Filed under: blister care, Foot Care, Foot Care Products, Health, Sports
Since the 6th edition of Fixing Your Feet came out and I worked Western States 100 and Badwater for another year, I’ve been thinking about putting on a few one-day foot care clinics in 2017.
I‘d like to do these around the U.S. – in Northern California, Southern California, Florida, maybe Texas and Oregon, and elsewhere if there is enough interest. If it were just me, I could teach 10 people. If I had a knowledgeable helper, we could teach 20 people. If there were enough in one area, we could do it twice in two days.
My preferred audience would be athletes who want to learn the finer points of patching feet, taping, blister care, shoe modification, and more. I envision different sections: the basics, hot spots and blisters, toes, general taping, specialized taping, post event care, and more. This would be full hands-on training. Ideally attendees would like to learn and then share the skills with others – medical people, runners’ crews, those with a keen interested to learn but without the opportunities to learn.
Attendees would received full instruction, watch and do the skills, get hands-on with the tools and tapes, handouts, copies of the presentations on CD, and a bunch of goodies I’d try to get from companies with relevant foot care products.
My plan is to hold these in a location easily accessible to those in the area – a hall or community center, a hotel meeting room or something similar. I realize some people would have to travel and would work to arrange nearby accomodations.
I have the outline of the day completed and it would run from 9am until 5pm. The clinic would cost participants to cover the meeting location, supplies, lunch and breaks, and associated miscellaneous expenses.
I had originally wanted to do the clinics on a Friday and then have participants work aid stations at a local 100-mile race the following day – but the logistics of that are too complex.
If you are interested in this kind of foot care clinic, please send me an email and tell me where you are located. I’ll collect names and locations, and if there is enough interest, will get back to everyone in future emails.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Health
Anyone who knows me has heard me talk about calluses.
I don’t like calluses – period. They indicate repeated pressure over time, generally from poor fitting footwear.
But the most important thing to know is that if or when you get a blister under a callus, it will be painful. No matter how small or how little fluid is inside the covered and hidden blister. You know it’s there. I know it’s there. But finding the exact location and depth of the blister in order to drain the fluid is very, very, very difficult. It can be painful too because it take a series of punctures with a needle to try and find the blister sac.
So for that reason, I prefer nice soft skin instead of calluses. I’ll accept a little bit of callus – but very little. I have spent too much time at aid stations and medical checkpoints trying to help athletes with thick calluses that have negatively affected their forward movement.
Your job is to reduce your existing calluses and then try to keep the skin soft. It’s not easy but in today’s blog post, I have a link to a Moo.Review webpage that goes into great detail about callus tools. Manual tools, battery operated tools, gels and creams, the list is long and the pros and cons are shown.
I encourage you to check out the webpage and even get one or several of the tools to work on reducing your calluses. Here’s the link to Moo.Reviews Callus Remover page.
Filed under: blister care, Books, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports
After 14 months of revising and updating, editing and then editing again, and issues with the cover, the 6th edition of Fixing Your Feet is available.
While it has been available for pre-order in Amazon, they now have the print version in stock and ready to ship. Amazon currently has the 6th edition priced at $13.64, well below the retail price of $19.95 – a great buy. Here’s a link if you want to order a copy.
The Kindle ebook version will be released in about two weeks.
As I meet runners and crews at races, I find many have an older edition. I encourage you to bite the bullet and get the 6th edition. It’s well worth it.
Every new edition has all products and URLs verified. In addition, the text has been tightened up to eliminate redundancy of topics, and remove out-dated information. Many topics have expanded and new information. Every chapter has been reviewed and some degree of change made.
The chapter on Extreme Conditions and Multiday Events includes new information on the growing problem with maceration, as well as new information on trench foot, chilblains, and frostbite, all possible in the adventures we participate in.
A new chapter is Blister Prevention – The New Paradigm. The chapter revises the thinking that moisture, friction, and heat are the causes of blisters. After much study by experts in the field, I introduce the concept of shear as the underlying cause of blister formation. Several charts show the relationship of moisture, friction, and heat to shear, and how new things like bone movement, skin resilience, and pressure; along with the usual things like fit, socks, insoles, lubricants, and more, influence blister formation. The chapter also stresses the value of ENGO Blister Prevention Patches.
