Common Toenail Question

March 17, 2015 by · Leave a Comment
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.

Draining a blister under a toenail

Draining a blister under a toenail

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.

Blister Repair – Your Way or Their Way?

March 7, 2015 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

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.

Kinesiology Tapes

February 24, 2015 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products 

If you have followed my blog long enough, you’ll know I have a preference for kinesiology tapes for protective taping before a race and patching blisters during a race.

Over the years I have used many different types of tape – most of which I no longer use. The one tape that has stood the test of time is the kinesiology tape. There are several to choose from including Kinesio Tex, Rock Tape, StrengthTape, and others. Since Kinesio Tex is a trademarked name of a brand of kinesiology tape, we should not use the term Kinesio tape when talking about a different brand than Kinesio Tex. For example, Rock Tape is a kinesiology tape, not Kinesio Rock Tape.

Last year I provided foot care at the Jungle Marathon Amazon and took Leukotape, Rock Tape H20 and StrengthTape. In the end, I stopped using the Leukotape because of the tape residue it left on the skin.

Here’s how I judge tapes:

  • I don’t want tape residue on the skin when the tape is removed or comes off
  • I don’t want a tape that is coarse
  • I don’t want a tape that is thick
  • I want a tape with superior adhesive
  • I want a tape that will hold in wet conditions
  • I want a tape that will conform (at least somewhat) to the shape and curves of the foot and toes
  • I want a tape that does not lose it sticking ability or workability in cold or hot conditions
  • I want a tape that can be used on all parts of the foot
  • I want a tape that is as smooth as possible
StrengthTape in the Amazon

StrengthTape in the Amazon

The benefits of kinesiology tapes are their stretchiness in length, softness, and smoothness, which allows them to be molded to the shape and curves of the foot and toes. In the image here you can see how the tape has molded to the toes and space between the toes. Imagine trying to patch a blister at the base of the large toe. Most tapes will fail at this because of their inflexibility or thickness, meaning they cannot mold around the toe into the fold at the base of the toe and onto the toe and ball of the foot. Kinesiology tape can do this with no creases or overlaps in the tape.

My favorite kinesiology tapes are Rock Tape H20 and StrengthTape. Both have excellent adhesive stickiness, even in wet conditions. The best application tip for kinesiology tape is to apply it the evening or night before your race. Use a tape adherent and after applying the tape to the skin, rub it for 15-20 seconds to warm the adhesive so it will stick better. Then put on the socks you’ll wear the next day. I have used these tapes in the Amazon Jungle and they stick better than others. Certainly the grit of the sand and dirt in the jungle will compromise the long term stickiness of the tape, but I still think it’s the best tape for wet conditions when a tape adherent is used and the tape is applied correctly and ahead of time.

A helpful website that offers a lot of information about kinesiology tapes and their uses is TheraTape.com. It’s where I get my tapes. In addition to selling most brands of kinesiology tape, the site has information about the kinesiology tapes, brand information, application instructions, and videos. TheraTape provides tapes in single rolls and bulk rolls and in a variety of colors, as well as educational materials if you want to learn more about using the tape. StrengthTape is also sold by ZombieRunner.

Please understand that kinesiology tapes are designed to provide healing benefits to athletes when injured and with inflammatory conditions. The videos do not show patching feet or taping for blisters since that is not what the tape makers promote. Here is a link to learn about kinesiology tape.

TheraTape just released a comparison chart of kinesiology tapes. I have included the chart below, split into two images. Click on each image for a larger view. Here’s the link for the kinesiology tape comparison chart if you want to go directly to the website to see the chart.You can order StrengthTape or Rock Tape H20 or another other kinesiology tape from TheraTape.com or StrengthTape from the ZombieRunner link above.

Connect directly to StrengthTape and Rocktape

  • StrengthTape.com has a number of informational videos on their website and is a good way to connect with the company.
  • RockTape.com also has a website with lots of good information and videos.
Kinesiology Tape Comparison Chart 1

Kinesiology Tape Comparison Chart 1

 

Kinesiology Tape Comparison Chart 2

Kinesiology Tape Comparison Chart 2

 

 

 

 

 

 

Typical Heel Blister Problems

January 12, 2015 by · 4 Comments
Filed under: blister care, Foot Care, Footwear, Footwear Products 

Heel blisters are quite common – although they shouldn’t be.

