Consequences of Wet Feet at a Dry Western States!  

July 4, 2015 by
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.

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Comments

6 Comments on Consequences of Wet Feet at a Dry Western States!  

  1. Rebecca Rushton on Sat, 4th Jul 2015 4:03 pm
  2. Great post John and great photo. Maceration is something we need to understand better (prevention / treatment). You highlight the issue wonderfully. Well done.

  3. John DeDoncker on Sun, 5th Jul 2015 7:37 pm
  4. Jon:

    I happen to be the happy finisher with the unhappy foot. First, thank you for the great care at the finish! I did get a tetanus shot and saw my doctor once back in Iowa. He has me applying an antibiotic cream normally used on burn victims. I am now the proud owner of Fixing Your Feet and hope to avoid such problems in the future.

    Having run four prior hundreds (and many 50s and marathons) without foot problems, I took for granted that my Injinji socks and a single shoe and sock change would get me through. I misplanned. I attribute the macerated condition to having gladly accepted cold sponges over my head at most all of the aid stations. I stayed out of the streams and am not one to pour water over my head. I failed to realize how much water squeezed over my head was making its way down to my shoes. I leaned forward when they were cooling me off, and even asked them to only wet my head. Water still runs downhill!

    I started having problems before Robinson Flat (29.7). I put Moleskin on my foot’s arch at that station, but made the mistake of not changing socks. By Last Chance (43.3), the entire arch of my foot was macerated and they applied 2nd skin and a wrap (once again no sock change). By (I think) the 65 mile aid station, the skin on my heal had completed separated into one big flap. The medical assistant at the aid station (Charlie), with limited supplies, put antibiotic cream, non-stick pads on the entire bottom of my foot and wrapped it. He felt the skin flap on my heal was too big to put back in place without having it fold up while I was running, so he trimmed it off. Running downhill from that point became extremely painful and not doable. I was able to run uphill and most flats, and power hike the steep stuff. . . so that’s what I did. I was on a 22.5 hour pace before the problem arose. Considering the extent of the injury, and 40 minutes having my foot worked on during the race, I was thrilled to finish in 27:41:58. Looking at my foot, I’m not sure how I did finish! As my photo suggests, I was super happy to receive my WS100 buckle.

    One week post race, and I’m just now able to walk on the foot in a normal fashion. I am reading your book with great interest (as I soak my foot in Epsom salt) and will use it as my guide to be much better prepared in the future. Thank you again for your compassion and care.

    John.

    PS: The three lost toenails would fall into what I expected to happen to my feet. I have Morton’s toe and my second toes seem to take a beating.

  5. Kelly Barber on Wed, 29th Jul 2015 5:16 pm
  6. I was glad I ran across your page. TRT was my first hundred last year and I ran into blistering on my last toes on both feet and end up walking much of the last 30 miles. I attributed this to lack of wicking from my socks and shoe toe box so I adjusted at Western States this year to run in shoes with a larger toe box and a newer pair of toe socks that were still wicking. The plan similar to John was for a single shoe/sock change after the river. I realized not long after leaving Robinson Flat that my feet were feeling like there was gravel under them only to take off my socks and find they were already macerated (a new word that I learned later that day) I really hadn’t been sponging down that much but had been running through streams but my feed were not drying out. I have wondered if the higher humidity that day played a part as well as my gaiters. I did sponge down quite a bit after than as well as getting in the rivers and creeks to cool off. I had not planned any shoe or sock changes before Green Gate so I didn’t have anything in my drop bags. My feet were sore but runnable but I could feel that the crease were beginning to blister. It was not until Foresthill that I was able to get my shoes and socks changed and dry and tape (KT) my feet. I made one more shoe/sock change at Green Gate to try and mitigate as much damage as possible. In the end the majority of the damage was blistering around the balls of my feet and my heel. Since I plan to run races much wetter than this in the future, Im trying to do as much research as possible since my feet seem to be the determining factor of my racing speed. I do appreciate the advice on ways to minimize getting feet wet but I do think I need options that assume ones feet are going to be wet.

  7. Al Lyman on Wed, 5th Aug 2015 11:52 am
  8. Great post, John Vonhof, thank you! John DeDoncker, Rebecca Rushton who also replied to this post above, is also, like John V., and expert in the care AND prevention of blisters. I had her on my podcast to discuss the issue, and in there you’ll find links to a couple of great resources she makes available. I highly recommend. We’re lucky to have two such experts here who care a great deal about helping us all to avoid these debilitating problems. Best, Al
    —–
    http://pursuitathleticperformance.com/2015/056-visiting-with-podiatrist-rebecca-rushton-podcast/

  9. Rebecca Rushton on Sat, 19th Sep 2015 12:47 am
  10. Dear John V, John D, Kelly and Al,

    I’ve been looking into maceration in recent months and just published an article that might be of interest (John D, I hope you don’t mind me using your photo). I hope to follow this up with part 2 on treatment and part 3 on prevention in the coming months. If you feel you have anything to add, please don’t hesitate to get in touch.

    http://www.blisterprevention.com.au/blister-blog/skin-maceration-of-the-feet

    Cheers
    Rebecca

  11. John Vonhof on Tue, 22nd Sep 2015 9:45 pm
  12. Maceration is an issue worth some serious discussion. I’d rather err on the side of prevention with some of the newer creams and ointments than try and fix a macerated foot after the fact.

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