A month ago I wrote a blog post about two multi-day races in Europe that are implementing a triage system for medical care at aid station – the outcome of their being overwhelmed by the amount of treatment and time that their participant’s blistered feet were requiring. Here a link to that post about Providing Foot Care for Athletes.
In this post, I want to expand on a quote from their website that I included in the original post. It was about the 6Ps of foot care.
They stated that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provided a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps. Let’s talk about these one-by-one.
Proper Preparation – In the months leading up to your race, and even race to race, you, and you alone need to be responsible for learning proper preparation. You need to learn how your feet respond to being wet and maceration starts, to being in sweat soaked and dirty socks, and when your feet are caked with dirt and grime. You need to learn about the best lubricants and/or powders, and insoles. You need to learn what causes the hot spots and blisters and what steps you can take if or when they develop. You need to practice taping or whatever strategy you plan to use. This is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Prevents – You need to know what to do when you develop hot spots and blisters, and have the materials and tools, and even more importantly, the skills, to fix your feet. This focus on “prevents’ needs to happen in the months before your race and during the race. It’s about proper toenail care, skin care, callus reduction, shoe and sock selection, whether to wear gaiters, preparation for a variety of weather conditions, and of course, putting the required and necessary training miles on your feet. This also is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Piss-Poor Performance – This is what can happen when you fail at any of the first three Ps. Your performance suffers. Your race may be over. In many races, medical volunteers will try and help patch your feet. Some races do not have the luxury of dedicated medical volunteers for all the aid stations, much less the finish line. You cannot and should not count on a race having medical personnel to help with your foot care needs. Just because there is a doctor, nurse, or EMT at an aid station, that doesn’t mean they know how to patch feet. You cannot and should not count on races to have the foot care supplies that you want for your feet. If you will have a crew, work with them so they know how to work on your feet with your supplies.
Some runners may feel I am being too harsh as I tell you these are your responsibilities. Let me share a story from years ago. In 1985 I ran Western States for the first time. After crossing the river at Rucky Chucky, I had blisters in the arch of one foot. Someone at the far side offered to help patch my feet. After lancing the blisters, I had a wad of gauze taped to my arch, which changed my gait. I finished the race, but learned a lesson. The treatment, while well intended, was not the best for my foot. I learned to take responsibility for my own foot care. For the next three years running Western States, I managed my feet – and I’m sure that experience helped fuel my interest in foot care.
So my point in expanding on the 6Ps in this blog post is to reinforce the notion that foot care of your feet is your responsibility. If there are medical volunteers at a race, and they know how to patch feet, and have the supplies – and the time, consider yourself fortunate – but don’t count on them being there.
Please feel free to agree or disagree with my position, and share by commenting below,
I love how technology continues to push the limits in sock construction. The companies below offer unique sock design that shows how companies are making products that stand out in a crowded field. Here are four interesting sock companies worth check out.
Ellsworth V-Channel socks have vapor channels to carry sweat vapors through the channels and off the foot – keeping the foot drier. The channels run from the toes to the heels.
Farm to Feet has developed their Blackburg Water Sock with a combination of nylons and elastic yarns in a unique design that allows water to drain quickly, dries quickly, and provides UIV protection. PTFE-coated nylon fibers create a frictionless feel.
Sensoria Fitness smart Socks harness new technology by embedding electronic threads and textile sensors, and pairs these with thin anklets on the tops of the socks, These are paired with a Smartphone app to capture step count, cadence, and foot strike forces. The full system also has a heart rate monitor for full data capture and a virtual coach in your ear.
ArmaSkin anti-blister socks offer a layer of dermal protection with their socks, engineered for extreme endurance athletes. These are thin but tight fitting and are worn under your normal socks. The Si Fusion coating sticks to the skin and prevents any friction generation next to the skin while giving a dermal like layer of skin protection. In addition, the Si Fusion hydrophobic inner pushes moisture to the outer layer and is bacteria static so the socks can be worn for long periods of time. ArmaSkin’s smooth outer fabric reduces friction by allowing the outer sock and shoe to move harmlessly over the foot – preventing blisters. They recommend not using any lubricant inside their socks – other than a small dab between toes as needed. The socks are made in Australia, making them harder to find, but their positive features make the search worthwhile.
When you purchase socks, spend a moment reading the washing instructions. With most performance socks, you should not use bleach and fabric softeners as these may break down the fibers.
Check out the above socks and buy a pair or two. As always, don’t try them for the first time in a race.
