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.
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.
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?
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.
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.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products
Many runners have a love-hate relationship with gaiters.
Some love them and swear by them when running trails. Others never wear them, and dislike them. Which camp do you fall in?
I have regularly promoted the value of gaiters since I made my first homemade set from a pair of old white cotton crew socks. I believe it was one of the first years I ran Western States, maybe in 1985 or 86. I cut the foot out of the socks, leaving the ankle part to pull on my foot and fold over to cover the top of my shoes. I used twist-ties to anchor the socks to the shoes. And – they worked – as primitive as they were.
Then as the years progressed, people with more business sense than I started to make and sell gaiters. Now days, you can get gaiters in a myriad of colors and types.
I still believe in gaiters for trail runners, and in one recent conversation, told a friend that should make them mandatory gear for multi-day trail events.
You have every right to ask why.
Today’s shoes have become increasingly lightweight and many shoes are made with mesh uppers. It’s this mesh that allows all kinds of sand, dust, grit, and dirt into the shoe. These bad things will work their way into your socks and onto your skin. Rubbing and abrasions can occur. If you use any type of lubricant on your feet, the bad stuff will be attracted to the stickiness. The bad stuff can be a contributing factor that can lead to blisters.
A good set of gaiters will cover the tops of the shoes and the toe box to keep bad stuff out.
I’ve included two images of special gaiters that are typically found at the Marathon des Sables (MdS).
Here is the link to the myRaceKit for the MdS page that shows two gaiters they support. And a page from their blog that describes the fit and application.
These are highly useful when doing races in the desert, but how about when running trails? I believe the weak point in some gaiters is how they fail to cover the top of the shoe’s upper, thus allowing bad stuff inside.
I have treated many runners’ feet that are filthy with dirt and grit that makes it hard to wash off in order to find, clean, drain, and patch blisters. Blister patches and tape usually does not stick to dirty skin. In addition to making it harder for medical personnel to clean one’s feet, it also means it takes longer, which can affect not only your race, but those behind you that also need their feet worked on.
Back when, I wore homemade gaiters because that’s all there was. Now there are many styles and fabrics to choose from.
If I was going to run a tail race of any length, but especially a 50M or 100M, or multi-day race, I would buy one of the gaiters that attached to the shoe with Velcro and cover the whole shoe.
Here are two of my blog posts about gaiters.
Blisters and Gaiters – this is by Lisa de Speville and adventure racer and ultrarunner from Soith Africa and her homemade gaiters.
In two weeks I will be working foot care at the Michigan Bluff aid station of the Western States 100. Then three weeks later I’ll be doing a foot care study at the Tahoe Rim Trail 100-Mile Run. I’d love to see a few runners wearing a more substantial gaiter.
When you enter a road or trail race, or start an adventure race, or plan a group or solo event, whether single day or multi-day, do you think about blister management?
There can be many responses to this question. Here are my guesses at the most common three responses.
For many, I’d guess the answer would be no. What happens, happens. They may have a simple first aid kit or blister kit. A bit of tape, maybe a pin and an alcohol wipe.
Others, if participating in an organized event, will count on aid station personnel to have the supplies and knowledge to fix whatever problems develop. They don’t understand that some aid stations do not have the right supplies or medical people, or if they do, they have little to no understanding of how best to treat blisters.
The third bunch takes a full hands-on approach. They have a fully stocked kit and either they or their crew know how to work on feet.
Then there’s the same question put to race directors and event organizers. When you put together the plans for your race, how much thought and planning goes into foot care for the participants?
Again, I think there are three typical responses.
The first is they don’t think about it. It’s either they simply don’t even think about it or they decide to let the runners deal with whatever problems develop.
The second group puts together simple kits of typical first aid equipment and puts them out on tables at the aid stations. Most likely, no one working the aid station knows what to do, or if they do, it’s hit or miss repair. Supplies often are minimal and sometimes not even helpful. I worked an event, a long multi-day race that fell in this category. Runners were hurting.
The third group is wiser. They have medical people and a well-thought out kit. Some, at larger events, have dedicated foot care people.
I need to say here that you don’t have to be a medical person to provide good foot care. I have worked at many events where non-medical people had excellent foot care skills.
