they do?

Of course, looking at the feet above, you might be asking, “What could have prevented this?” or “How do we fix this?” Those are questions for a different post on a different day.

I’ll give you a hint though; the first question is answered in the pages of Fixing Your Feet. And if you have an old edition, you are shorting yourself because these are new information, new techniques, and new products in every edition.

The second question is harder. I have some ideas that other might not think of. This runner will struggle for many days as his feet heal. I pray that he’ll wonder what he did wrong and what he could have done better – and then seek out answers so his next race has a different outcome.

Note: I wish I could credit the photo to a photographer. If I find out, I’ll add a comment to this post.

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Comments

  • chip

    Agree with all of the points above, BUT. Calluses? I had a podiatrist shave a callus off the ball of my left foot. I know you do not recommend having this done-with good reason! After this treatment, for which I did not ask, I had serious foot pain. This was to the point where I had to stop running for ~a week. After 4-6 weeks the callus “healed” and I no longer get these pains. BEWARE- do not let anyone shave a callus. File it a little at a time and check to make sure you will not start having foot pain.

  • johnvonhof

    George Miller commented: Thank you for this, John. I recall you’ve sent something very similar out in the past and it’s great advice. Sometimes runners come in with an expectation of service. I am happy to give it to them but wonder what they would do if foot care people were not around. I have a friend who’s training for her first 100 in SD next month. I’ve talked with her about taking the responsibility of taping 2 areas each day between now and her race. She says her feet are fine and she does not need to tape now. I tell her that she needs to have a really good grasp on what to do at mile 75 when she’s between aid stations and that blister is keeping her from running well. 2 tape jobs a day for a month gives her 60 practices! That should be enough to get a handle on it.

  • Todd Baum

    Ball of foot callus can be debilitating. Removal over time, not all at once just before a race, is best approach IMO. I have this file called “Silk Feet” it is wonderful to use after shower. Excellent article John, amen to runners taking responsibility for their feet.

  • johnvonhof

    Joe Lugiano commented: John, how true. And yet we see many runners who look for a medical person to take care of their blisters. At the Umstead 100 we have a great Red Cross team who has been supportive in doing that and in the last couple years a few specially trained volunteers (ultra runners) have also volunteered. I think it’s a hard model to keep up. I always figured if I created them I should fix them. I would never expect my crew, my wife or anyone else to take care of any blisters I had.