Many of you use kinesiology tape in either patching feet or for pain relief after injury. This week TheraTape.com is having a kinesiology tape Black Friday & Cyber Monday sale – all week. The sale goes through Sunday November 30.
Kinesiology tape is my tape of choice for all types of foot taping. whether preventative or as treatment. TheraTape is offering deals on rolls of RockTape and GO kinesiology tape, and several manufactures precut strips. For example, buy two rolls of RockTape and get three more free. Here’s the link to the TheraTape sale.
Be sure to check out their blog for articles about using kinesiology tape, how to apply it without touching the tape’s adhesive, using it to prevent injuries, and the what, when, why and how of using kinesiology tape.
Joanne and her staff at TheraTape are helpful if you have questions – order online or give them a call.
Filed under: blister care, Books, Foot Care, Foot Care Products
Rebecca Rushton is a podiatrist from down-under in Australia. She has championed the important of blister prevention and I have shared about her in past blog posts. Her website, BlisterPrevention.com.au is a wealth of information on the subject.
In an effort to resolver her own blister problems, Rebecca has investigated podiatry and sport publications, diabetic foot disease and prosthetic limb skin management, the field of tribology (the study of friction and wear), and military research. These have led her to write a number of publications about blister management, and continually address it in her blog.
Her latest work is a book and ebook, The Blister Prone Athlete’s Guide to Preventing Foot Blisters: Insider Tips to Take You From Blister Victim to Champion. These are available through Amazon – and for a limited time, the ebook version is available for FREE through Amazon’s Kindle. Here’s the link for the free ebook. Get it soon because after five days, it reverts back to normal prices. You can also get a print copy of the book to have in your foot care kit and share with your crews.
The 75-page book discusses blister formation and then tackles the causes and prevention of blisters on the most common areas of the foot: heels, the arch, the ball of the foot, and toes. The content is easy to understand and follow.
Rebecca is a friend and I highly recommend her book. I’d also suggest visiting her BlisterPrevention.com.au website and subscribing to her email updates.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Health
After years without an expedition length adventure race in northern California, the Primal Quest Adventure Race returned this past August. Even though there were openings for 20 four-person teams, only 11 teams toed the starting line in South Lake Tahoe.
For those unfamiliar with adventure racing, races generally consist of a mix of disciplines: trekking, mountain biking, orienteering, white waters, rafting, kayaking, and ascending and rappelling. Some events have caving and other exotic disciplines.
This year’s race stated with a downhill run to kayaks on the shore of Lake Tahoe, after which they paddled north, and then took off on mountain bikes for a long ride. Unfortunately, much of the 80+ miles turned into a hike-a-bike. Then at Kirkwood, they took off on foot for a long trek / orienteering section. For some teams, this section took hours longer then expected.
I was at TA3 (transition area) and we expected the first team early Friday morning, but in fact they arrived almost 24 hours behind schedule. The rest of the teams were spacer further and further apart as time progressed.
My point is that many of the racers had been on their feet for more than two and three days by the time they reached us. Then teams went back on their bikes, into kayaks, and into another long trek. Some teams were short-coursed – taken ahead on the course
Fast forward to TA6, a day and a half later and teams are still racing. Some of the racer who have done the full course to this point have had little time to rest and their feet are extremely sore to the point of being very painful. They may also have some degree of maceration going on too.
One such racer, Thomas, asked me to look at his feet. There were no blisters on the balls of his feet, just very soft and tender skin – very sore with some maceration. I told him I could help.
I cleaned his feet and allowed them to air dry. I applied Tincture of Benzoin Compound to the skin from mid-foot upwards to the base of the toes. Over this I place a piece of soft, 1/8 inch thick Hapla Fleecy Web (adhesive felt), cut to follow the shape of foot at the base of the toes, square at the bottom, and curving up a bit on each side of the foot. At the base of the felt, mid-foot, I placed a strip of Leukotape to help hold down the bottom edge of the felt. Benzoin was used under the tape and edges were rounded. The last touch was two figure 8’s, cut from HypaFix cotton tape, placed between the 1st and 2nd toes and the 3rd and 4th toes, with the bottom of the 8 under the foot and the top of the 8 on top of the foot. This anchors the forward edge of the felt against the skin and keeps it from rolling, especially on downhills. Each figure 8 is about three to four inches in length and the tape is two inches in width.