You Can Help
So here are my questions for you.
- As a runner or adventure racer, what do you want to see at a race?
- What do you expect to see?
- If the race website and material does not specific what kind of aid or foot care is provide, do you assume it will be there?
Here’s my reason for asking.
A few days before Western States next month, I will be presenting a session about Blister Management at the 2nd Annual Medicine & Science in Ultra-Endurance Sports Conference in Squaw Valley. Plus two hands-on workshops teaching foot care skills.
I have my presentation pretty well planned. I’ve done this long enough and have learned a lot of material and skills. But sometimes I am puzzled at what I see from the race participants. Ill-prepared runners and crews and even some dumb decisions by runners (socks with holes, brand new shoes, serious athletes foot, bad toenails, and more).
My audience will be medical personnel and race directors from many ultras and adventure type races. The aim of my presentation will be to teach them about blister management during a race.
What I need to know is a bit about your expectations about blister management at races as a runner. Send me an email. You can copy in the three questions above and answer all three or as many as you want.
Thanks for your help.
Most of you know how much I like kinesiology tape for taping feet. Over the years, I have used several brands and refined my taping skills. I can tape any part of the foot, and for any blisters or prevention desired.
As I have talked to others who tape, runners or crews, or medical people, I have heard stories of tape not sticking as well as needed. And I have seen first-hand tape coming off – generally because of a lack of skin preparation and taping skill levels.
So I was pleasantly surprised to see an article over at www.theratape.com about How to Get Kinesiology Tape to Stick – the 6 P’s of kinesiology Taping.
When properly applied, kinesiology tape will stick for days through all kinds of conditions. When improperly applied, it may last for less than a day, or in some cases, only a few hours.
The article at Theratape.com identifies three phases to taping: skin preparation, tape preparation and application, and wearing the tape.
Here is a summary of the three phases.
Phase 1: Skin Preparation
- The skin must be completely dry before applying the tape
- The skin needs to be clean
Phase 2: Tape Preparation and Application
- Use good quality tape
- Round the corners
- Don’t touch the adhesive
- Go easy on the stretch
- All strips must end on skin, not on another piece of tape
- Activate the adhesive
Phase 3: Wearing the Tape
- Avoid contact at the ends
This is a very good article and you’ll learn a lot about taping with kinesiology tape. Click of the link to read How to Get Kinesiology Tape to Stick.
What you didn’t read is a few things we have learned when using the tape on feet. The typical use of kinesiology tape is for injuries to muscle and soft tissue, very different than taping feet. Once you put the tape on feet and go running through streams, dust, mud, swamps, and other adverse conditions, things change. There are more stressors on the tape and many times its applied just moments before resuming your adventure.
Here are my extra tips exclusive to taping feet:
- Use a tape adherent on the skin
- For extra tough cases, run a strip of tape adherent over the edges of the tape/skin
- Apply the tape the day before your run if possible
- Make sure you apply either a thin layer of powder or lubricant over any remaining exposed tape adherent
- Always roll your socks on and off to avoid pulling the tape loose
While you are Threatape.com, check out their line of kinesiology tapes and supplies. Their website offers a lot of information about kinesiology tapes, information about different brands, application instructions, and videos by body part and brand. I have worked with the good folks at Theratape for several years and love their products and service. For medical professionals, they also offer a professional discount.
Today I received an email asking for help in finding a certain type of footwear. Here’s the email.
I’m looking for new shoes and thought you might have some expert counsel? I’ve loved my New Balance Vibram Minimus for three years and am ready for a true barefoot experience–I think. I keep hearing about the FiveFingers, but can’t find them locally and am reluctant to order a pair without trying them on. I walk and do some cardio at the gym. Got any suggestions?
I told her that I get an email from a minimalist shoe website called Birthday Shoes. They have a free online newsletter with almost 5,800 subscribers. Check them out. Five Fingers are not for everyone. There are other very minimal shoes out there. The birthdayshoes.com website has most of them – and shoe some reviews too. They have 17 shoes companies represented on their website. Each review has a full report and photos of the shoes. Each review has comments from readers, which adds value. Definitely worth reading before you buy.
If you are in the market for minimalist shoes for trail running or just kicking around the yard, check out Birthday Shoes.