Providing foot care for athletes at ultramarathons and multi-day events is a huge responsibility. Their feet are what keep them going, and if you are known for providing foot care, the athletes will be appreciative of whatever you can do. If you are simply helping one runner, you might be a bit more casual. But if you will be part of a foot-care team, you need to be prepared.
In 2015 race directors of several multi-day ultramarathons in Europe were overwhelmed by shear volume of runners seeking medical attention for blisters. They said it took upwards of 30 minutes per foot to treat most of the runners, which caused a significant drain on the ability of the medical team to look after more serious problems. Beginning in 2016, these races are introducing a triage system for medical care. Patients will be assessed prior to treatment with the most needy being treated first, regardless of how long others have been waiting. If the assessment indicates “minor” blisters, advice will be given and runners will be expected to treat their own feet. All runners must have their own blister treatment kit as part of their mandatory gear kit. They candidly state that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provide a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps.
Rebecca Rushton, an Australian podiatrist and owner of blisterprevention.com.au, and I agree that foot care at multiday events is vital. I consider a 100-mile ultramarathon a multi-day event. The problem is that many runners have become dependent and expectant that events will have medical personnel providing even the most basic foot care. Participants have come to treat foot care services at events as a perk of the event. While it’s nice to have, it’s not practical and sustainable long term. Race directors need volunteers with the time and expertise in foot care techniques, and the budget for supplies and equipment. The larger and longer the event, the more volunteers are needed and the more costly it becomes.
I wrote in a blog post that, “… at some events participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up and they want someone at the next aid station to redo their feet. That’s a lot of work and supplies.” Many athletes also fail to take care of their feet and fail to plan, and in many cases fail to take common sense action (reduce calluses, trim toenails, do self-care, etc) that could have prevented or reduced the problem. Rebecca and I support what we call assisted self-management. In the aid station, provide a table and a few chairs, and basic foot care supplies. Medical personnel will be available to give advice and tend to more serious treatment. It could even be that runners are shown how to patch the first blister and then they manage the rest. It’s a workable model and builds on today’s popular DIY (do-it-yourself) method of learning new skills.
This leads to a new mindset among many medical professionals that manage medical direction at races and multiday events that is worth considering. An article in the April 2014 Sports Medicine summarized it well. “Although participants in ultra-endurance events should be educated and prepared to prevent and treat their own blisters and chafing, blister care will likely be the most frequent use of medical resources during ultra-endurance foot races.” The mindset is that participants need to shoulder some of the responsibility for managing their feet. Medical staff at aid stations can quickly become overwhelmed even to the point of running out of supplies. We can help promote and support this new mindset in several ways:
- Give participants tips to prepare their feet in advance of the event. (Refer to “Foot Care in Multiday Events” in chapter 16.)
- Give participants tips on the best footwear selections for the event (types of shoes, gaiters, oversocks, camp shoes, and so on).
- Give participants a list of foot-care gear they must carry. A section on mandatory foot-care gear can be found at the end of this chapter. Even runners in a 100-mile race can carry a small Zip-lok bag pinned to their bib number or in their hydration pack.
- Advise participants whether or not foot care services will be provided and if so, to what degree. This includes no foot care and supplies, limited self-management, or full service.
- Provide a self-service table of supplies for runners to use in DIY patching of their feet. This can speed up their in and out times at aid stations.
- Stress the importance of knowing how to work on one’s feet (by reading this book or through other sources, or workshops).
- Stress the importance of runner’s having crews knowledgeable in foot-care work and prepared with a well-stocked foot-care kit.
How you implement the principles of self-management or whether you decide to provide full service foot care services depends on several factors: The number of participants, the difficulty, the remoteness, the number of medical volunteers, the availability of supplies (and being able to absorb the cost) and the number of aid stations and how far apart they are. It should be a well-thought out and joint decision between the race director and the event’s medical director.
Please comment how you feel about foot care services at the races you run or help with, or as a race director. We’d love to hear your thoughts.
Filed under: blister care, Books, Foot Care, Foot Care Products, Footwear Products
This summer will see the release of the 6th edition of Fixing Your Feet: Injury Prevention and Treatment for Athletes. The exact date is still up in the air, but I’d expect it sometime in late July or early August.
The 5th edition was released in February 2011 and it was due for an update. Nothing in foot care remains static. New products and techniques are constantly being identied.