I received a report later in the race that the patch job had held. After the race ended, Thomas let me know the patch had helped his race.
The adhesive felt helps pad the forefoot and provide cushioning to the sensitive tissues, and can help relieve pain and discomfort from maceration. This is not moleskin, or a version of moleskin. It’s a thicker product and much softer. The felt can be found in 1/8 and 1/4 inch thicknesses. In the Amazon we used fleecy web that is 1/8 inches thick. In the Amazon Jungle Marathon I used the patch job many times on macerated feet – after drying the skin as much as possible.
Medco Athletics sells adhesive felt in a variety if thickness and lengths. You can search on “adhesive felt” or for a specific product I have used, “Fleecy Web.” To give you an estimate on pricing, four Hapla Fleecy Web 9” x 16”, x 1/8 thick sheets sells at Medco for about $26.00. The Hapla Feecy Web is 100% cotton and is latex free.
It also works well for padding around blisters, bunions, heel bumps, and more. Because it is thicker than tape, I would use Benzoin to help it stick better and consider adding extra tape as I described above.
My October issue of Backpacker magazine featured an article about Bil Vandergraff, a Search and Rescue (SAR) Ranger. He served as a ranger for 25 years in the Grand Canyon backcountry. In the article he shared tips on surviving in the backcountry – especially in the harsh and unforgiving Grand Canyon with its heat and extreme elevation changes.
His tips on dealing with the heat are right on: wear the right clothes, embrace the sweat, go slow, stick to mornings and evenings, and know when to stop.
He stresses the importance of helping yourself and to study up – studying the route and conditions.
The one line that struck me was this:
“I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Wow. I like that.
That same philosophy could be applied to runners, adventure racers, hikers – in short, anyone venturing into the outdoors on their own. Badly blistered feet can stop you in your tracks, can make it hard to climb out of the Grand Canyon, or off a mountain or out of any trail.
Can we apply that to races too? That’s a hard question. A huge question!
If a race has crew access, should the crews be responsible for foot care? Some races don’t provide specific foot care. Others have it in limited form based on whatever foot care knowledge any aid station volunteers or medical personnel may have and based on whatever supplies they have.
I know that at some ultras and adventure races 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 a lot of supplies.
What compounds this question is that many athletes fail to do what SAR ranger Vandergraff stressed, helping yourself and study up. Anyone who has worked an aid station knows full well that many of the participants fail to take care of their feet to start with, fail to trim toenails, fail to reduce calluses, fail to wear the right socks, fail to wear gaiters, fail to replace worn shoes, insoles and socks, fail to learn how to do self-care, fail to educate their crew on good foot care techniques, and fail to have adequate foot care supplies. So then, when they run into problems, they want help. Their failure to plan, and in many cases, take common sense action that could have prevented or reduced the problem, then creates work and expense by others.
I remember an old quote by Benjamin Franklin, “If you fail to plan, you are planning to fail.”
Many events would see their finishing rate drop dramatically if they eliminated foot care. There is a definite need for medical care to ensure that participants don’t get into trouble that could cause them serious injury or bodily system failure – but is foot care one of those?
I’ll repeat Vandergraff’s statement. “I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Again, can we apply that to races too? That’s a hard question. A huge question!
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Sports, toenails
8 Top Tips for Foot Care
If you are a subscriber to Backpacker magazine, check out the October issue, page 34 for a full page of eight top tips to care for your feet. I have included an image of the page in this post. If you click on the image, you’ll get a larger view.
I was contacted by Backpacker several months ago and did a phone interview. Here are the eight tips:
- Trim nails
- Get in shape
- Fix calluses
- Prep your shoes
- Pack camp sandals
- Two ways to treat blood under a nail
- Wash your socks
- Lance right
The tips are good whether you are a backpacker, runner, walker, adventure racer, or just plain person who loves the outdoors.
I like Backpacker magazine. It’s one of my favorites. I encourage you to pick up a copy and check it out.
The 2015 Primal Quest Expedition Adventure Race concluded a few days ago, after nine days of challenges to the 11 four person teams. This was an unsupported race, meaning there was no crew support. Race organizers, medical staff, and general volunteers all worked together to provide levels of support that were awe-inspiring. People worked together to help the racers get through over 400 miles of a variety of disciplines: trekking, orienteering, white water kayaking and rafting, mountain biking (sometimes referred to as hike-a-bike), ascending and rappelling, sleep deprivation, extreme heat and more. Through all this I am fairly certain that everyone had fun.
At the eight TAs (transitions areas), where racers changed from one discipline to another, were a number of volunteers. Medical staff included doctors, podiatrists, nurses, paramedics, physical therapists, athletic trainers, and more. Our job was to care for whatever medical needs the racers had, including anything and everything. Even though the teams carried mandatory medical gear, most relied on the medical staff for their advanced foot care skills and materials. Khristy Gavigan, an RN and the medical volunteer coordinator, had done an amazing job of assembling extensive medical kits for each TA.
I worked two TAs – TA3 and TA6. At each TA, we set up and area where the teams checked in, arranged their gear so they could get to their gear and bike boxes, and decided on an area for medical and foot care. Generally we went through all the medical bags to see what supplies we had.
Because the four person teams were seen at each TA, there was a lot of foot care required. Many times we worked on all four team members in assembly line fashion. There was a mix of problems, but it seemed we saw more toe blisters and toenail care required than usual. Many toes had the skin torn off the top of blisters. While there was a lot of heel blisters, there didn’t seem to be many ball-of-the-foot blisters. Treatment was with kinesiology RockTape and in some instances, Leukotape.
Teams might receive some foot care at one TA, and the next, and the next, and so on. That’s the nature of an adventure race with multiple disciplines.
Some of the teams were short coursed – meaning they bypassed one or more discipline due to overall time cutoffs. This reduced the number of racers with maceration from one of the kayak sections, and reduced more foot issues from the following 50-mile trek. All in all, I think feet were pretty much what I expected. The majority of teams were prepared with supplies to repair their feet, which is always nice to see.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports, toenails
The seven tips below are written for the Primal Quest Expedition Adventure Race starting next week. They are also applicable to any race you may have coming up.
Primal Quest is less than two weeks away and here are seven things you can do to improve your chances of finishing with healthy feet.
1. Wear the best fitting shoes you can. Have a bit of space in front of your longest toe and enough height in the shoe’s toe box to avoid squishing the toes from the top.
2. Bad toenail care can result in toe blisters and black toenails, where fluid or blood is under the nail. Trim your toenails short and then use a nail file to smooth the tip of the nail. File the nails from the top over the edge down toward the tip of the toe. The goal of the trimming and filing is to remove any rough or sharp edges. File the nails so when you run your fingertip up and over the tip of the toe no rough edges are felt. It’s even better to file the nail so that no tip of the nail is felt. If you have thick nails, file the top of the nail down to reduce its thickness.
3. Any time you can, remove your shoes and socks to dry and air your feet. Your feet will be wet from water disciplines, stream crossings, cooling yourself off by pouring water over yourself, and simply sweaty feet. When stopping to eat or rest, remove your shoes and socks. Lay your socks in the sun to dry and switch to a clean dry pair if possible. Issues caused by wet feet will multiply over time and can end your race or at the least, result in extremely painful feet.
