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.
Years ago, back in the late 80′s, I has the good fortune to run the Western States 100 Endurance Run four times. While I never earned the silver buckle, I had respectable times: 26:32, 26:00, and 24:32. The fourth time, I pulled myself at Rucky Chucky. I always did my training in the Ohlone Wilderness, Lake Chabot, and Mt. Diablo.
My third time, when I missed the silver buckle by 32 minutes, I never should have finished. My training for the six months before the race was only 750 miles! I was 250th into Robinson Flat and 100th at the finish line. Between the two, no one passed me and I passed everyone I could. My pacer and I had a great night run, picking people off as we ran. I thought I had a shot at 24 hours, but when I got to Highway 49, I knew I would fall short.
So it is with those memories that I wish everyone at Western States the best of luck for a safe and fun run.
I’ll be doing foot care at Michigan Bluff and then Sunday morning at the finish line. I hope some of you crewing will have the opportunity to stop by medical at Michigan Bluff and say hi. If you are running the race, I hope you can run past with great looking feet.
But if you need help with blisters or any foot related care, I’ll be there.
Several weeks ago I was interviewed by Gabriella Boston, a reporter for The Washington Post. She emailed me asking whether I was available and when could we talk. When she called we talked for about an hour. She asked all kinds of questions about foot care based on my experiences for runners.
The article came out on the 17th and is worth reading. The title is How Runners Can Keep Their Feet Happy. Sections include, run training, proper footwear, cross training, and foot care. Gabriella interviewed two podiatrists, a physical therapist, and me. Fixing Your Feet is also mentioned in the article. Click on the link in the paragraph above to read the full article. My bet is that you’ll learn something new.
I’ve been on vacation much of the past two weeks and given my time away, have turned to a good friend, Alene Nitzky, an experienced and well qualified ultra runner who wrote an article published at the Coloradoan website. You have heard me go on and on about the importance of god foot care. Here’s another slant, from an ultra runner who has run Badwater and many other ultras.
Runners spend all kinds of money on entry fees, clothing, travel to races, nutritional supplements and race foods. They spend all kinds of time on training, body work, stretching, weight training or cross training.
They worry about their weight, hydration, nutrition, sleep, and preparing for race-day conditions. And most of all, they obsess about finding the right shoe.
But in all this obsession, the two things they forget are the most essential tools they have to carry them from start to finish and go into those expensive running shoes.
Your feet are your base of support. They are the vehicle that carries you forward and through the distance. You can’t run without them. So why do so many runners neglect them?
You can do all the right training and preparation, wear the right shoes and gear, but if your feet fail you, it can ruin months of hard work.
The problem is lack of foot care. Blisters are just a symptom of the problem. Friction and moisture are the two culprits in creating blisters. Improper hydration plays an important role, too.
Blisters are caused by layers of skin and fabric or debris trapped inside the shoe or sock, combined with friction from running motion. Creases in socks, rough edges inside shoes, and dirt contribute to these rough spots. Calluses that are allowed to develop on feet and are not removed can lead to deep, painful blisters. Rough or jagged toenails can catch on socks, causing the fabric to bunch and rub against the toes.
The role of hydration, especially too little sodium relative to fluid intake, also contributes to blistering. Fluid travels out of the blood vessels into the tissues and separates layers of skin, making shoes tight and contributing to more friction. Check your hands while running. If your hands are swollen, your feet are swollen, too. Popular sports drinks often don’t have enough sodium to replace what is lost during long, hot weather events.
Regular pedicures are helpful. If you don’t want nail polish and all the extras, you can do much of it yourself. Softening and removing calluses over time reduces the likelihood of blisters under these trouble spots. Soften rough, dry spots with lotion when you’re not out running. Keep your toenails trimmed and filed. Underneath the ball of the foot, most people don’t realize they have callouses, and these are a common trouble spot.
Moisture is another problem, even in our dry climate. If you are running trails with stream crossings or crossing snow banks at high altitude, you are also at risk for developing blisters. But even without water crossings, your feet sweat, and moisture in socks and shoes can become a problem.