The new edition will be fully updated with new material, websites, new foot care products and product information, and new techniques and learning’s in footcare. I have been working with the publisher since last summer in talking about ways of improving the content. Every paragraph on every page has been evaluated to determine whether the content could be made clearer, or whether it is dated and needs to be removed. Much of the content has been expanded to provide more benefit.
The sixth edition has an important new chapter, Blister Prevention – A New Paradigm. It contains new information about blister formation and introduces the concept of shear, which in turn, changes the way we look at blister prevention and treatment. This chapter itself is worth the cost of the book.
It’s available for preorder at Amazon with their pre-order price guarantee. You can order now and if the Amazon.com price decreases between your order time and the end of the day of the release date, you’ll receive the lowest price. Here’s the link: Pre-order Fixing Your Feet, 6th edition on Amazon.
The cover is still being worked on and will likely change.
Disclaimer: the above link contains my Amazon affiliate code and a purchase through it earns me a few pennies.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports
A while back I was interviewed about foot care by Shawn Bearden of Science of Ultra website and podcast. Here’s the link to the Science of Ultra website.
Shawn asked great questions and got deeper into foot care than any other interview I have done. We talked about the essential components of good foot care, from shoe fitting to blister care. Then we wrap it up by defining the essential features of a good minimalist foot care kit for your next run or adventure. The whole episode is about an hour and 22 minutes.
I encourage you to listen to the interview on the Science of Ultra website and then check out his website and other interviews. Podcasts can be subscribed to in iTunes and Stitcher Radio. By subscribing, you’ll received shows on your device (smart phone or tablet) as they are released.
We can learn a lot from shoe reviews. Whether the reviews are in magazines or websites, or posted in online forums and blogs, they can be helpful to hear what others have to say about shoes you are considering. RunRepeat.com is a website that features running shoe comparisons. In late 2015 they ran the numbers from 134,867 customer reviews of 391 running shoes from 24 brands. Shoes were ranked from one to five stars based on satisfaction. Interestingly, their conclusion was that expensive shoes are not any better than more moderately priced shoes. This means inexpensive running shoes are often better rated then expensive ones. They pointed out that perceived shoe quality is very subjective and the study was not a scientifically based. One possible finding from the comparison is that runners who buy more expensive shoes likely have higher expectations, and are more critical in their reviews.
Many shoe and boot companies suggest specific models that are best for certain types of activities and sports, and for certain types of feet. They do this because many shoes are made for a specific type of foot—and many people have feet that will work better with one type of shoe than another. Look for the buyer’s guides in the magazines of your sport. Runners can find shoe reviews in Runner’s World, Trail Runner, and UltraRunning. Backpackers and hikers can check out Backpacker magazine’s reviews, and Outside magazine’s Buyer’s Guide for helpful information.4 Wear Tested Gear Reviews (weartested.org) is another good site with reviews. Many online shoe retailers also offer phone advice support or online guides. For information on shoe reviews and gear review sources, see page xref in the appendix. Other sport-specific magazines may offer similar reviews. Many websites are now posting reviews, and some offer reader comments or reviews.
The September 2015 Runner’s World Shoe Finder asked up front if readers knew the type of shoe that worked best for them. If so, they were guided to a four-section grid based on more shoe, less shoe, and more cushioning, less cushioning. Each box of the grid contained shoes they recommended for that more/less choice. Other readers were asked questions about BMI, running mileage, and injury experience, after which they too were directed to one of the four boxes to find their recommended shoes. Each shoe reviewed was also rated for heel cushioning, forefoot cushioning, and flexibility; and the shoe’s weight and heel and forefoot heights were given. Unfortunately, these guides of suggested shoes usually only include 12-18 shoe models.
It’s a good starting point, but I would use the guides as a reference point to shop at my local running store and get their personal insights.
Even after buying shoes that fit well, be alert to changes inside your shoes as you walk, run, and hike. Jason Pawelsky, with Tamarack, the maker of the popular ENGO Blister Prevention Patches reminds, “We all know that changing conditions (terrain, temperature, distance, etc) can make even the best fitting pair of shoes feel and perform differently so there is no perfect fit 100% of the time. The challenge is to get runners, hikers and team sports players to not only recognize that, but to react proactively.”
Never ignore an injury. Pushing through an injury or returning to your sport too soon after being injured can lead to additional injuries. You do not want to turn a temporary injury into a permanent disability. Too often athletes rely on self-diagnosis rather than consulting with a medical specialist. If during or after running or hiking you have persistent foot problems or recurring pain that you cannot resolve, seek medical treatment from a medical specialist who can provide his or her medical expertise for your problem.
