Toenails – Again #@!$#@

July 31, 2015 by · 1 Comment
Filed under: blister care, Foot Care, toenails 

A month ago I provided foot care at the Western States 100. Then two weeks ago I worked the Tahoe Rim Trail 55KM, 50M, and 100M. And finally this week I worked Badwater in Death Valley. As much as I hate to say it, I saw a negative common denominator as I worked on or saw runner’s feet.

The common negative was runners’ toenails.

I wish I didn’t have to say the toenails were bad, but a lot of them were. While not every runner suffers with their bad toenails, many do. Enough to warrant this blog post.

The picture here is an example of nails that could be better – much better. I won’t identify the runner or the race because I saw these same toes at each of the three events.

Bad Toenails

Bad Toenails

Toenails that are thick can be smoothed with a nail file. In severe cases, a Dremel tool can be used to reduce the nails quicker, especially when the nails are really thick and tough.

Your nails don’t have to be thick. They don’t have to be rough. They don’t have to have an upward curl or edge. They don’t have to be wavy. They don’t have to stick over the end of your toes. In short, candidly, they don’t have to look like your toes are 90 years old and you live in a nursing home. If you think you might have toenail fungus, check with your doctor – and take care of it.

An inexpensive toenail clippers will set you back about $5. If you have tough nails, you may want to buy a stronger set of clippers that look something like wire cutters. Then get a file for another $1 or $2.

Toenails that are too long, too thick, have rough edges or corners, will catch on your socks, which will push the nail back into the nail bed and cause trauma, fluid or blood under the nail, or toe blisters. During a race, these nails become painful to touch – meaning you can’t trim or file them without pain.

So we see you at an aid station, and you are hoping we can fix your feet. If there is fluid or blood under the nail, we can drain them. We can run a strip of tape over the tip of the nail to provide a bit of protection to the nail. But we cannot fix the discomfort and pain.

I can patch most anything on your feet, but I cannot fix a thick toenail that sticks up way above normal. I cannot smooth the rough edges if you cannot tolerate the filing. I cannot trim the nails if you cannot tolerate the pressure.

Caring for one’s toenails isn’t that hard. Once a week, use a clippers and nail file to trim them. Clip them fairly short and then run the file over and down the tip of the nail, removing any rough edges. The goal is to have nails that you can’t feel when you run your finger over the front edge of your toes.

If you have lost a toenail, as the new one comes in, file the top of the nail thin. Wrap a Band-Aid around the toe to help train the nail to curve naturally to the shape of your toe.

Toenails are not complicated. But just as you care for other parts of your body, you need to care them them too.

Foot Care Study at the Tahoe Rim Trail 100

July 16, 2015 by · 1 Comment
Filed under: Foot Care, Footcare 

This weekend is the running of the Tahoe Rim Trail (TRT) series of trail runs – a 55K, 50-miler, and a 100-miler. After a lot of planning, the dream of doing a foot care study has materialized.

Tahoe Rim Trail Runs

Tahoe Rim Trail Runs

The TRT is perfect for a study. There are two main medical aid stations, Tunnel Creek and Diamond Peak. 55K runners are seen at Tunnel Creek twice. The 50-mile runners are seen at Tunnel Creek three times and Diamond Peak once. The 100-mile runners are seen six times at Tunnel Creek and twice at Diamond Peak. The multiple contacts offer increased opportunities to talk to the runners, work on their feet, and record what we see and do.

In addition to the personal contact, runners are being asked to participate in two online surveys. A pre-race survey asks about their running and injury history, choices in socks and footwear, and how they typically manage their feet. A post-race survey asks how the race went in regard to their feet.

After the event, the data will be compiled, studied, and a report or paper will be written. The aim is a formal paper that can be submitted to medical journals and later distributed to the running public.

The purpose of the TRT Foot Care Study is to learn:

  • Correlations of finishing rate against the number of miles run in training
  • Correlations of foot injuries / problems against miles run in training
  • Percentage of runners who are pro-active with foot care before the race
  • Effectiveness of footwear modifications
  • Effectiveness of lubricants / powers
  • Effectiveness of blister dressings / taping
  • Correlations of percentage of runners wearing gaiters against finishing rate and foot care injuries / problems

If you are one of the hundreds of runners doing the TRT this year, we hope you will participate in the study and surveys. Thank you.

The study will be supported by a number of professionals: Tonya Olsen (physical therapist), Kristy Gavigan (RN), George Miller (paramedic), Zak Weis (Podiatrist), Tracie Giambrone (Podiatrist), Doug Doxey (Podiatrist), and Andy Bussell (Chiropractor).

George Ruiz, the race director, and Dr. Andy Pasternak, the medical director, have been extremely helpful in making the study happen.

If you are at the TRT this weekend, we’d love to chat.

As we are able, some of the learnings from the study will be shared on this blog.

Consequences of Wet Feet at a Dry Western States!  

July 4, 2015 by · 6 Comments
Filed under: blister care, Foot Care, Footcare, Footwear 

Last Saturday was the Western States 100 Mile Endurance Run over the California Sierras. As you probably know, California is in year four of a severe drought. Most of us expected the trails to be dusty and dry. From everything I heard, they were.

So in a dry Western States year, why did so many runners have macerated feet from being wet?

So in a dry Western States year, why did so many runners have macerated feet from being wet? Click To Tweet

There are several reasons. First, runners often cool themselves off by pouring or squirting water over their heads and on their body. We all know water runs downhill – right? So the water naturally runs down the legs and into the shoes. Socks become wet and as I often say – the skin of one’s feet prune up. In other words, they look like a wrinkled prune. Better to bend at the waist and let the water run off the head and shoulders rather than down the body.

Secondly, runners sometimes cool off by getting into the water at any stream. Several runners talked of sitting in the streams. While this can cool the runner, it is the worst thing a runner can do to their feet.

When they remain wet long enough, the skin becomes soft, often creating creases. Many times these creases are deep and in severe cases, the skin can split open.

Most often the runners complain of badly blistered feet. In fact, there are no blisters, just macerated skin on the bottom of their feet. This condition can be very painful. Walking and running hurts one’s feet.

There is no fast cure. They say time heals all wounds and with maceration, it takes time for the skin to dry and return to its normal state. Putting powder on the skin can help, as can clean fresh socks, gentle massage, and letting the skin air-dry.

I saw a lot of macerated feet at Michigan Bluff, mile 55.7. More than I expected. And of course there were lots of runners wanting treatment for bad blisters at the finish, and it was maceration.

Severe results of macerated feet

Severe results of macerated feet

The picture here is of a runner who completed the race, I think sometime around 28-29 hours. I don’t know his story but at some point before the race or in the race, he had his right foot wrapped in what appeared to be a self-adherent wrap, with a thick pad of some kind at the heel. Then that was wrapped with layers of what seemed to be silk type medical tape. Tonya and I had to use trauma shears to cut the thick wrap off his foot. Once it came off we saw the extent of the damage to his foot.

If anyone knows the runner or recognizes him, I’d love to find out more. It’s possible that because of maceration the skin at the heel had sheared off and someone at a medical aid station, or crew, had cut the skin and put on the wrap.

What we did at the finish was to apply a coating of antibiotic ointment to the open and raw skin, cover it with a wound care dressing, and wrap with a self-adhering wrap. We gave him instruction on how to care for this in the days after the race.

Look closely at the picture. He’s happy. He has his finisher’s medallion and knows he’s getting his buckle.

  • Subscription Form

    Enter your email address:

    Delivered by FeedBurner

  • Recent Posts

  • Categories

  • Recent Comments

  • Archives

  • Pages

  • Circulation

%d bloggers like this: