13 Foot Care Tips for Success at 100’s

It’s five weeks until the 2018 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.

Every week somewhere there’s a 100 mile race, of 100KM, or 50 miler with runners of all levels of experience trying to finish their event. Many will complete it with their feet in bad shape. It doesn’t have to be that way. You don’t want feet like in this picture.

Feet at the finish line of Western States

Feet at the finish line of Western States

So I am reposting my tips from 2016 and updating it a bit. This year it’s my top 13 foot care tips for success at 100’s – whether Western States or any other 100-mile run.

  1. 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.
  2. 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.
  3. 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.
  4. Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
  5. 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.
  6. Consider putting ENGO Blister Prevention Patches over any problem areas in your shoes, i.e., the rough edges of your insoles in the heel, in the shoe’s forefoot on the side of the shoe, and under any problem areas in the ball of the foot.
  7. Use a high-quality lubricant like Squirrel Nuit Butter, SportsShield, Sportslick, RunGoo, or Trail Toes. Do not use Vaseline.
  8. 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.
  9. 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.
  10. 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 with what you want done.
  11. 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.
  12. 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.
  13. 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. You have five weeks to make them feel and learn what to do!

Skip These Two Foot Care Products

March 31, 2018 by · Leave a Comment
Filed under: Foot Care, Foot Care Products 

I have always told athletes that I have three absolutes when it comes to foot care. Over the past years, they have not changed. The three are: 1) Proper toenail care, 2) reduce calluses, and 3) wear gaiters when running trails. I still stick by the three because, in my mind, they are proven.

Now’s the time to share two foot care products to skip. Years ago, the two may have worked because there were not many alternatives. But time changes things. Yet I keep seeing these pop up on social media as people tell other athletes to use them.

The first product to avoid is white athletic tape. Typically this is the stuff trainers use when wrapping an ankle but many runners use it on their feet. It can come in 1 or 2 inch rolls. Unless something has changed I don’t know about, the tape does not stick well on skin. I never buy the stuff. Tapes have evolved. Kinesiology tapes can be used to tape either as a pre-tape or over blisters, or to wrap ankles, and along with HypaFix, Coverall, Fixomull, and Leukotape are all excellent alternatives. Don’t penalize yourself by using white athletic tape. Replace it with one of the other tapes and make your feet happy.

The second product to avoid is Vaseline. I know I probably got some of you upset because you like the stuff—but hear me out. Vaseline is 100 percent pure petroleum jelly. It’s so old school and there are better alternatives for lubricants. Vaseline is sticky and greasy. It attracts dirt, grime, trail dust, sand, and anything that gets inside your shoes. Over time all that stuff becomes an irritant. It also tends to harden on socks over time. Newer lubricants like Squirrel’s Nut Butter, Trail Toes, RunGoo, Bag Balm, and even Desitin Maximum Strength Original Paste are excellent alternatives. Do yourself a favor and replace your Vaseline to keep your feet happy.

That’s it. Two products I will never use and never suggest others use.

I welcome your feedback.

Diminished Heel Pad Treatment

I know a number of runners and athletes who struggle with loss of the fat pad under their heels. It’s a fairly common problem as we age. Some people have more of a problem with this than others. Several weeks ago I received an email from John Marnell. He wanted to share what worked for him.

John is 73 years old and has run for 40 years. He’s done many marathons plus a period of ten years when he did ultras. He says, “I feel fortunate to still be sort of running.”

Here’s John story about his fat pad history and treatment.

“I thought my condition was plantar fasciitis and tried self-treatment for quite a while. Finally, with no improvement I went to a sports podiatrist who ordered an MRI. Results showed a severely diminished heel pad on the left foot. He wanted to try these additions to my orthotics before considering other treatments.

“It’s best described as a horseshoe shaped dense foam pad he cut and trimmed to fit and then glued them directly onto both orthotics. They keep the bottom of the heel from direct impact on the orthotic. Heel pain gone. I’ve used them for six months with continued success.

