Filed under: blister care, Foot Care, Foot Care Products, Sports
I have often mentioned the website BlisterPrevention.com.au as a great source of information on blister care. Rebecca Rushton, manages the website and is on top of developments in the prevention and care of blisters. She’s a podiatrist in Australia – and a friend.
Through research and looking at the mechanism of how blisters form, Rebecca has changed some old theories of what causes blisters. Heat, moisture, and friction were always considered the three contributors of blisters. Further consideration has found that shear is a major factor. Shear and friction combine to cause blister formation.
I want to quote a blog post by Rebecca about Healing Foot Blisters Faster to help you understand more about friction and shear.
“You know friction is responsible for friction blisters. But I bet you think friction is rubbing. It isn’t. Friction is about grip. High friction means two surfaces grip together. Low friction means they don’t … they’re slippery.
“Here’s how friction is responsible for foot blisters … There is high friction in your shoe. There just is. This means your skin grips your sock; and your sock grips your shoe. All three surfaces grip together so your foot doesn’t slide around in your shoe.
But with every step you take, your bones are moving around under the skin. And while the skin is stuck and the bones are moving back and forth. Everything in between is pulled and stretched. This pulling and stretching is what causes blisters.
We call it shear. And it needs high friction to get anywhere near blister-causing.”
With this opening, Rebecca starts to explain the effect of shear and friction on blister formation. She talks about cutting friction levels, especially when a blister develops, and gives examples of six friction reducers. Some of these are better than others.
We have always tried to reduce friction in both preventing blisters and when treating blisters. As Rebecca says, and I support, “Otherwise all that stretching (shear) continues at the blister base while it’s trying to heal. Making it hurt more. And taking longer heal.”
So take a moment and click on the Blister Prevention link and read Rebecca’s full blog post. While you are there, I encourage you to subscribe to her email list.
Many of you have participated in a 50-mile race, a 100-mile race, an adventure race, or some other type of multi-day race. Some multi-day races are non-stop while others are stage races. A lot of these races provide medical care at aid stations – and some also provide foot care.
If you have received foot care aid at these aid stations, you have been helped by the generous people I’ll call the “heroes” of foot care.
The picture shown here is from the Amazon Jungle Marathon this past October. Every one of the 15 members of our medical team helped with foot care. No one said they didn’t want to do feet. You can see the working conditions: sand everywhere, water bottles as footrests, a tarp to protect the runners and our knees (that quickly filled with sand), and supplies strewn all over and shared between medics. What you don’t see are the flies and bugs that were constantly in our faces, and the sweat running down our faces from the humidity. Now keep this up for hours, well into the night.
These are the heroes of foot care.
Most races have them. They volunteer their time and even supplies. They often go to races at their own expense. They work often under adverse and uncomfortable conditions. They want to do the best patch job possible. They are dedicated to getting you back into the race. They want you to have a great race experience. In short, they care.
I’ve been at races that have well-organized foot care services and others that have nothing. Some people providing their services are podiatrists, doctors, nurses, paramedics or EMTs, physical therapists, chiropractors, or other medical specialists. Other times they are simple people who have learned foot care techniques on their own or from someone else.
I know you appreciate these foot care people.
So how can you thank them? Let me share a few ideas.
- Simply say thank you.
- Make sure you have done everything possible to have healthy feet going into the race.
- Trim your toenails short and then file them smooth.
- Reduce calluses as much as possible.
- Wear quality shoes and socks.
- Know how to do your own foot care just in case we aren’t there or there’s a line for our services
- And finally, be patient. Good foot care and blister patching takes more than a minute.
We love helping runners and always welcome your appreciation.
Filed under: blister care, Foot Care, Footcare, Health, Sports, Travel
In early October I had the unique opportunity to return to Brazil and provide foot care to runners at the 10th Annual Jungle Marathon Amazon. The race is more than a marathon. It’s three races in one event set in a stage race format. Every day the race camp moves to a new location as the runners go through the jungle and along the beaches of the Amazon River. There’s a seven day, six stage race and a four day race, that both start at the same time. Then on day four, the single day marathon stage starts.