Keeping your feet as dry as possible helps. If you have a dry pair of shoes and socks to change into after the stream crossings are behind you, that will help.
Use a good sock that wicks moisture away. There are many different brands at specialty running stores. Keep your shoes and socks clean. If you’re running a road marathon, don’t race in shoes or socks you wore on trails. The dirt will stay inside and cause friction.
A foot kit should be part of every runner’s supplies. You can learn how to give yourself a pedicure, how to stock a foot kit and tips for avoiding blisters and other foot problems by doing some research.
Band-Aids are fine for knees and hands, or even on feet that aren’t being used, but they are not meant for use on feet while running. They don’t hold up to friction, moisture and shearing. The Band-Aid will soon bunch up and crease, and any dirt in your shoes and socks will stick to them, causing more friction.
Two excellent resources for learning how to take care of your feet are John Vonhof’s book, Fixing Your Feet, 5th Edition, Wilderness Press, 2011, and website fixingyourfeet.com. You can also get a free subscription to his fixing your feet blog with helpful tips.
I encourage you to check out Alene’s websites. She’s a great person with a big heart.
Filed under: blister care, Foot Care, Footcare, Health, Sports
Last weekend I worked the finish line at the Ohlone 50KM Trail Run in San Francisco’s East Bay hills. This is a tough trail, very exposed to the day’s sun, and every step is either up or down. Some people say, and I believe that if you finish Ohlone, you have a great chance of finishing Western States.
One runner who I admire and consider a close friend is Catra Corbet. She has proven herself as the “owner” of this trail. Many years she will run an Ohlone 100 or more just because she loves the trail so much. This year, Catra did 200 miles on the trail!
In talking to Catra after she completed the 200 miles, she mentioned that she had no blisters. I remember years ago taking a picture of her taping her toes. She used to tape every toe. I have a photo of her with a heel blister too. Now though, Catra runs blister free. What’s the difference?
I believe Catra’s success with blister free feet came through the miles of running she puts on her feet. She doesn’t run short runs, she doesn’t run a couple of times a week – she runs a lot. Many of you know Catra, or have heard of her – and know how much she runs. She also has found the right shoes for her feet – Hokas. She also wears Drymax socks – a favorite of mine.
But it’s not just Catra. I have worked medical and provided foot care at hundreds of ultramarathons, adventure races, walks, and multi-day races and have seen the same thing.
At the Western States 100 at 55.7 miles, for example, the top 20 to 30 runners come through Michigan Bluff without needing any type of foot care. There may be one of two that get some type of foot care from their crew down the road, but if so, is generally pretty minor. Most often, if anything, they just change socks or shoes.
As the race progresses and more runners come through, we begin to see runners needing help with foot care. The farther back the runners are, the more foot care they need. Not every runner, but many of them. And many of them have multiple issues. Not just one blister, but quite a few. The more problems that have, the more complex the repair, and the longer it takes to complete the fix. This becomes a huge issue if they are trying to stay ahead of the cutoffs at each aid station. I remember a runner several years ago that we patched up. At the next aid station, she need more care and wanted to get out of the aid station quickly to avoid the cutoff. That meant not doing a quality patch job –and she came back to the aid station after going a bit down the road. She knew her race was over.
So the point here is that you need to put lots of miles on your feet in order to train them for long conditions. You can run 10 miles a day, day after day, and then try and do a 50 miler, and odds are – you will have problems. You have 10-15 mile feet – not 50 mile feet.
This applies to walking, running, adventure racing, hiking, – any activity where you use your feet.
It all boils down to how many miles you are putting on your feet.
We all can’t be the top runners. Many runners don’t have unlimited time to train. So what can the rest of us do? Make sure you get some long runs, especially closer to your race. Make sure you have the best possible fit in your shoes. Make sure you wear quality socks. Reduce your calluses. Learn proper toenail care. Change your socks and shoes as necessary for the conditions of your run or race.
Over the years, I have talked to too many runners who think blisters are naturally a part of running and racing. They don’t have to be. Make smart choices and put miles on your feet, and your feet can be blister free.