Horseshoe pad for fat pad treatment

Heel Pad Treatment

The pad is 3/16” thick at the back and along the sides of the orthotic, tapering slightly to fit, and cup my heel toward the center of the orthotic.”

This is a simple fix that could work for many people. You can see the horseshoe shaped pad on the heel of John’s insole. Any podiatrist or pedorthist could make the same thing for you. If you struggle with pain from the loss of your fat pads. Give this a try.

Thanks John for sharing your treatment and the picture.

Results of Tape Survey

February 19, 2018 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, Sports 

I recently asked two questions in an online survey. Very simple questions.

  1. What is your favorite tape for pre-taping for blister prevention?
  2. What is your favorite tape for blister patching?

KT Pro TapeThere were 57 responses.

Let’s start with the first question. What is your favorite tape for pre-taping for blister prevention?

The tapes ranked highest were, Leukotape P and KT Tape kinesiology tape both at 19.3%. However if you add all the kinesiology tapes mentioned, it’s a different outcome. With KT Tape at 19.3%, RockTape at 12.3% Strengthtape at 7%, and Kinesio Tex at 3.5%, the total of all kinesiology tapes is 42.1%. With those numbers, more than twice as many are using kinesiology tapes at 42.1% versus Leukotape at 19.3%. Worth noting is the mix of HypaFix, Coverall, and Fixomull came In at 14%. These three are basically the same kind of tape, which is great for toes. Micropore paper tape came is at 7%. Surprisingly, duct tape came in at 7%.

Now let’s look at what some people said under the “other” choice, which came in at 21.1%. What I was looking for was other types of tape. Unfortunately, some of the answers were things like, Trail Toes; none, I stopped taping five years ago; and I don’t get blisters. Also in the other column was one person who said surgical paper tape, which is the same as Micropore; and two that mentioned Elastikon, which is hard to find and has fallen out of favor with most runners.

The second question was what is your favorite tape for blister patching?

Here the tapes ranked highest were Leukotape by a large margin at 29.8%. But again, add up all the kinesiology tapes with KT Tape at 19.3%, RockTape at 12.3% Strengthtape at 7%, and Kinesio Tex at 3.5%, the total of all kinesiology tapes is 42.1%. So again, kinesiology tape scored highest, but by a narrower margin.

In the “other” choice, 21.1% were a variety of answers. Two again mentioned Elastikon, Trail Toes was again mentioned, and several said they don’t blister or don’t know how to tape, along with a few other mixes of answers. Some of the other comments were that runners used a mix of two tapes, or moleskin and one of the tapes.

So, was did I learn from this?

Kinesiology tape is popular but Leukotape P is a strong second. Leukotape is known for its aggressive stickiness, which is great for adverse conditions. It’s inexpensive and easy to apply, although it does not conform to the shape of one’s feet. It also leaves tape residue on the skin when worn for long periods like 24 hour and multi-day races, which makes good foot care hard to do. I will always keep a roll of Leukotape around for times I think it’d be the best tape.

Kinesiology tape is easy on the skin, and when applied correctly, will stick for long periods. When used with a tape adherent, it will stick for days. It conforms to any shape of your feet and it breathes well. The trick with any of the kinesiology tapes is to prepare the skin with an alcohol wipe, use a tape adherent, apply the tape with little to no stretch, and then rub the tape with the paper backing for 20 seconds to warm the adhesive to help the tape stick. It’s best to tape before it’s needed, like the night before if possible, or a few hours before.

I like it the large percentage of people who use either Micropore paper tape of one of the HypaFix, Coverall, or Fixomull tapes. These tape are easy to use and quick to put on. They are thin and don’t require any special cutting to work. They are great for toes, as I mentioned earlier, but also work well for a quick covering for a hot spot or to hold a blister patch against the skin. Of the two types of tape, I prefer one of the HypaFix, Coverall, or Fixomull tapes because they are wider than most commonly carried paper tapes, which means often one piece will do.