Primary Medical Specialists for Feet
Orthopedists are orthopedic surgeons, experts of the joints, muscles, and bones. This includes upper and lower extremities and the spine. Look for an orthopedist that specializes in the foot and ankle. The American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society can provide referrals. There are also Orthopedic Clinical Specialists (OCS).
Podiatrists are doctors of podiatric medicine (DPM) that work on the feet up to and including the ankles. They specialize in human movement, and medical and surgical problems including foot diseases, deformities, and injuries, such as nail, skin, bone, tendon, and diabetic disorders. Podiatrists treat such disorders with surgery, custom-made orthotics (shoe inserts), physical therapy, injections, casting and braces, prescription medication, and medicated creams and ointments. The American Podiatric Medical Association and the American Academy of Podiatric Sports Medicine can provide referrals.
If you have chronic foot problems, or you are uncertain what your feet are trying to tell you through their pain, consider consulting a podiatrist or orthopedic surgeon. Listen to your whole body and especially your feet. Be attentive to when the pain begins and what makes it hurt more or less. Then be prepared to tell the specialist about the problem, its history, what you have done to correct it, and whether it worked or got worse.
There is a wide range of skill overlap between orthopedists and podiatrists. Each can treat most of the same foot problems. When searching for a medical specialist for your feet, talk to doctors about their training, experience, and whether they have a specialty field. Each of the two specialist fields has doctors who specialize in sports medicine, and these would be my first choice. Weigh this information when making a decision about who to turn to for help. Additionally, a variety of other specialists can provide assistance in strengthening, alignment, rehabilitation, and footwear design and fit.
Pedorthists work with the design, manufacture, fit, and modification of shoes, boots, and other footwear. Pedorthists are board certified (C.Ped) to provide prescription footwear and related devices. They will evaluate, fit, and modify all types of footwear. A C. Ped. can help find a shoe built on a last (the form over which a shoe is constructed) that best matches a person’s feet, and then construct a custom orthotic that meets his or her particular biomechanical needs and interfaces with the shoe in a way that improves its fit and performance. The American Orthotics and Prosthetics Association and the Pedorthic Footwear Association can provide information and referrals.
Sports Medicine Doctors specialize in sports-related injuries. They are typically doctors of internal medicine with additional training in sports medicine. When treating athletes with lower-extremity injuries that do not improve with their initial treatment, they may refer the athlete to a podiatrist or orthopedist. Most are members of the American College of Sports Medicine (which does not provide referral services).
Physical therapists (PT) are licensed to help with restoring function after illness and injury. Most work closely with medical specialists. Physical therapists use a variety of rehabilitation methods to restore function and relieve pain: massage, cold and heat therapy, ultrasound and electrical stimulation, and stretching and strengthening exercises.There are also Masters of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT). The American Physical Therapy Association can provide referrals.
Athletic trainers are licensed to work specifically on sports-related injuries. Rehabilitation methods may be similar to physical therapy but can additionally focus on maintaining cardiovascular fitness while injuries heal. The National Athletic Trainers’ Association can provide referrals.
Massage therapists work with athletes in reducing pain and tightness in muscles, tendons, and ligaments—the body’s soft tissues. The American Massage Therapy Association can provide referrals. Look for either Licensed Massage Therapists (LMT) or Board Certified in Therapeutic Massage and Bodywork (BCTMB).
Chiropractors are doctors of chiropractic (DC) medicine who specialize in the alignment of the body’s musculoskeletal system. Pelvis, back, and neck pain and muscle imbalances are often treated by a chiropractor. Some may specialize in sports injuries. There are also Certified Chiropractic Sports Physicians CCSP). Two organizations, the American Chiropractors Association and the International Chiropractic Association, can provide referrals.
When the time comes to seek medical attention, ask others in your sport for referrals, ask at your local running or outdoors store, look in the Yellow Pages, or search online. If you have a choice, choose a sports medicine specialist over a general doctor.
Filed under: blister care, Books, Foot Care, Foot Care Products, Health, Sports, Travel
I have known Terri Schneider for a long time. She did triathlons, moved up to focus on Ironman’s, then discovered adventure racing. When I heard about her new book, I knew I had to interview her. Her just released book, Dirty Inspirations, tells the stories of her “lessons from the trenches of extreme endurance sports” – the subtitle of the book.