This year’s race was the toughest of any event I have been a part of. There was single track trails hacked through the jungle, red dirt roads with loose dirt, swamps and streams and rivers, humidity, heat, rain, sand that got everywhere, never ending wet feet and water-logged shoes, bugs and spiders and snakes, jaguar sightings, a lot of bee stings, either cold food or food heated with hot water, jungle and beach camps, carrying all your gear in a backpack, and nine nights in a hammock. Runner’s feet took a beating and as the days progressed, it was harder for them to recover. The cumulative affect of having your feet wet for the majority of every day, became a struggle for many runners. Maceration was a serious problem for everyone, and blisters affected all runners to varying degrees.
After the race ended, I was able to take a a few minutes and interview Amy Gasson, the second place women in the seven day race. Amy was a joy to know and smiled every day with a great positive attitude. Here’s the link to listen to the audio interview. It’s 17 minutes long.
Considering the interview was recorded with a handheld digital recorder, in the lobby of our hotel with all it’s normal background noises, the sound quality is remarkable. There’s a lot we can learn from what Amy shares. She did her homework and prepared well – both physically and her feet. Here’s a photo of Amy and me at the finish line.
Thanks Amy for letting me get to know you at the Jungle Marathon Amazon.
This post is an editorial about foot care at races – and more importantly, the lack of it.
Last week I returned from my second trip to Brazil to help provide foot care at the Amazon Jungle Marathon. I plan to write a post about the race later, so I won’t go into detail here – but this is the toughest race I have seen. Over the years I have worked many multi-day multi-sport adventure races and multi-day running races. Most of these are six or seven day events. Adventure races are races where the clock doesn’t stop until the team gets to the finish. Running races are typically stage races where each day is a specific mileage and camp changes every day.
Please continue reading – even if you don’t do multi-day races – because this blog post applies to those doing 24-hour races, 100 mile races, and athletes in general.
These types of races always have a list of mandatory gear. The list is composed of mostly safety items with a mix of medications and first aid stuff. Some of the first aid items can also be used for foot care. The photo shows an example of a first aid mandatory gear list. Here’s the rub though. Most athletes want to minimize, as much as possible, the amount and the weight of the stuff they have to carry. If the list calls for tape, they’ll carry a ½ inch wide very small roll, as few as possible blister patches, 2 or 3 alcohol wipes, 2 Band-Aids – you get the picture. They don’t have the right stuff because the lists are very general and don’t specify exact brands or types of supplies. They don’t have enough because they are not the average athlete and will need more. They only carry what they are required to carry and miss what they need for their feet. And many of these athletes don’t know how to use what they carry.
I have worked many multi-day races and have seen athletes finish a day’s stage and come to medical for every little thing. The medical staff should not have to manage all your foot care. You can manage the small pea-size blister on your toe. If you have hot spots, you can tape over them and check your shoes for seams. There is usually not enough medical staff to care for 100% of each runner’s needs. In addition, the supply of medical equipment is limited and can easily be over taxed by runners wanting everything done for them.
One runner in the Jungle Marathon came to see the medical team every day, telling us what he wanted down to the color of the tape and showing us all the spots on his feet he wanted fixed. We would have had to spend an hour just on him, with a lot of supplies, when he had a medical kit but wanted us to do it for him.
I am becoming more and more convinced that mandatory gear lists should be material specific. The width, length and type of tape should be listed. The number and type of blister patches. Scissors rather then a needle. Specific powder and amount. A specific number and type of tape adherent. And do on. The mandatory gear list needs to be reviewed with the medical director. This applies to runners in any race 50 miles or longer too. While the majority of runners don’t typically carry foot care supplies in a 100-mile run, their crews need to have the supplies.