And of course with any taping on your feet, make sure to bunch up and roll your socks on and off. This keep the socks from pulling on the tape. When cutting the tape, round any corners—square corners start to peel off fast when putting socks on and off.

Some of you might ask, what I carry in my foot care kit. It’s easy, several types of kinesiology tapes in two and three or four inch rolls, a roll of Leukotape, and a roll of HypaFix.

If you want to check out kinesiology tapes, here’s my favorite source: TheraTape.com.

 

An Advanced Course about Maceration

Several weeks before Western States last year I wrote a blog post about conditions on the course and how feet were going to be wet. The title was Running a Wet 100-Mile Trail Run. I talked about what would happen to runners’ feet, and steps I would take to manage my feet if I were running. Based on the feet we saw on the course, the majority of runners did not read the post and if they did, they ignored the advice.

In a normal year at Michigan Bluff, we treat 40-60 runners for blisters on the heel, forefoot, arch, and toes. Last year we treated one, yes – 1 for blisters. Everyone else had feet in a different stages of maceration. It was clear than runners did not take steps to manage their wet feet.

My friend, Rebecca Rushton, is a podiatrist in Australia. She wrote the forward for the 6th edition of Fixing Your Feet and I value her opinion on fixing feet. She’s very sharp and manages the website Blister Prevention. Yesterday Rebecca send out an important email about the question How Do I Keep My Feet Dry?

I want to share Rebecca’s email and the links to her three articles on maceration. It’s like an advanced course about maceration. I urge you to take a few minutes and read all three articles and heed her advice. The three articles cover the problem (maceration), treatment, and prevention. In my opinion, it’s a must read.

Here’s the email from Rebecca:

 

Most people know that moisture increases friction levels; and higher friction levels means more blisters.

So keeping the feet dry is an important blister-busting aim.

That’s a tough gig! Think about how your feet are wrapped up in shoes and socks the whole time. How can you keep the skin dry from the sweat being expelled from the skin? And dry from water coming into the shoe from the outside (environmental water – puddles, rain, dew, river-crossings, water tipped over the head which runs down the legs and into the shoes)?

Blisters are one thing. But in extreme waterlogging situations, the skin can become macerated. This is something every single athlete wants to avoid!

I’ve written a series of 3 articles on this very subject. If your feet are going to be exposed to water for an extended period of time, you owe it to yourself to read these articles.

And a word of warning … there are some pretty shocking photos in here. Don’t say I didn’t warn you! Talk soon 😉

Rebecca

 

Here’s the link to the first article on the problem of maceration. Each article has a link to the next article so you can read all three.

A Survey about Your Favorite Tapes

I have often shared information about different types of tape for blister prevention and blister patching. I have my favorites, but am always open to learning about new tapes.

When I first learned about taping, there were only a few commonly used tapes. There was duct tape, Elastikon, and white athletic tape. That was back in the 80s and 90s.

I remember the blister patching job on my feet one of the years I ran Western States. I left the Rucky Chucky aid station with a wad of gauze taped to the ball of my foot with white athletic tape that made it hard to walk or run. Several years later at the Gibson Ranch 72 Hour I had a duct tape patch between two toes.

Now things have changed. Elastikon is hardly ever used. Duct tape is still used by some. White athletic tape is not popular but some still use it. Micropore paper tape is popular. HypaFix (or Coverall) is fairly popular. Leukotape P has a good following. KinesioTex and other kinesiology tapes like RockTape, StrengthTape and KT tape have become very popular. Outside the United States, other tapes are often used too. For example, in the United States, HypaFix is the same as Coverall, but it’s also called Fixomull in other countries.

Sometimes certain tapes are used because of the conditions like heat, water, humidity, sand, and the length of the event. Other times tapes are used based on what’s available at an aid station.

So my question is, “What’s your favorite?”