From the back cover, we read, “By choosing to walk the path of more resistance, we come to a better understanding of ourselves and our potential for physical, mental, and emotional growth. And nowhere is this better represented than in the crucible of extreme endurance sports, where athletes are truly pushed beyond the bounds of what seems possible. Seen through the eyes of one of the most diversely experienced female athletes on the planet, the stories in Dirty Inspirations showcase discomfort as virtue, and demonstrate the truly indomitable nature of the human spirit.”
Chapters in Dirty Inspirations take readers into Ironman and adventure races and ultramarathons in Utah, Australia, California, Costa Rica, Malaysia, Tibet and Nepal, New Zealand, Egypt, China, Argentina, Alaska, and Ecuador. Terri raced in many countries, with huge awe-inspiring challenges, and unforgettable memories.
Along the way, she also learned a lot about her feet and how to do foot care. In this unique audio interview, I talk to Terri about the races, foot care secrets, and a lot more. It’s about 23 minutes in length.
Along the way, Terri learned a lot about herself as an athlete and a person. You and I may not have the opportunities to do the races she did, but we can live them through her stories.
For an in-depth interview with Terri about the book and how she wrote it, check out my Writers & Authors on Fire podcast where I interview her for an hour about the writing process.
If you run in the dark, whether roads or trails, the Night Runner 270 Degree Shoe Lights might be perfect for you. The lights are designed by athletes.
The lights attach to the shoelaces with multi-position adjustable brackets and weigh only 1.5 ounces. The lights give off a combined total of 150 lumens to light up the road, sidewalk, or trail in front of you. With white LEDs pointing forward and a red LED on the outside facing backwards, you are covered with 270 degrees of visibility – and you get 30+ meters in beam distance. The units are made with high-impact water-resistant casings for durability. The lights are powered by rechargeable Li-ion batteries with 4-8 hours of battery light. A supplied micro-port USB cable with a Y connection charges both units at the same time. A pair of lights sells for $59.95 and a two pair set for $109.95.
If you have carried hand-held lights or a headlamp, the Night Runner 270 Degree Shoe Lights are worth considering. They could also be used for cycling. The Night Runner lights started as a Kickstarter project.
This past week I read about two new high technology running shoes. They are very different from what we have seen in the past. The shoes show how far researchers and athletic industry innovators are going in the search to find the perfect running shoe. When I first started running, in the late 80’s, there were about nine shoe companies. Today there are more than 30 and the list is growing.
I’d be willing to try both of these shows – given the opportunity. They peak my interest. We need to be open minded about new shoes coming into the shoe marketplace, because we all remember what people first thought about the Vibram Five-Finger shoes, the minimalist shoes, the maximum cushioned Hokas, and more.
The Enko Running Shoe
The first shoe I saw was simply called Enko Running. It comes in five colors. You select your size and a body weight range. It is the most futuristic shoe I have seen in years. You can see the shoe in the image. The forefoot is fixed while the back heel and mid-foot parts of the shoe are controlled by a platform with springs running from mid-shoe to under the heel. The “studs” in the outersole are replaceable. The springs act as shock absorbers, and are delivered to you based on your weight. Enko claims impact is deadened, your stride is smooth and their system conserves all the energy stored in each stride. The springs are interchangeable.
The Enko Running shoe won a CES Innovation Award in 2016. The shoe is in a fundraising campaign at IndiGoGo.com where you can fund a pair for $330, $60 off the advertised price on their website. They are 153% funded.
The Ampla Fly Running Shoe
The second shoe I saw was the Ampla Fly from AmplaSport.com. Ampla is founded by a “world-renowned sports scientist and athletic industry innovators.” Dr. Marcus Elliott has trained elite athletes through his P3 Sports Science Institute in California.
The Ampla Fly shoe is unique with its split outersole, as you can see in the image. It claims to “… empower the efficient use of force. Encourage better mechanics, which provides a platform to help you run faster, run farther…” Their carbon fiber powerforce plate “… glides the foot to a better ground contact position, gather force at mid-stance, and maximizes force application at big toe push-off.” Two videos on the website shows the technology in action. My guess is that the split outersole, with the gap in the forefoot mid-foot, acts as a flex point with the carbon fiber powerforce plate. The shoes come in two colors, in both men’s and women’s sizes. The advertised price is $180.
What do you think about these two new shoe? Does the design intrigue you enough to plunk down your cold hard cash?