I also am convinced that runners need to know how to patch their feet. Running a 100-mile race with no knowledge of how to care for one’s feet if and when problems develop is asking for trouble and putting undue burdens on the medical teams. You cannot assume that all medical personnel know how to patch feet – and have the best supplies for doing so.
Earlier this year I worked a multi-day event that had only basic medical supplies at the aid stations. There was virtually nothing that could effectively be used for foot care. The participants were not promised foot care, only first aid and medical personnel. In fact the pre-race materials did not mention foot care. Many aid stations did not allow crew access. The result was runners who were generally not carrying a foot care kit, had no crew access at many aid stations to help with their feet, and no medical personnel trained in or equipped to do foot care – a disaster waiting to happen. I had my complete foot care kit and worked on many runners’ feet. I know several other aid stations happened to have medical people who knew how to do basic foot care. But we each used our own supplies. I can honestly say that without the few of us on the course, the finishing rate would have been less than 30% because the race organizers did not think through the possible problems and build in solutions. Their disclaimer to me was that they had not promised foot care and runners were on their own.
In my opinion, putting on a race of any length requires race organizers to put runner safety as their first concern. Runners pay their money and expect a certain amount of good organization and common sense in return. In what has become a catch-22 situation, many runners genuinely expect there to be medical personnel able to manage emergencies as well as manage their feet. They think “first aid” and “medical personnel” means foot care. In reality, many races make no provision for foot care and take an “Oh well – that’s life” attitude. In fairness to medical personnel, I know anyone doing medical at an aid station will try and help any runner needing it. However they may not have the supplies and / or the training.
The Jungle Marathon had multiple doctors and paramedics, a fully stocked medical cache of basic and emergency supplies including medicines and narcotics, bandages and foot care supplies galore, and a complete set of medical protocols. Each checkpoint was manned by at least two medical personnel with a complete medical kit. Western States has great medical care at the major aid stations. So does Badwater.
In the end, every race lives and dies based on runner perceptions and what they share with their friends. Give them a bad experience; bad or non-existent medical care and / or foot care, and the word will spread.
Filed under: blister care, Foot Care, Footcare, Footwear, Health, toenails
Here are a few foot care tips I wrote to help runners at the Amazon Jungle Marathon. I’ll be there in a few weeks to help with foot care on the medical team. The tips are valuable for anyone doing a 24 hour race, a multi-day event, an adventure race, or a long backpack. Remember, your feet will carry you day to day only if you take care of them.
Start with good toenail care. Trim your nails short and then use a file over the front edge to remove any rough edges. File the tip of the nail so when you run your fingertip over the tip of the toe and over the nail, you don’t feel any rough edges. You can also file the top of the nail if it’s thick. Coming to the race with bad toenails will ensure toe blisters and black toenails.
Make sure your shoes fit well. Have enough room in the toe box for your toes to wiggle. Your feet may swell over the race and you don’t want shoes that are too tight. Some shoes, like Hokas, retain water and become heavy over the days, as they are wet so much of the time. Wet and waterlogged shoes are heavy.
Get good socks. Don’t show up with cotton socks. Socks made with Coolmax or wool are good choices. Injinji toe socks are great. Have several pair and wash then after each day’s stage or have one pair per day. Also don’t show up with old socks or ones with holes in them.
Do whatever you can to reduce any calluses. Getting a blister under a callus can be painful and it’s very hard to find the pocket of fluid for draining. After showering, use a callus file or pumice stone to shave the callused skin from your feet. Then apply some callus cream. This is something that should be done several times a week. Calluses are the result of friction and pressure between your shoes and feet. Make sure your shoes will drain water.
Shoes that hold water inside will increase the maceration effect of your feet being wet to long, leading to wrinkled and soften skin that can fold over, crease, and split open. Check this by filling your shoes with water and seeing whether it will drain out. You can heat a nail (at least 1/8 inch round) or an awl and make several holes at the inside and outside arch, and the heel of your shoes. Learn how your feet respond to being wet for long periods. Do some long walk or runs three to six hours long with wet feet. Try several products like Desitin or similar cream for baby bottoms that works to control moisture on the skin. Google “baby bottom cream” to see many options.
Do not skimp corners on your foot care kit you need to carry in your pack. Have several yards of a good quality tape, several needles to drain blisters, and learn how to drain and patch blisters. The medical team will try and help with your foot care needs, but we can become overwhelmed by the number of people wanting help. Part of your responsibility as a runner is to know how to do good foot care.
Carry a good pair of camp shoes to wear in the camp after each day’s stage. You don’t want to walk around barefoot and doing so will destroy the taping or blister patching done by you or the medical team. Lightweight Crocs, flip-flops, or sandals are easy to strap to your pack. Change into these after running to allow your skin time to heal from the moisture.
Filed under: Foot Care, Foot Care Products, Footwear, Health, Sports
Insoles and Beyond is a family-owned small business based in North Carolina. They want to help you be comfortable, avoid injury, and reduce any pain you are experiencing. Their insole line includes a wide variety of insoles from manufacturers including, Birkenstock, currexSole, New Balance, Powerstep, Sof Sole, and Sole. Whether you are looking for orthotics for plantar fasciitis pain, arch support inserts for comfort, or insoles for running shoes and other sports performance, you can find them at Insoles and Beyond. Within each company’s line are a variety of insoles and sizes. You can look for insoles by company name, foot type, activity, pain/condition, and shoe type. They also carry compression wear from CEP compression and Mediven, and offer ankle braces, knee braces and splints as well.
Because many athletes don’t understand insoles, I asked Stacey some questions about insoles. I think the questions will help you when you need insoles, or if you are unsure why you should replace the standard “sock liner” that came with your shoes. For years, I have told people that generally speaking, the stock sock liners shipped in shoes offer little support and are of little help. Many are simply thin pieces of foam or cardboard. Read on to learn about insoles. Then check out Insoles and Beyond’s website.
I’ve run for years and always used the regular insoles that come with shoes. Why should I consider a replacement pair of insoles? Most running shoes (expensive and inexpensive alike) use very simple and cheap foam insoles despite the tons of science that goes into making the rest of the shoe. Many runners will spend $100 to $200 on a pair of running shoes based on the materials and technology used to make them but then leave in the relatively generic insoles that come with the shoes. It makes sense that shoe manufacturers don’t invest much in the insoles – everyone’s foot is different. Shoe manufactures leave it to the consumer to purchase the appropriate insoles for their specific foot needs – high arches, low arches, overpronation, etc. Additionally, some people want more cushioning than others. Some want more support than others. Personally, the first thing I do when I buy a pair of shoes is rip out the “sock liner” and put in a pair of my favorite insoles.
There’s a whole bunch of replacement insoles to choose from, how can I make an intelligent choice? Our website has some good information on the various types of insoles and categories (collections) to help you find the insole that is appropriate for you. So, that’s a good starting place. However, within the categories (insoles for plantar fasciitis, insoles for running, insoles for hiking, etc.) there may still be questions. At that point, I’d suggest calling us or sending us an email to discuss things further.
Are certain insoles better than others for minimalist shoes and zero-drop shoes? Absolutely. Lower profile/volume insoles are best for minimalist shoes. Sole’s ThinSport and currexSole’s RunPros are both low volume options. The ThinSport has the same arch support as Sole’s Response and Ultra, but with less cushioning. The currexSole RunPros pack a lot of cushioning and less arch support (allowing for a more natural feel). Most insoles are neutral in terms of drop – they can be worn in zero-drop shoes.
How long do these insoles last? That depends. Many manufacturers recommend that you replace the insoles as often as you replace your shoes. Generally most running shoes should be replaced at 500 miles. I find that the BirkoSport by Birkenstock last pretty long – I’ve used them through four or five shoe replacements. Sole, New Balance, and Powerstep insoles tend to last a while (3 or 4 changes). Birkenstock and Sole both mold to your feet the longer you wear them. SofSole tends to only last one or two changes, but they are also less expensive. Generally speaking the more cushioned the insoles and the more activity they are subjected to, the more frequently you’ll need to replace them.
What’s the difference between inexpensive insoles and the more expensive ones? I believe you can get a really good pair of insoles in the $25 to $65 range. Custom insoles can run hundreds of dollars and many customers who’ve had custom insoles have shared with us that the $40 insoles they got from us were just as effective as the $400 custom pair they got from their doctor. The cheap insoles ($10 to $20 insoles at the drugstore) tend to not be much better than the insoles that come in the shoes to begin with. Among the insoles we offer, the materials used and the overall durability of the insoles set inexpensive and expensive insoles apart. I find that the more expensive the insoles, the longer they tend to last. Conversely, the less expensive insoles last a shorter period of time. Materials like carbon fiber, cork latex, tend to be more expensive and durable than gel insoles.
I cross-train and ride bikes too. Are there insoles made for biking shoes? There are definitely insoles specifically made for biking shoes. You can, however, use general purpose or running shoe insoles for biking shoes as well. The trick is to make sure that the insoles are low volume (since most biking shoes will not accommodate thick insoles) and that they have good cushioning in the ball of the foot (the part that is in contact with the bike pedal the most). Something like the currexSole RunPro can easily go from your cycling shoes to your running shoes if you are cross-training.
You may be asking why you would order insoles from Insoles and Beyond. Yes, you can find insoles in the foot care section of your local drugstore, sporting goods store, and running store. But will they be the right ones for your feet? Check out their lines of insoles and if you have questions, give them a call. On the right side of their page, is a 10% coupon and they offer free shipping in the U.S.
Disclosure: I have no financial involvement in Insoles and Beyond.
Today’s blog post is a little bit by me and a lot by Rebecca Rushton. Rebecca is a friend and podiatrist from Australia. I admire her work regarding blister formation and prevention. I follow her website and whatever she writes.
Having worked many events over the past years, I have seen hundreds of toe blisters. These may be at the tip of your toes, between your toes, or under your toes. They are very common, especially in ultras, adventure racing, and multi-day stage races. Understanding the causes of toe blisters, and ways to prevent them is important, not just for you but for your crew too.
Rebecca’s recent blog post details seven likely causes of toenail blisters. Here’s the link to Toenail Blisters.
- Shoes too small
- Shoes too big
- Nail shapes and deformities
- “Cocked-up” big toe
- Clawed toes
- Downhill terrain
- Long, thick or rough toenails
Make sure you sign up for Rebecca’s emails and you’ll get a free copy of her premium resource The Advanced Guide to Blister Prevention. The sign-up box is in the upper right corner of her web page. While you’re on her website, be sure to check out the rest of her content.
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.
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.
Back in the early 80’s I bought my first pair of running shoes. I went for New Balance, and they coast an amazing $45.00. There were the big names at that point: Adidas, Asics, Brooks, Nike, New Balance, Puma, and Reebok.
That was then. This is now. Shoe companies galore.
- Hoka One One
- New Balance
- Newton Running
- Pearl Izumi
- Topo Athletic
- Under Amour
- Vibram FiveFingers
Twenty nine shoe companies! I faint that amazing and overwhelming. There may be more I missed.
Then of course, each of these companies have different versions of shoes, typically road and trail. Then different types of control and support features. Then “regular” shoes versus minimalist shoes. And zero-drop shoes.
I went to one online website of a well-known company that sells many different shoes and some of the shoes manufactures had 16 or 18 different shoes models to choose from.
Companies that were known for their hiking boots and shoes now make running road and trail shoes. An underwear company makes shoes. It’s a hot market and everyone want a piece of the pie.