4. Do everything in your power to prevent and reduce maceration. This means not letting water poured over your head get into your shoes by bending over before dousing yourself. If means following the tips outlined in # 2 above. Use a moisture-controlling agent to help prevent the skin on the bottoms of your feet from macerating. Several include Desitin Maximum Strength Original Paste (available at drug stores, Walmart, etc), zinc oxide, Chafe X, SportsSlick, Trail Toes, and RunGoo. Apply liberally and before all water segments to help prevent damage to your skin. Once serious maceration happens, only drying your feet and letting them air, with the help of powder and warmth, will reverse the condition. If left unchecked, the skin can fold over on itself, split open, and tear layers of skin off the bottom of your feet.
5. Use gaiters to prevent pebbles and rocks, trail dust, and other debris from getting inside your shoes and socks. These become irritants and can lead to hot spots and blisters.
6. Take care of small issues before they become larger problems. Lance and drain small blisters whenever you feel them to keep them from becoming larger. Put a dab of ointment over the blister and then apply a strip of tape over the top to protect the skin.
7. Finally, make sure you have the supplies to treat your feet out on the course. Waiting to get to a TA to repair a blister can make a small problem much larger.
A month ago I provided foot care at the Western States 100. Then two weeks ago I worked the Tahoe Rim Trail 55KM, 50M, and 100M. And finally this week I worked Badwater in Death Valley. As much as I hate to say it, I saw a negative common denominator as I worked on or saw runner’s feet.
The common negative was runners’ toenails.
I wish I didn’t have to say the toenails were bad, but a lot of them were. While not every runner suffers with their bad toenails, many do. Enough to warrant this blog post.
The picture here is an example of nails that could be better – much better. I won’t identify the runner or the race because I saw these same toes at each of the three events.
Toenails that are thick can be smoothed with a nail file. In severe cases, a Dremel tool can be used to reduce the nails quicker, especially when the nails are really thick and tough.
Your nails don’t have to be thick. They don’t have to be rough. They don’t have to have an upward curl or edge. They don’t have to be wavy. They don’t have to stick over the end of your toes. In short, candidly, they don’t have to look like your toes are 90 years old and you live in a nursing home. If you think you might have toenail fungus, check with your doctor – and take care of it.
An inexpensive toenail clippers will set you back about $5. If you have tough nails, you may want to buy a stronger set of clippers that look something like wire cutters. Then get a file for another $1 or $2.
Toenails that are too long, too thick, have rough edges or corners, will catch on your socks, which will push the nail back into the nail bed and cause trauma, fluid or blood under the nail, or toe blisters. During a race, these nails become painful to touch – meaning you can’t trim or file them without pain.
So we see you at an aid station, and you are hoping we can fix your feet. If there is fluid or blood under the nail, we can drain them. We can run a strip of tape over the tip of the nail to provide a bit of protection to the nail. But we cannot fix the discomfort and pain.
I can patch most anything on your feet, but I cannot fix a thick toenail that sticks up way above normal. I cannot smooth the rough edges if you cannot tolerate the filing. I cannot trim the nails if you cannot tolerate the pressure.
Caring for one’s toenails isn’t that hard. Once a week, use a clippers and nail file to trim them. Clip them fairly short and then run the file over and down the tip of the nail, removing any rough edges. The goal is to have nails that you can’t feel when you run your finger over the front edge of your toes.
If you have lost a toenail, as the new one comes in, file the top of the nail thin. Wrap a Band-Aid around the toe to help train the nail to curve naturally to the shape of your toe.
Toenails are not complicated. But just as you care for other parts of your body, you need to care them them too.
This weekend is the running of the Tahoe Rim Trail (TRT) series of trail runs – a 55K, 50-miler, and a 100-miler. After a lot of planning, the dream of doing a foot care study has materialized.
The TRT is perfect for a study. There are two main medical aid stations, Tunnel Creek and Diamond Peak. 55K runners are seen at Tunnel Creek twice. The 50-mile runners are seen at Tunnel Creek three times and Diamond Peak once. The 100-mile runners are seen six times at Tunnel Creek and twice at Diamond Peak. The multiple contacts offer increased opportunities to talk to the runners, work on their feet, and record what we see and do.