I have a two-question survey that I would appreciate your participation in getting good data. The first question is What is your favorite tape for pretaping for blisters prevention? The second question is What is your favorite tape for blister patching?

There are only nine answers to choose from so the survey will take only a few minutes. The list of possible answers is the same for each question.

Here’s the link to take the survey: What’s Your Favorite Tape survey.

Thank you for helping compile the data. In several weeks. I’ll share the answers.

The Power of ENGO

December 5, 2017 by · 1 Comment
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear 

Tamarack Habilitation Technologies, a company dedicated to the prevention and relief of skin breakdown for individuals with prosthetic limbs and orthopedic braces, created ENGO Blister Prevention Patches in 2004. The patches are designed to prevent blisters and reduce pain from existing blisters. These patches are one of the best products to help athletes that have been released in many years. I think two or three of these thin ENGO Patches patches should be in everyone’s foot care kit.

ENGO Heel Patches

ENGO Heel Patches

ENGO low-friction patches are applied to your shoe, insole, or orthotic—not your skin. The patches are made with three layers: a low friction outer surface made of polytetrafluoroethylene (PTFE), a fabric backing, and an adhesive. Patches range from small and large ovals to a large rectangle to a shaped strip for heels—and each can be cut to size. These thin patches can greatly reduce friction in targeted locations within your footwear by giving a slick, slippery surface to the area of your footwear or insole where friction is a problem. Socks slide over the patch, reducing the usual drag, which allows the foot’s skin and the sock to glide with the underneath bone through the foot strike, reducing shear distortions in that area.

ENGO offers multiple advantages over other blister prevention and treatment products:

  • Reduction in friction levels
  • Targeted protection at the specific problem area to reduce friction
  • Durable and can last for months
  • Cost-effective based on their small size and durability
  • Well tolerated because it is placed on and in footwear
  • Takes up virtually no space so it doesn’t change the fit of the shoe
ENGO side of the foot patch

ENGO side of the foot patch

ENGO patches can work in footwear to reduce shear, prevent blisters, and provide relief almost anywhere on the foot: the bottom and sides of the heel, ball of the foot, side of the foot, and arch areas. Patches should be applied to dry and clean footwear, which makes them perfect for proactive prevention. Sometimes when shoes are wet, patches are applied to dry socks. The patches have many uses, including on bike seats, paddles, tool handles, and more.

ENGO rectangle patches in a package

ENGO rectangle patches in a package

Types of ENGO Patches

ENGO patches come in small and large ovals, back of the heel patches, and rectangles. A good rule of thumb is to select a patch that is slightly larger than troubled area or blister. Select the patch that is right for you, based on the area where you have a blister:

  • Heel: ENGO Back of Heel Patches
  • Arch: ENGO Large Oval Patches
  • Ball of foot: ENGO Oval or rectangle
  • Side of foot: ENGO Large Oval Patches
  • Toes: ENGO Small Ovals
  • Skates, Helmets, Boots: ENGO Rectangle Blister Patches
  • Multiple Blisters: ENGO Blister Prevention Patch Variety Pack

Using ENGO Patches

  • Remove half of the patch from the backing, using the backing to create a tab. Use tab for handling patch.
  • Apply adhesive side of ENGO patch to desired location of clean, dry footwear.
    Tip: ENGO may last longer when anchored to a surface. For example, wrapping patches around the edge/sides of the insole.
  • Peel remaining backing away from patch.
  • If blisters form at interface of footwear & insole, use two patches. One patch is placed on the footwear. The other patch is placed on the insole. A smooth interface is created.
  • Press firmly around entire patch surface to secure.
  • To protect remaining patched and preserve their quality, store your unused patches in the re-closable, heavy duty ENGO bag that they came in.

Tamarack is always developing new products, for instance, a thin lowfriction tape that could be useful for athletes and special socks with a low friction forefoot. The best way to connect with Tamarack is through the ENGO website, goengo.com.

Note: ENGO patches need to be applied to dry shoes.

