Still Learning Foot Care

April 20, 2018 by · Leave a Comment
Filed under: Foot Care, Footcare, General, Sports 

I have been doing foot care for more then 20 years–and some things don’t change. What disturbs me is that there are still large numbers of athletes who seem to give little thought to their feet. Oftentimes these are newer runners, newer adventure racers, and new hikers. They come into the sport without a base of knowledge and awareness of the best ways to manage their feet. They make mistakes. Many times they don’t have buddies who help them learn about foot care. Maybe you can be someone who helps another learn. I encourage you to  try it.

So here are my thoughts on things they need to understand. The athletes with the most foot problems share the following characteristics:

  • They shove feet into shoes without straightening their socks.
  • They wear the wrong socks and do not look inside their socks for seams that cause toe blisters.
  • They have sacrificed fit and buy a shoe because a friend recommended it and not because it was the best shoe for their feet.
  • They try to fix blisters with Band-Aids.
  • They fail to change their socks often enough when their feet are wet.
  • They fail to trim their toenails and wonder why they get black toenails and toe blisters.
  • They fail to put in the miles that their feet need to be toughened for the rigors of racing.
  • They speed through checkpoints feeding their faces but not tending to their feet.

As Billy Trolan, MD, said in the foreword for the first edition of Fixing Your Feet, “The one factor that continues to amaze me is that individuals and teams will spend vast amounts of money, time, and thought on training, equipment, and travel, but little or no preparation on their feet. Too often the result has been that within a few hours to a few days, all that work has been ruined. Ruined because the primary mode of transportation has broken down with blisters.” That was written in 1997 and is still true today.

Your First Ultra and Foot Care        

April 7, 2018 by · Leave a Comment
Filed under: blister care, Foot Care 

It’s been many years since I ran my first ultra. It was probably about 1984 and it was the Skyline 50KM in the East Bay from San Francisco. I think I had a few smallish blisters. In later years as I ran longer ultras, I recall having more blisters. The one thing I know is that I had no idea what to do to manage prevent and blisters. I was a newbie and there was little or no information available about foot care.

So looking back to that first ultra and what I’ve learned since, what would I say to those doing their first ultra? I’m going to write this as a list. The list in in priority order.

  1. Wear the best fitting shoes possible, which means
    1. Getting fit for shoes at a reputable running shoe store
    2. Making sure there’s wiggle room in the toe box.
    3. Making sure the heel counter grips my heel
  2. Checking my shoe laces to make sure they are not worn through
  3. Wear high quality moisture wicking socks that are not threadbare in any area
  4. If it’s a trail run, getting a pair of gaiters to keep trail dirt and grip out of my shoes
  5. Pick the best lubricant I can find and apply a dab between my toes
  6. Making sure I have trained in similar conditions for the race I’m going to do
  7. Making sure I have trimmed my toenails short and filed them smooth
  8. Making sure I have spent time reducing any calluses on my feet
  9. Get two ENGO Blister Prevention patches to pin to my bib number in case of a hot spot
  10. Pin a six inch strip of kinesiology tape to my bib number, with rounded corners
  11. If I’m prone to blisters on any part of my feet, I’d know how to pre-tape over the area
  12. Know the right way to drain any blisters that might develop
  13. Know the right way to patch any blister
  14. Know to stop and clear any rocks or stones out of my shoes when I first feel them

This list assumes you are running either a 50KM or a fifty miler. If you are doing a 100KM or 100 miler or 24-hour race as your first ultra, I’d challenge you to run something shorter to start. Longer races require many more steps and much more care as more things can go wrong.

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.

Cutting Your Calluses

February 28, 2018 by · Leave a Comment
Filed under: Foot Care, Footcare 

When I saw this video, I knew I had to share it with all of you. You probably know how much I dislike calluses on runner’s feet. You can easily blister under a callus, however draining the fluid can be painful and sometimes is impossible.

Most people have some degree of callus somewhere on their feet. Often it’s on the heels and forefoot. The use of a callus file is the most common way of reducing your calluses. Not this guy though.

The man in the video is shown cutting the hardened calluses off his left foot—with a very sharp knife. His foot is dark with dirty and hard calluses. Watch as he slices through deep layers of callus over and over. The video is 2 1/2 minutes long and you keep watching to see of he’ll cut into raw skin. I’ll let you make that call. And the extra touch is watching what the dog does.

Video of a man cutting his calluses.

Of course, I don’t recommend this method of reducing calluses. If I ever ran into someone with calluses as bad as this man, I’d probably take some pictures and laugh at him.