In addition to the personal contact, runners are being asked to participate in two online surveys. A pre-race survey asks about their running and injury history, choices in socks and footwear, and how they typically manage their feet. A post-race survey asks how the race went in regard to their feet.
After the event, the data will be compiled, studied, and a report or paper will be written. The aim is a formal paper that can be submitted to medical journals and later distributed to the running public.
The purpose of the TRT Foot Care Study is to learn:
- Correlations of finishing rate against the number of miles run in training
- Correlations of foot injuries / problems against miles run in training
- Percentage of runners who are pro-active with foot care before the race
- Effectiveness of footwear modifications
- Effectiveness of lubricants / powers
- Effectiveness of blister dressings / taping
- Correlations of percentage of runners wearing gaiters against finishing rate and foot care injuries / problems
If you are one of the hundreds of runners doing the TRT this year, we hope you will participate in the study and surveys. Thank you.
The study will be supported by a number of professionals: Tonya Olsen (physical therapist), Kristy Gavigan (RN), George Miller (paramedic), Zak Weis (Podiatrist), Tracie Giambrone (Podiatrist), Doug Doxey (Podiatrist), and Andy Bussell (Chiropractor).
George Ruiz, the race director, and Dr. Andy Pasternak, the medical director, have been extremely helpful in making the study happen.
If you are at the TRT this weekend, we’d love to chat.
As we are able, some of the learnings from the study will be shared on this blog.
Last Saturday was the Western States 100 Mile Endurance Run over the California Sierras. As you probably know, California is in year four of a severe drought. Most of us expected the trails to be dusty and dry. From everything I heard, they were.
So in a dry Western States year, why did so many runners have macerated feet from being wet?
There are several reasons. First, runners often cool themselves off by pouring or squirting water over their heads and on their body. We all know water runs downhill – right? So the water naturally runs down the legs and into the shoes. Socks become wet and as I often say – the skin of one’s feet prune up. In other words, they look like a wrinkled prune. Better to bend at the waist and let the water run off the head and shoulders rather than down the body.
Secondly, runners sometimes cool off by getting into the water at any stream. Several runners talked of sitting in the streams. While this can cool the runner, it is the worst thing a runner can do to their feet.
When they remain wet long enough, the skin becomes soft, often creating creases. Many times these creases are deep and in severe cases, the skin can split open.
Most often the runners complain of badly blistered feet. In fact, there are no blisters, just macerated skin on the bottom of their feet. This condition can be very painful. Walking and running hurts one’s feet.
There is no fast cure. They say time heals all wounds and with maceration, it takes time for the skin to dry and return to its normal state. Putting powder on the skin can help, as can clean fresh socks, gentle massage, and letting the skin air-dry.
I saw a lot of macerated feet at Michigan Bluff, mile 55.7. More than I expected. And of course there were lots of runners wanting treatment for bad blisters at the finish, and it was maceration.
The picture here is of a runner who completed the race, I think sometime around 28-29 hours. I don’t know his story but at some point before the race or in the race, he had his right foot wrapped in what appeared to be a self-adherent wrap, with a thick pad of some kind at the heel. Then that was wrapped with layers of what seemed to be silk type medical tape. Tonya and I had to use trauma shears to cut the thick wrap off his foot. Once it came off we saw the extent of the damage to his foot.
If anyone knows the runner or recognizes him, I’d love to find out more. It’s possible that because of maceration the skin at the heel had sheared off and someone at a medical aid station, or crew, had cut the skin and put on the wrap.
What we did at the finish was to apply a coating of antibiotic ointment to the open and raw skin, cover it with a wound care dressing, and wrap with a self-adhering wrap. We gave him instruction on how to care for this in the days after the race.
Look closely at the picture. He’s happy. He has his finisher’s medallion and knows he’s getting his buckle.