The Components of Prevention

November 12, 2017 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, General, Health, Sports 

This is Part IV in a series of posts about blisters, their formation, causes, and prevention. In this post we look at the 13 components of blister prevention – five major and 8 minor components. They all play a role and are important to understand.

Blister prevention takes place through a combination of 13 components. Five are the most major components: fit, socks, ENGO patches, lubricants, and powders. Eight others are minor but still important components: skin toughening agents, taping, insoles and orthotics, skin care and hydration, antiperspirants for the feet, gaiters, lacing, and changes of socks and shoes.

Within our shoes many things are happening, and everything is related in some way. Where something touches another, we have what we’ll call an interface. The basic interfaces are between the skin and sock, the sock and the insole, and the sock and the inside of the shoe. When you put tape on the skin, it adds two more, between the skin and tape, and the tape and the sock. Adding an ENGO patch adds two more. Since the tape and the ENGO patch are stuck to the skin and shoe respectively, the only interfaces we are concerned with are the tape and the sock, and the ENGO patch and the sock. The interface with the lowest COF determines or limits the magnitude of friction. If the tape loosens on the skin, another damaging interface is added.

The Five Major Components

We’ll start with the top circle comprised of fit, socks, ENGO patches, lubricants, and powders—the first line of defense against blisters. It’s important to remember that these five components and the eight from the next circle all work in some way to reduce shear distortion. They may increase skin resilience; reduce bone movement, pressure, friction, and moisture; absorb shear; or reduce the number of repetitions. Remember that the more you use shear-reducing or shear-absorbing materials in your shoes, the more you are taking that stressor off the skin.

  1. FIT comes first. You need to start with properly fitting shoes with a quality insole. No matter how well you tape, how good your socks are, or how good any other component is, if the shoes fit incorrectly, you will have problems. If your footwear is too loose, your feet will slide around, creating shear. If your footwear is too tight in certain areas, your feet will experience excessive pressure. Wearing too-loose or too-tight footwear will change the biomechanics of your foot strike, which in turn will affect your gait and throw off your whole stride and balance.
  2. SOCKS come in either single- or double-layer construction. Some singlelayer socks, particularly those without wicking properties, allow friction to develop between the feet and the socks, which in turn can create blisters. Double-layer socks allow the sock layers to move against each other, which reduces friction between the feet and the socks. Socks can also wick moisture away from the skin. Injinji toe socks give each toe its own sock.
  3. ENGO BLISTER PREVENTION PATCHES are effective at reducing shear distortion by reducing friction at the skin and sock–shoe interface. The patches are an alternative to taping.
  4. LUBRICANTS create a shield to reduce friction and protect skin that is in contact with socks during motion. This lubricant shield also reduces chafing.
  5. POWDERS reduce friction by reducing moisture on the skin, which in turn reduces friction between the feet and the socks.

 

Prevention Components

The 13 components of defense against blisters

LEGEND

Outer Circle: Fit, Socks, ENGO patches, Lubricants, and Powders.

Inner circle: G=Gaiters T=Taping N=Nutrition and Hydration C=Shoe and Sock Changes I=Insoles and Orthotics L=Lacing A=Antiperspirants S=Skin Tougheners and Adherents

The Eight Minor Components

Now, imagine another circle made up of eight components that play a strong supporting role in prevention—the second level of defense against blisters. This innermost circle is made up of skin toughening agents, taping, insoles and orthotics, skin care and proper hydration, antiperspirants for the feet, gaiters, lacing, and frequent sock and shoe changes. Each can contribute to the prevention of blisters and other problems. You could argue that these outer components should be identified as major components, and to some extent you may be right—some components may be more important for your feet than for mine. The trick is to determine what we each need to keep our feet healthy under the stresses of our particular sport. Let’s look at each component.