What’s a runner to do when they need new shoes? In my mind, there are three answers:
- First, visit your friendly neighborhood running store. And no, I don’t mean Big 5. I mean a running store with people who actually run, know shoes, and can make recommendation based on your form and gait, foot strike, shoe history, and even injury history.
- Secondly, use the services of a reputable online running shoe company. They typically offer call-in support to help you select the right shoes or a chat pop-up box to ask a sale person questions to determine the right shoes. Some even have online shoe buying guides.
- Thirdly, take a chance and just buy or order a pair of shoes on your own.
I recommend the options in the order presented. The running shoe marketplace is too crowded to make an intelligent choice any other way.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Health, Sports
Last weekend I worked foot care at the Western States 100 Mile Endurance Run. We had a fairly dry winter with not much snow in the high country and I had heard runners talk of the dust on the trail. Based on that, I did not expect to see high number of runner’s having foot trouble because of maceration.
Working Michigan Bluff aid station, at 55.7 miles, I was surprised by the runners coming in with wet feet, and varying degrees of maceration. For some, it was minor skin softening and maybe a few surface creases. Others had more severe maceration, with creases that were deeper over widespread areas on the bottom of their feet. A few were really bad – deep creases and skin folding over on itself. In extreme cases, the folded skin can split open.
While maceration is commonly caused by stream and river crossings, it also happens when runners pour water over their heads and body and it runs down into their shoes. Feet also sweat a lot, some people’s more than others, and this also can lead to maceration.
I also worked the finish line. There I saw even worst cases of maceration.
Severe maceration can manifest itself as a burning sensation, and the feeling of large blisters all over the bottom of their feet. Taking off the runner’s shoes and socks, we found virtually all of these complaints to be degrees of maceration. Two facts are evident. First, as might be expected, the longer a runner is on the course, the worse the feet can become. Secondly, not changing one’s shoes and socks during the race can magnify the effects of maceration.
The photos here are of one runner. My recollection is this runner finished the 100 miles in about 29 hours. She came into the podiatrity area of the medical tent and could barely walk. This is not uncommon. Runners dig deep and finish on adrenalin and then once they stop, the extent of the injuries to their feet hits them.
Photo 1 shows the bottom of the right foot – it’s worst than the left. You can see the white of the skin, and the creases running over much of the foot. The creases extend down to the mid-foot. Notice the white skin flap on the tip of the little toe.
Photo 2 is a close up if the toes. You can see the large skin flap on the little toe. This flap of skin was very white and looked as if the skin on the tip of the toes had been pulled outward and pinched. It was about ¼ inch in length. It runs from the toenail to the bottom of the toe.
Photo 3 shows the side of the forefoot. You can see the large fold of skin of the inside of the ball of the foot. This can be very painful and can split open under pressure.
Unfortunately, there is no quick fix for maceration. Typical treatments include warming the feet, moisture-absorbing powder, dry socks, allowing the feet exposure to air to dry, and time. In talking to this runner, she did not change her shoes nor socks during the 100 miles. I don’t recall the type of shoe, but my guess is that it did not allow water to drain.
There are several ways to manage possible maceration. Several years ago I watched as an adventure racer coated the bottom of his feet with Hipoglos, a European version of zinc oxide. The compound helps control moisture on the skin, whether zinc oxide or Desitin or a similar product. RunGoo, Century Riding Cream, and Blue Steel Sports Anti-Chafe Cream are similar products. I may have another product to announce early next month.
Another helpful tip is to make sure your shoes drain well. Whether that means mesh uppers, mesh or a draining material down to the shoes upper sole, or making drain holes with a heated nail, draining water out of the shoe is important. Then of course, changing your shoes and socks is also important. Most 100’s have aid stations with drop bags and it’s easy to put a pair of shoes in one or two drop bags, or have your crew have them ready.
Maceration can be cruel. It ruins the race for some runners. It’s painful. It can take days to heal fully. But there are ways to minimize its effects. If you are running a 100 or a multi-day race, and there is a chance of water on the course, plan accordingly.