Spring is here. The weather is turning and the days are longer thanks to the earlier day light saving’s time change. I, for one, love the longer daylight.
As the weather gets better, we look forward to spending more time outdoors. This is a good time to take a few minutes and check out your footwear. Haul them out and go over them, one pair at a time.
Check your shoes and/or boots for excessive sole wear, frayed shoelaces, torn uppers, lint and debris inside the shoes, flattened out insoles, and squished down midsoles. Any of these can cause problems as you change your gait in response to the worn shoes. More than your feet are affected. Changes move upward, affecting your ankles, knees, hips, and back. Don’t risk an injury because of worn out shoes.
Keep your feet happy with good footwear.
If you follow the shoe companies and read any of the popular running, backpacking, and outdoors magazines, or follow their websites, you know many have released new models. Check them out at your local store. There are some great new shoes being introduced. I’d bet one of them has your name on it.
There is an old Chinese proverb; “Failure results not from the length of the journey or the height of the mountain but the pebble in one’s shoe.”
We have all had it at some point – the pebble that is.
We are running or walking or hiking and feel a small irritant. We think to ourselves that maybe our sock bunched up. But, after a bit, we realize its something else. So we move our foot around a bit or kick it up against a rock or log, or maybe sideways on the ground. The hope is that that kick will move the irritating thing to the side where we won’t feel it.
Sometimes it works for a while. But it always comes back. We are always better off to stop, take off your shoes, and clear whatever the problem is. Even the smallest pebble can cause problems. It can start with a hot spot and develop into a blister. It can cause a hole to develop in the sock. It can tear into the insole’s covering.
So stop and remove it.
I remember a few years back when I was at the Gold Rush Adventure Race and encountered a similar situation. One of the racers came into the transition area and in the process of changing socks, I told her I’d clean out her shoes. The race route had taken runners through muddy areas and some had gone down into her shoes.
As I used my hands to clean inside her shoes, I found very rough hard edges under both heels. I thought it was a defect or tear in the insole. Surprisingly, it was hardened mud that was so hard, it took a lot of pressure to remove it from the insole. This must have hurt through the socks – but the racer had not bothered to clear out her shoes.
In reality, it might be a pebble – or mud. In either case, you are always better off to take a moment and get rid of the irritant.
Of course, I have to recommend gaiters for trail running. They can keep the pebble out in the first place!
Filed under: blister care, Footcare, Health, Sports, toenails
I get questions by email all the time. Toenail questions are quite common, so I thought I’d post this one. Here’s the question.
“I am emailing you because I have a 50K trail race this Saturday and for some reason I am just starting to get pressure from under my large toenail. It is in its early stages and my nail has not turned black yet, but it is starting to be uncomfortable. At what point do I decide to puncture thru my nail and lance the fluid under the nail? Also, if I should be lancing the fluid, what are your thoughts of using a really thin and clean drill bit (turned by hand) to get thru the toenail? I lost a toe nail once before and tried using a really hot paper clip and needle, but I had a hard time getting all the way thru my toe nail. Any help and advice you can give me would be much appreciated… thank you!”
The answer is pretty straightforward.
Can you recall any nailbed trauma? Once fluid is underneath the nail, the pressure becomes painful You’ll know. If you can see the fluid from under the tip of the nail, lance it there. A drill bit works better than a paperclip. Be forewarned that as it goes through the nail, it can go into the soft tissue underneath, so go slowly. Then press on the nail to expel as much of the fluid as possible. Cover with a Band-Aid for now (tape on race day) but don’t plug the hole with ointment, as it will still need to drain for a few days.
Relieving fluid from underneath a toenail is a simple skill that every runner should know how to perform – just in case. It could be on one of your toes, or the toe of a friend. If you have ever experienced the intense pain of a black toenail with blood or fluid underneath, you’ll appreciate knowing how to fix it.
One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.
I recently received an email from Rob, asking for some advice. Here’s Rob’s email:
“I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area.
“I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of the donut hole – now a huge blister about the size of a silver dollar and 1/4-inch thick. The camp staff took pictures of the biggest tennis-related blister they had seen.
“I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot.”
This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.
The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.
Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.
This post is from July 2102, but is important for athletes to understand.