I would be remiss if I didn’t comment on the new cover. The first cover mock-up had an image of an athlete trying to patch her feet, but it did not capture my view of doing foot care and blister patching well. I arranged a photo shoot with a local photographer and Tonya Olson, a physical therapist and well-trained foot-patching expert as our model. Thanks Tonya. I’ll let you be the judge, but I like the cover and the design.
If you have an older edition, you will benefit from the new edition. Even if you have the 5th edition, you’ll find value in the new 6th edition. Order the 6th edition through Amazon.
Once you have the new edition, I’d be appreciative of a review in Amazon when you have time. Reviews are important and help other buyers make informed decisions.
Note: The links above are my Amazon affiliate link.
Filed under: blister care, Foot Care, Footcare, Footwear, Health, Sports
Over the next few days, over 90 ultra runners will test themselves at the Badwater Ultramarathon in California’s Death Vally. 135 miles. Extreme heat, scorching roads, sand, wind, hot winds, and then at the finish line – much colder temperatures. I’ll be there to help with runner’s foot care issues, working with Denise Jones.
I decided to rerun this blog post from 2010. It describes an issue that can harm a runner, and can happen when time is not taken to repair small blisters before they become large, and then huge.
Here’s the post from July 2010.
This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.
For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.
At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.
She should have.
After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.
What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.
There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.
We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.
What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.
I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.
It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”
This is an update to my blog post of May 28, A Thru-Hikers Story About Feet. The thru-hiker is Tami and she is still hiking the PCT.
When possible I love to share people’s before and after stories with their feet.
Her story was interesting because she was having huge issues with her feet. I shared three pictures that she sent me, which shows the damage to her skin. I’d suggest going back to read the first part of her story and seeing the pictures. It’s important because it put today’s blog post update in a real-life perspective.
“I just wanted to drop you a follow up line and let you know that my feet have never been better thanks to you! I just walked 600 miles (trudging over 20 miles per day in the High Sierra on rough rock during dehydrating heat spells carrying an extremely heavy pack complete with bear canister…yes this is a run-on sentence but I can’t help myself) using your preemptive taping methods and tincture of benzoin for toughening and I didn’t get one single blister! This is a huge breakthrough for me and I’m giving acknowledgements to your book and your suggestions everywhere I can- you truly are helping me hike the Pacific Crest Trail.
“Yes, I’m still hiking and super in tune with these feet. Every tiny hot spot or slight discomfort makes me stop and evaluate everything. Thanks for the reminder to not get complacent, it seems like my feet are tough, but it wasn’t too long ago that I was disabled to due horrible blisters.
“I thought my foot issues would be putting the cabosh on my plans, but here I am with happy feet! I met a girl on a bus who was limping around with blister pain and pulled out my foot kit for her to look at. She took notes, jotting everything down including your book title. These are hard lessons learned, but then again, I never seem to do anything the easy way. Thanks so much.”
So what do we learn here? We see that there is hope. It shows that athletes can survive and find help and solutions for their foot issues. Whether you are a thru-hiker, like Tami, an ultramarathoner, marathoner, walker, adventure racer, or anything else, you don’t have to quit because of your feet. Tami was smart and reached out for help – and was willing to put in the effort to learn what to do and what her feet needed.
You can do the same thing.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Health, Sports
At Western States we saw a lot of negative results from wet feet. Even though we tried to spread the word, many runners did not protect their feet. Runners had poured water over their heads, which went into their shoes, and they sat in streams. Runners were complaining of blisters on the feet, mainly the balls of the feet but it was maceration. In reality, almost everyone had one or more skin folds common to their feet being wet for long periods of time. These might be in the center of the mid-foot or at the ball of the foot near the toes. Some did fine by warming their feet, applying powder, changing socks and shoe when possible, and maybe sitting a bit – and continued on and ran well. Others did not stop at aid stations or get crew help, and ran on with wet feet. Then they reach a pain point at which they cannot continue, or they reach the finish line – and they want help with their feet.
There is no quick fix to maceration. The more severe it is, the longer it takes to return to normal. Maceration can be painful – and yes, feel like one’s feet are burning. The skin is so soft and tender that every step is painful. Many times the skin has folded over on itself or has lifted to form deep creases, which can split open. I have seen maceration go through several stages:
- First, the skin begins to soften and becomes tender.
- Second, the pruning starts as the exposure continues. The skin wrinkles and softens even more.
- The third stage is when the skin can form creases and folds over onto itself. The creases may be shallow or deep, but are painful.
- The fourth stage is the most severe. The folds split open and/or the skin may tear.
If there are blisters, they must be drained and covered with a waterproof dressing to help keep tissue swelling under control. Tissue swelling leads to cold and damp skin, swollen and difficult to patch.
There are ways to deal with maceration, but it’s even more important to take steps upfront to prevent it. For instance, change into dry shoes and socks whenever possible, change socks as often as possible. When getting crew aid or at aid stations, remove your shoes and socks to allow your feet to dry, sprinkle with powder and rub it in, warm your feet with light massage, let them see some sunshine, and use one of the moisture control agents.
For moisture control, RunGoo from Foot Kinetics is one of the best. Its thick white paste works wonders on the skin and helps keep moisture at bay and it last a long time. FootKinetics.com has created a great product that works. Other excellent products include Trail Toes, ChafeX. SportsSlick, and Desitin Maximum Strength Original Paste. One thing to look for in these products is how long they last and do they come small packages or could they be packaged small enough to be carried in a hydration pack. My preference for applying any of these is to use them liberally. Then bunch your socks and roll them over your feet. Avoid just pulling your socks on, which can thin the product around your toes and forefoot.
Having severely macerated feet is not a badge of courage. It’s a sign that you could have made better earlier choices in foot care. Some of the worst feet I have seen have been because of severe maceration.
For 20% off your purchase of RunGoo from Foot Kinetics, use the coupon code “tfk20john.” I’m even using it as a chamois cream when road bike riding. It does last.
In a future post, I’ll talk about treating feet and maceration at a race finish line.
Filed under: blister care, Foot Care, Foot Care Products, Footwear, toenails
Next week is the Western States 100 Mile Endurance Run and all the fun and hoopla that goes with it. I ran the race from 1985 – 1989 with a best time of 24:32. It was a challenge but I had fun every year. Ever since then I have been associated with the run in some capacity and for the last 16 or so years have provided foot care help at an aid station or two and the finish line. In that time I have seen a lot of runners come through aid stations needing foot care.
This year I decided to make a list of my top 12 foot care tips for success at 100’s – whether Western States or any other 100-mile run. You don’t want feet like in this picture.
- Make sure your shoes fit. That means a bit of room in the toe box and good grip in the heel. It also means that the shoes are in good shape.
- Make sure you wear good socks. That means no cotton, but only moisture wicking or water-hating socks. If you are prone to toe blisters, consider Injinji toe socks.
- Trim your toenails short and then file them smooth so when you run your finger over the tip of the toe, you don’t feel any rough edges or points. This goes for thick toenails too – file them down.
- Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
- Wear gaiters over the top of your socks and shoes. This keeps dust and grip from going down inside the shoes and inside your socks. Understand though that the mesh in today’s trail shoes does allow dirt and grits inside the toe box, even with gaiters.
- Use a high-quality lubricant like SportsShield, Sportslick, RunGoo, Trail Toes, or ChafeX. Do not use Vaseline.
- Know how to treat a hot spot and blister between aid stations – and carry a small kit in your hydration pack. Early care is better than waiting until a blister has formed or until the blister has popped and its roof torn off.
- Just as you have trained by running and conditioning, you need to know what your feet need to stay healthy and blister-free during the race. Just as you have learned what foods you can tolerate during a race and during the heat, you need to be prepared for foot care problems. Your feet are your responsibility.
- Make sure you have a well-stocked foot care kit(s) with your crew and they know, in advance, how to care for your feet. Trailside, at an aid station, is not the time to learn or to train them what you like done.
- When you pour water over your head and body to cool off, lean forward to avoid water running down your legs and in your shoes. Getting wet feet or waterlogged socks can lead to maceration very fast.
- Consider using RunGoo or Desitin Maximum Strength Original Paste liberally on your feet and toes to control moisture from excessive sweat, stream crossings, snow melt, and water poured over your head that runs down into your shoes. Reapply at aid stations. Maceration can quickly lead to skin folds, tender feet, skin tears, and blisters.
- Finally, DO NOT assume that every aid station has people trained in foot care or have the supplies necessary to treat your feet. If you have a crew, have them work on your feet. Many times the medical personnel are backed up or dealing with more serious medical emergencies. And, truth be told, blister are not a medical emergency. Heat stroke, heat exhaustion, dehydration, and the like are more serious than blisters.
Every year I am amazed at the number of runners who are ill prepared. They put extra socks in their drop bags – that have holes in them. The have open Athletes foot sores between their toes. Their shoes are shot and should have been replaced. They have not done good toenail care. They have thick calluses. They start the race with old unhealed blisters. Their shoes don’t fit. They wear full-length compression socks and then are amazed when we can’t get them off at the aid station to work on their feet. Tight fitting compression socks may feel good but are almost impossible to get off and even worse to get back on over patched feet.
While medical people will always try to help you, we can’t work miracles with your feet when you have neglected caring for them from the start. Again, your feet are your responsibility.
Today’s post is a thru-hiker’s story about her experiences with her feet. It’s one that make you grimace when you hear the details and see the pictures. I share the story because there are lessons to be learned. Here’s her story.
“This past April, I started the Pacific Crest Trail intending to thru-hike northern-bound to the Oregon/Washington border. I’m an experienced long distance thru-hiker and frequently hike 20-25 miles without issue.
“Rarely do I get blisters, and I have no calluses. The day I started at Campo, California, I hiked a 20-mile day and was shocked to find my toe pads laden with deep blisters at the end of the day and a couple smaller surface blisters on my little toes. This is how the trip started! I did my best triage but wasn’t very familiar with how to treat such ailments, and so continued hiking.
“By the time I’d reached mile 350 on the trail, my feet were an absolute mess. Blisters had become wounds, wounds became infected, toenails were falling off and each foot was severely compromised. At one point I sat on the edge of the trail so frustrated I was in tears! What was wrong with my feet?
“Only after my feet got good and angry did I switch to a larger size shoe in hopes of accompanying the swelling. I think one of my mistakes early on was that I used gauze and Neosporin along with athletic tape and made mummies of the feet. Add to this 90-degree heat through the desert and my feet looked like big balloons, which barely fit in shoes. They were so painful that one day while walking, I took my socks off to give my feet more room. That caused heel blisters. But aside from cutting the sides out of my shoes, I had no other choice. I was in a remote area hardly able to walk despite taking NSAIDS.
“After I hit Big Bear Lake, I rested for 4.5 days in hopes of curing my issues. When I set back out on the trail I switched to Altra Olympus 2.0, in a half size larger than normal (for swelling issues) since they offered more cushion. I hiked for two days, but my feet were not healed all the way and I suffered terribly during that timeframe. Blisters popped up in places they’d never been, likely because my gait was compromised and I was still in pain. I was finally able to hobble down to a highway and hitchhike to a town where I put on flip-flops, rented a car and flew home.
“I’d never had these issues before in all my years of long treks. When I got home, I started researching foot care online and came across your book, which I downloaded. I read it cover to cover and feel it’s the part of the puzzle that I never knew I needed and also, the solution moving forward. I’m following your advice with the tapes and have been practicing with bandaging as you suggest, including the betadine prep and a dab of zinc oxide on the new recovering skin. I also purchased some powders and lubes and will take the whole shooting match with me when I get back out on the trail.
“I’m also trying Injinji liners to see if that helps, although my feet aren’t particularly sweaty. I believe that the deep blisters in my toe pads were due to the heavy water weight I had to carry through the desert, which was different than how I trained since I underestimated how much water I’d need in such a harsh environment. I did wear trail gaiters, but my shoes were Altra Lone Peak 2.5’s and they allowed dirt to come in. There was a lot of abrasive mica in the desert soils and it’s hard to keep feet clean with little water available. I used wet wipes but it was still hard to get the grit out. My pack’s base weight is very low at 14 pounds, so I’m doing everything I can to keep the pack as light as possible and have lots of experience with backpacking. Nothing else hurts – no hip, knee or ankle pain – just these silly feet.
“I did not make any changes to my shoe or sock choices before starting. I used the same combination I’ve used for years without problems. Things I did not do which I probably should have: take more breaks, start out slower and not push huge days, wipe my feet off several times a day with wet wipes, change socks more frequently, stop more for hot spots, listen to my body, and take preventative measures to not get blisters.”
I initially asked the thru-hiker my usual questions. Did you change footwear, socks, conditioning, etc? Were you wearing good socks? Was the weather a factor? Do you wear gaiters? Do your shoes/boots have a mesh upper that allows grit and dirt inside? It sounds like your feet rebelled at what you wanted them to do. We traded emails several time with her providing answers and my giving suggestions.
The lessons I mentioned at the start of the post? Here are a few that pertain to thru-hikers, hikers in general, runners, ultrarunners, and adventure racers.
- Know your event. Carrying extra water, food, and other supplies in a weighted fannypack, hydration pack or backpack can put extra stresses on your feet.
- Know any possible weather issues. Heat, rain, and humidity can all cause problems.
- Know any possible trail/road issues: water, stream crossings, desert sand, grit, and rocks.
- Know about any special accommodations necessary for like swelling feet, and grit or sand getting into your shoes’ mesh uppers.
- Know what to do when you have problems with your feet and have the supplies to fix them. Practice ahead of time to refine your skills.
- Know how to get your blistered feet back into hiking/running condition.
A month ago I wrote a blog post about two multi-day races in Europe that are implementing a triage system for medical care at aid station – the outcome of their being overwhelmed by the amount of treatment and time that their participant’s blistered feet were requiring. Here a link to that post about Providing Foot Care for Athletes.
In this post, I want to expand on a quote from their website that I included in the original post. It was about the 6Ps of foot care.
They stated that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provided a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps. Let’s talk about these one-by-one.
Proper Preparation – In the months leading up to your race, and even race to race, you, and you alone need to be responsible for learning proper preparation. You need to learn how your feet respond to being wet and maceration starts, to being in sweat soaked and dirty socks, and when your feet are caked with dirt and grime. You need to learn about the best lubricants and/or powders, and insoles. You need to learn what causes the hot spots and blisters and what steps you can take if or when they develop. You need to practice taping or whatever strategy you plan to use. This is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Prevents – You need to know what to do when you develop hot spots and blisters, and have the materials and tools, and even more importantly, the skills, to fix your feet. This focus on “prevents’ needs to happen in the months before your race and during the race. It’s about proper toenail care, skin care, callus reduction, shoe and sock selection, whether to wear gaiters, preparation for a variety of weather conditions, and of course, putting the required and necessary training miles on your feet. This also is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Piss-Poor Performance – This is what can happen when you fail at any of the first three Ps. Your performance suffers. Your race may be over. In many races, medical volunteers will try and help patch your feet. Some races do not have the luxury of dedicated medical volunteers for all the aid stations, much less the finish line. You cannot and should not count on a race having medical personnel to help with your foot care needs. Just because there is a doctor, nurse, or EMT at an aid station, that doesn’t mean they know how to patch feet. You cannot and should not count on races to have the foot care supplies that you want for your feet. If you will have a crew, work with them so they know how to work on your feet with your supplies.
Some runners may feel I am being too harsh as I tell you these are your responsibilities. Let me share a story from years ago. In 1985 I ran Western States for the first time. After crossing the river at Rucky Chucky, I had blisters in the arch of one foot. Someone at the far side offered to help patch my feet. After lancing the blisters, I had a wad of gauze taped to my arch, which changed my gait. I finished the race, but learned a lesson. The treatment, while well intended, was not the best for my foot. I learned to take responsibility for my own foot care. For the next three years running Western States, I managed my feet – and I’m sure that experience helped fuel my interest in foot care.
So my point in expanding on the 6Ps in this blog post is to reinforce the notion that foot care of your feet is your responsibility. If there are medical volunteers at a race, and they know how to patch feet, and have the supplies – and the time, consider yourself fortunate – but don’t count on them being there.