  1. SKIN TOUGHENING AGENTS form a coating to protect and toughen the skin. These products also help tape and blister patches adhere better to the skin and lead to a reduction in perspiration.
  2. TAPING provides a barrier between the skin and socks so friction is reduced. Proper taping adds an extra layer of skin (the tape) to the foot to prevent hot spots and blisters. Taping can also be a treatment if hot spots and blisters develop. ENGO patches can be an alternative to taping or compliment taping. Toe caps are silicone gel devices that go over the toes and absorb shear.
  3. INSOLES AND ORTHOTICS help maintain the foot in a functionally neutral position so arch and pressure problems are relieved. Some also have absorption qualities. Small pads for the feet may also help correct foot imbalances and pressure points. They can be bought over the counter or be custom made for your feet.
  4. SKIN CARE for the feet includes creams and lotions to smooth and soften dry and callused feet. This also includes good toenail care. Proper hydration can help reduce swelling of the feet so the occurrence of hot spots and blisters is reduced. These all contribute to skin resiliency.
  5. ANTIPERSPIRANTS for the feet help those with excessively sweaty feet by reducing the moisture that makes the feet more prone to blisters. It’s another help in skin resiliency.
  6. GAITERS provide protection against sand, dirt, rocks, and grit. These irritants cause friction, hot spots, and blisters as shoes and socks become dirty.
  7. SHOE LACES and boot laces often cause friction or pressure problems. Adjusting laces can relieve this friction and pressure and make footwear more comfortable.
  8. FREQUENT CHANGES OF SOCKS AND SHOES help keep the feet in good condition. Wet or moist socks can cause problems. Changing the socks also gives an opportunity to reapply either powder or lubricant and deal with any hot spots before they become blisters. Sometimes shoes are also changed as they become overly dirty or wet.

The next post will look at how we found the right combination of blister prevention components that will work for us.

Understanding Shear

This is part II of a series on blister formation and prevention. If you’ve missed the first post, I encourage yo to go back and read it to get a foundation on blisters. Here the link: Blister Formation.

In this part II, we’ll look at shear. For years we didn’t understand the concept of shear and its effect on blister formation. So let’s start with a story.

In Fixing Your Feet I tell the story of a runner at Badwater whose feet I patched. In short, he had run 90 miles of the 135-mile race, on pavement, in extreme heat. He had Elastikon tape on both balls of the feet. His feet were hurting to the point of quitting. I replaced the Elastikon tape with smoother kinesiology tape, which allowed movement between the tape and his sock, greatly reducing the shear movement between the layers of skin and the bones of his feet. I also added a large ENGO Blister Prevention Patch on each insole under the ball of each foot. By reducing the shear level, the runner was able to finish the race with less pain. Try to picture the following: as your foot moves through its foot strike, the bones of the foot move against the layers of underlying skin—then you apply a tape that is not smooth to the skin, pull on a sock, and finally put your foot inside a shoe. The tape sticks to the skin. As you run, the foot naturally moves a bit inside your shoes.

However, the sock cannot move freely against the coarseness of the tape. The sock and tape move as one, which stresses the outer layer of skin against the inner layers. The only movement is the shearing effect between the layers of skin.

That experience was the first time I made the connection to shear, although I didn’t know it by that name. All I knew is the stickiness at the sock–shoe interface, the tape–sock interface, and the tape–skin interface—and one, or all three, had created this major problem for the runner. I never forgot the story. His skin was stuck to the Elastikon tape, the coarse tape didn’t move against his sock, and the sock didn’t move against the shoe’s insole. With the smoother kinesiology tape and the new slipperiness between the tape and the sock, the coefficient of friction was reduced and in turn shear was reduced.

Shear is a new concept for most athletes, especially as it relates to blisters. Shear is defined as a strain in the structure of a substance when its layers are laterally shifted in relation to each other. Applying the definition to the above example, shear happened between the layers of skin as the bones of the foot moved through the foot strike. The internal layers of skin were connected. But those connections can break under the stress of shear and the cavity fills with fluid—and you have a blister.

To understand shear, try this. Place the tip of your index finger against the skin on the back of your hand. Keep it stuck to the same bit of skin while you move it back and forth while. See how your skin stretches? The skin on your hand has moved against the underlying bones. That is shear that causes blisters.

Note that nothing has rubbed against the skin. Your finger did not rub the skin. J. Martin Carlson, the founder of Tamarack Habilitation Technologies, has championed shear as the cause of blisters. Tamarack has a long history of providing innovative orthotic-prosthetic componentry and materials. Their focus on friction management, especially for amputees, has won them many awards and much recognition. This knowledge in turn led to the creation of a new product that can be applied to footwear to reduce high friction levels and, in turn, the shear that leads to blister formation: ENGO Blister Prevention Patches.

Shear in Action

After watching a video on Tamarack’s website, I understood more about shear in action. The video showed a cutaway on the heel area of a shoe, showing the sock and foot inside moving through a foot strike motion. In one video, the cutaway showed a sock and foot on an insole where there were high levels of friction. The sock and foot were distorted as they were held against the insole. It was as if they were stuck together. In another video, the sock and foot were on an insole with an ENGO patch underneath. No distortion occurred as the sock and foot moved easily through the foot strike, over the slippery surface of the ENGO patch.

It’s important to grasp how shear happens. As described above, shear results in distortion occurring between the skin and soft tissues underneath. This shear distortion is what causes blisters. The bones in our feet move back and forth as they move through each foot strike. When the skin at the bottom of the foot is stuck by high friction (stickiness) to the sock and shoe, the middle tissues are distorted. When this is repeated over and over, traumatic levels are reached and a blister forms. This distortion can happen anywhere on the foot: in an up-and down motion in the heel, the sides of the foot, and between toes; in a side-to-side motion at the ball of the foot, under the heels, and at the bottom of the toes; and in rotation as the foot moves through its foot strike. As we walk, run, and pivot in our shoes, the surface of our skin incurs a shearing force.

Certain amounts of shear are normal, and our feet can deal with a lot. However, with repeated traumatic levels of shear, blisters will develop. How much is too much? It varies from person to person, and some people are simply more blister-prone than others.

Part III will look at the five factors of blister formation.

Doc on the Run

September 19, 2017 by · Leave a Comment
Filed under: Foot Care, Foot Care Products, Footcare, Health, Sports 

I recently attended a conference where I had the opportunity to meet Dr. Christopher Segler. He’s an award winning foot and ankle surgeon and podiatrist who is a runner and 15-time Ironman finisher. His practice is in San Francisco and the Silicon Valley in California. His focus in on helping runners, triathletes, and athletes to stay active and keep running.

Christopher is unique in that he is literally the Doc on the Run – i.e., he makes house calls. His website is a wealth of information on everything foot related, his Runner’s D.I.Y. advice, products, videos, courses, and ways to connect with him. Even if you don’t live in the area, you can get a consultation over the phone or through Skype.

Doc on the Run

Take a look at his Doc on the Run website and read some of the articles. His Runner’s D.I.Y. page has information on arch pain, ball of the foot pain, ankle sprains, and five other areas. The Advanced Treatments page has information on Platelet Rich Plasma injections, stem cell therapy, neuroma treatment toenail fungus treatment and more. Many pages have videos.

There’s also a Doc on the Run podcast with 58 episodes. Many are under 30 minutes in length. Show topics include sprained ankles, neuromas, tendon injuries, shin splints, toe and toenail injuries, plantar fasciitis, and more. You can subscribe to his podcast in iTunes or on his website to receive notice of new episodes. If you haven’t discovered podcasts yet, Christopher’s show is an excellent place to start.

Finally, he has a book Runner’s Heel Pain: Self-Diagnosis and Self-Treatment available as an ebook.

I encourage you to check out the Doc on the Run website and podcast. Every athlete at some point suffers from injuries. Dr. Christopher Segler will help you get healed and keep on running.

He also has a Facebook page and videos on YouTube.

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