Feet in the Jungle Marathon

Heels in the Jungle Marathon

Today’s post shows one participant’s feet at the 2014 Amazon Jungle Marathon.

If you look closely at this picture, you’ll see two heel blisters, both on the outside of the runner’s feet. The right foot blister is large but is not blood-filled. The blister on the left heel, however, is very large and filled with a large amount of blood.

It’s easy to think these are normal blisters – but their size makes they abnormal.

In my experience, heel blisters are caused by the constant shear when either 1) the heel is moving up and down inside the shoes’ heel, or 2) by the constant movement at the place where the shoe’s insole touches the inside of the shoe. Over the years, the majority of heel blisters have been the latter. One of the characteristics of this “insole/shoe junction” blister is that they often are flat across the bottom. The blister starts at the point where the insole’s edge at the side of the heel touches the inside of the shoe. That’s what makes the flat line at the bottom. Then the blister forms upward as the fluid forms and it grows. Given enough time and movement, you’ll get blood inside.

Patching

These are relatively simple to patch. The skin must be cleaned with alcohol wipes, and then the blister can be lanced and drained. Depending on the size of the blister, you’ll need to apply some type of blister patch. The bottom line is that you need to have something over the blister to protect the skin and prevent the top layer of skin from tearing off. For these, I would use strips of kinesiology tape (my preference is either StrengthTape or RockTape H2O) with antibiotic ointment over the blister to keep the tape from sticking to the skin. The larger the blister, the harder these are to patch but it can be done.

Prevention

You are better off to prevent these blisters in the first place.

Start with the fit. Make sure your shoes hold your heels in place with just a little movement.

Check your shoes and insoles for rough and/or thick edges at the inside and outside of each heel. Side blisters are much more common than the back of the heel. If the insole has a large thick edge, replace them. If the shoe’s fabric is worn into a hole, you are due for new shoes. Under the fabric is generally a plastic edge of the shoe’s heel counter – the plastic that curves around the heel from side to side.

Engo Blister Prevention Patches are perfect for to help prevent these types of blisters. These patches are super slick. Either the small or large oval can be applied to the inside of the shoe and cover the offending edge of the insole/shoe junction. Clean the inside of the shoe and insole first. I work the patch with my fingers to form a curve to fit with area I need to cover. Then remove the backing and apply the center of the patch first and then push the top and bottom of the patch into place. Rub it a bit to assure adherence.

Reduce Friction to Reduce Shear

December 21, 2014 by · Leave a Comment
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.

You must reduce friction to  blister-causing shear.

You must reduce friction to blister-causing shear.

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.

The Heroes of Foot Care

December 12, 2014 by · Leave a Comment
Filed under: blister care, Foot Care, Health, Sports 

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.

Foot Care Triage in the Amazon

Foot Care Triage in the Amazon

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.

  1. Simply say thank you.
  2. Make sure you have done everything possible to have healthy feet going into the race.
  3. Trim your toenails short and then file them smooth.
  4. Reduce calluses as much as possible.
  5. Wear quality shoes and socks.
  6. Know how to do your own foot care just in case we aren’t there or there’s a line for our services
  7. And finally, be patient. Good foot care and blister patching takes more than a minute.

We love helping runners and always welcome your appreciation.

An Interview with Amy Gasson at the Jungle Marathon Amazon

November 20, 2014 by · 2 Comments
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.

Interview with Amy Gasson at the Jungle Marathon Amazon

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.

Amy Gasson and me

Amy Gasson and me

Thanks Amy for letting me get to know you at the Jungle Marathon Amazon.

Mandatory Gear for Foot Care?  

October 22, 2014 by · 1 Comment
Filed under: blister care, Foot Care, Footcare, Health, Sports 

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.

A Mandatory Gear List

A Mandatory Gear List

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.

Foot Care Tips That Can Save Your Race

September 14, 2014 by · 2 Comments
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.

Toenail Blisters – 7 Causes

August 18, 2014 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Health 
BlisterPrevention's website

BlisterPrevention’s website

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.

  1. Shoes too small
  2. Shoes too big
  3. Nail shapes and deformities
  4. “Cocked-up” big toe
  5. Clawed toes
  6. Downhill terrain
  7. 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.

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