Maceration in a Dry Race

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

Maceration in a Dry Race

Two weeks ago I worked medical at Badwater. This year’s course had some serious uphills and downhills – but the course was dry. Unless one has feet that sweat heavily, there typically would not be any issues with wet feet.

Yes, this post is going to talk more about maceration. I’ve done a number of posts this year on maceration, but the problem won’t go away, so there must be more to learn.

So here’s how maceration happened in a dry year at Badwater and what you need to learn from it.

It’s very simple – really. Runners pour water over their head to cool themselves. Or well-meaning crews douse their runners with water over their heads, or spray them up and down with some kind of tank sprayer. The water runs down the runner’s clothes and body, down their legs, and ends up in the runner’s shoes. Socks and shoes become saturated.

Wet and macerated feet

Wet and macerated feet

Sometimes runners will changes socks and shoes during the run, and this helps for a bit, until more water is poured over the runner’s head and down into his or her shoes.

The water buildup leads to softening of the skin and maceration. In the photo you can see three areas of concern. If you click on the image, you’ll open a much larger copy image where you can see the detail even better.

First, the skin has torn at the base of the fourth toe. There may or may not have been a blister with fluid under the skin on the ball of the foot. My guess is it was not a blister, but simply wet softened skin that was stressed and then tore.

Secondly, notice the fold of skin at the bottom of the baby toe. The toe was probably pinched in the shoe toebox, folding under the fourth toe. This puts pressure on the skin of the baby toe, pushing the skin forward into a fold from the tip of the nail to under the toe. When I see these folds, the skin in usually intact and not torn.

Thirdly, notice the fold of skin going down the center of the ball of the foot. This is the most serious of the three problems. The fold is painful. The skin is not torn, but has pulled up and then folded over on itself.

As the skin goes through the maceration process, it first looks like the skin of a prune – shriveled up. The longer the maceration continues, the more chance for the skin to soften. The foot inside the sock, inside the shoe, can be squeezed and as the runner moves through the foot strike, with his whole body weight carried on his feet, pressure is put on the skin leading to creases in the skin. The creases are most common in a line down the length of the foot rather than across its width. Continuing through the maceration process, the creases of softened skin can lead to the skin lifting up and folding over on itself. In the photo you can see the shadow from the fold – it’s significant and can be quite painful.

In this case, all three problems were caused, by the runner’s admission, his pouring water over his head and allowing it to run down is legs into his socks and shoes.

It seems so beneficial to cool yourself off by pouring water over your head and/or by spraying your body and legs – but there are negative side effects.

The hard part for the runner, besides the pain, is that there is no quick fix to remedy the skin folds. It takes time, sometimes days for the skin to return to its normal state.

In an upcoming post I’ll talk about some products to help protect your skin from wet conditions. For now, avoid pouring water over your head. Protect your feet.

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4 Comments on Maceration in a Dry Race

  1. David Woodall on Mon, 11th Aug 2014 12:18 pm
  2. When it is really hot, you need to be able to cool your head. I pour water over my head all the time and my feet never get wet – primarily because I’m thinking about keeping them dry. I either don’t pour enough water for it to run past my shirt, or if super hot, I’ll lean forward so the water runs directly onto the ground (which requires stopping for a few seconds – always welcome in high heat).

  3. johnvonhof on Mon, 11th Aug 2014 12:52 pm
  4. David makes a good point. Debra also pointed pointed out that “It is very important to keep one’s cool in races such as Badwater – and recent research shows keeping skin temperature cool is more important than one’s inner core temperature! So I would hesitate to advise someone to avoid pouring water over themselves during a race. I would caution them to not allow the water into their socks and shoes. (Using unique interventions such as a towel.)”
    As I have instructed people, lean forward and drip water or pour water over your head. This avoids it running down your body. You can also use sponges or wet towels. Thanks guys for the correction.

  5. Christie McAuley on Wed, 7th Jan 2015 3:15 pm
  6. Hello,
    Nice website! Weird question for you here.
    I work at Project ECHO in Albuquerque, NM, which is part of the University of New Mexico School of Medicine. We are a non-profit organization who works with doctors, PAs, NPs, and community health workers in rural areas so patients can be treated in their own communities instead of traveling long distances to Albuquerque.
    I am producing a diabetes skills guide for community health workers (CHWs) that we train to be diabetes educators to the patients who work with the providers I mention above. One of the things we teach CHWs is how to teach their diabetes patients about foot care. For this reason, I am looking for images of feet with macerations to include in our skills guide. The 2 images on your site are good quality and illustrate the condition well. Is it possible to use these images with your permission?
    I am happy to include this website or an attribution listed in our skills guide, but unfortunately, cannot pay you for use. Please note that we do not charge trainees for this skills guide, nor do we sell it at all. (FYI, all of our materials are given away free to organizations who want to replicate our model.)
    Please let me know if you have any questions or need clarification. I’ve included our website above if you would like to learn more about Project ECHO. Thank you,
    Christie McAuley

  7. John on Sun, 8th Feb 2015 3:03 pm
  8. Send me an email at and we can chat. Thanks.

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