Please feel free to agree or disagree with my position, and share by commenting below,
Providing foot care for athletes at ultramarathons and multi-day events is a huge responsibility. Their feet are what keep them going, and if you are known for providing foot care, the athletes will be appreciative of whatever you can do. If you are simply helping one runner, you might be a bit more casual. But if you will be part of a foot-care team, you need to be prepared.
In 2015 race directors of several multi-day ultramarathons in Europe were overwhelmed by shear volume of runners seeking medical attention for blisters. They said it took upwards of 30 minutes per foot to treat most of the runners, which caused a significant drain on the ability of the medical team to look after more serious problems. Beginning in 2016, these races are introducing a triage system for medical care. Patients will be assessed prior to treatment with the most needy being treated first, regardless of how long others have been waiting. If the assessment indicates “minor” blisters, advice will be given and runners will be expected to treat their own feet. All runners must have their own blister treatment kit as part of their mandatory gear kit. They candidly state that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provide a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps.
Rebecca Rushton, an Australian podiatrist and owner of blisterprevention.com.au, and I agree that foot care at multiday events is vital. I consider a 100-mile ultramarathon a multi-day event. The problem is that many runners have become dependent and expectant that events will have medical personnel providing even the most basic foot care. Participants have come to treat foot care services at events as a perk of the event. While it’s nice to have, it’s not practical and sustainable long term. Race directors need volunteers with the time and expertise in foot care techniques, and the budget for supplies and equipment. The larger and longer the event, the more volunteers are needed and the more costly it becomes.
I wrote in a blog post that, “… at some events participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up and they want someone at the next aid station to redo their feet. That’s a lot of work and supplies.” Many athletes also fail to take care of their feet and fail to plan, and in many cases fail to take common sense action (reduce calluses, trim toenails, do self-care, etc) that could have prevented or reduced the problem. Rebecca and I support what we call assisted self-management. In the aid station, provide a table and a few chairs, and basic foot care supplies. Medical personnel will be available to give advice and tend to more serious treatment. It could even be that runners are shown how to patch the first blister and then they manage the rest. It’s a workable model and builds on today’s popular DIY (do-it-yourself) method of learning new skills.
This leads to a new mindset among many medical professionals that manage medical direction at races and multiday events that is worth considering. An article in the April 2014 Sports Medicine summarized it well. “Although participants in ultra-endurance events should be educated and prepared to prevent and treat their own blisters and chafing, blister care will likely be the most frequent use of medical resources during ultra-endurance foot races.” The mindset is that participants need to shoulder some of the responsibility for managing their feet. Medical staff at aid stations can quickly become overwhelmed even to the point of running out of supplies. We can help promote and support this new mindset in several ways:
- Give participants tips to prepare their feet in advance of the event. (Refer to “Foot Care in Multiday Events” in chapter 16.)
- Give participants tips on the best footwear selections for the event (types of shoes, gaiters, oversocks, camp shoes, and so on).
- Give participants a list of foot-care gear they must carry. A section on mandatory foot-care gear can be found at the end of this chapter. Even runners in a 100-mile race can carry a small Zip-lok bag pinned to their bib number or in their hydration pack.
- Advise participants whether or not foot care services will be provided and if so, to what degree. This includes no foot care and supplies, limited self-management, or full service.
- Provide a self-service table of supplies for runners to use in DIY patching of their feet. This can speed up their in and out times at aid stations.
- Stress the importance of knowing how to work on one’s feet (by reading this book or through other sources, or workshops).
- Stress the importance of runner’s having crews knowledgeable in foot-care work and prepared with a well-stocked foot-care kit.
How you implement the principles of self-management or whether you decide to provide full service foot care services depends on several factors: The number of participants, the difficulty, the remoteness, the number of medical volunteers, the availability of supplies (and being able to absorb the cost) and the number of aid stations and how far apart they are. It should be a well-thought out and joint decision between the race director and the event’s medical director.
Please comment how you feel about foot care services at the races you run or help with, or as a race director. We’d love to hear your thoughts.