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.

Another Horrific Blister Story

January 28, 2018 by · 2 Comments
Filed under: blister care, Foot Care, Footcare, General, Health, Sports 

Last July I wrote a blog post about The Year’s Best Blister Horror Story. I told how Marin Cilic was unable to continue in his championship tennis match at Wimbledon against Roger Federer—because of a blister that formed under a callus on the ball of his left foot.

Before you decided to skip reading this post because it’s about a tennis player, please know there is an important lesson here for any athlete. Fast forward to a couple of days ago, to the Australian Open where Roger Federer is playing against Chung Hyeon in a semi-final match. Here’s the headline: Australian Open: Hyeon Chung reveals the extent of blister that forced him out of semi-final with Roger Federer. The same thing happened! A blister. Chung had to withdraw from the tournament because of a blister on his left foot. Depending on the news source, he had one blister on the left foot or blisters on both feet. Above is a link to the story.

Federer won over Marin Cilic in the championship on Sunday. They had said that this would be a repeat of last year’s final day at Wimbledon. But no mention was made about how a blister affected the outcome of that match too.

Photo 1 – What’s on his foot?

I have a few photos of Chung’s foot and blister and will give my interpretation of what I see and then what can be learned from the incident.

In this first photo, I can’t tell what the white stuff is on Chung’s foot. It could be some kind of cream, zinc oxide, or even tape residue from that that was removed. It appears to spread across the whole ball of the foot. I would love to know what this is.

Photo 2 – Some kind of tape patch/covering

In the second photo, some kind of tape patch is being applied to the whole ball of the foot down into the arch area. Would love to know what this stuff is.

Photo 3 - Fully patched foot

Photo 3 – Fully patched foot

The third photo shows Chung’s fully tapes and wrapped foot. It could be Coverall, or HypeFix, or what is Australia is called Fixomull, a thin soft cotton type tape. Unfortunately they did not put one or two figure 8 pieces of tape between the toes from bottom to top to anchor the forward edge of the tape and keep it from rolling. I would have loved to have seen the patch job when they removed his socks.

Photo 4 - Deep blister on left foot

Photo 4 – Deep blister on left foot

The fourth photo shows the blister. It’s hard to tell whether this is a fully deroofed blister going down several layers of skin, or a blister that split open and foot strike pressure opened it even more into a gaping wound. I see tape residue on the skin and the tapes mentioned above do not leave such residue, so something else was used. Maybe white athletic tape or Leukotape P. There appears to be a small blister in the arch of the foot too.

Watching a championship tennis match with the world’s best payers, you can see the way their feet move. There is an extreme amount of side-to-side shear, and front-to-back shear, as well as rotational shear. Compounding the shearing movements is that they are made as the foot is landing on the court surface. It’s instantaneous under a lot of pressure. Unlike runners when a foot is planted and moves through its foot strike, tennis players subject their feet to much more shear and it can change each time the foot lands.

So the question is what can we learn from this?

Go back to my post from last year about Marin Cilic’s feet to see what I would have done for him. Not much would have changed here. I would have filled the open blister with a cut and shaped wound care pad. Even though I have years of experience patching feet, I would have patched Chung’s feet based on what I saw, customized for him. I also read that this problem started to develop a day of two before. It’d be nice to know what they did than as a preventive measure.

So what’s the lesson here?

It goes without saying that we are each responsible for our own feet. When you rely on others for their expertise, or lack thereof, and their supplies, or lack thereof, you sometime win and sometimes lose. A lot of questions should be directed at Chung’s coach and trainers. Did they follow best practices in their treatments? Who worked on Chung’s feet, both in the days leading up to this and at the final event? Did they have the knowledge and skills, and the materials to do the best patch job possible?

It’s just like running into an aid station at a 100-miler, and needing foot care, you get what’s there. It could be pot luck. That said, I know all the people I’ve seen work on feet try their best and I am not suggesting Chung received less than stellar care. But I do know from experience that patching a blister on a runner in a ultramarathon or multi-day race takes a certain amount of knowledge and skill. More than most medical people have. I still vividly remember many years ago at WS100, watching two podiatrists wrap a runner’s foot with half a roll of white athletic tape in a feeble attempt to patch him up. They were doing what they knew from their experience.

Maybe it’s time to raise the bar in regards to what doctors, podiatrists, nurses, and other medical people should know. What’s taught in podiatry school to patch blisters? Is what they learn the best way? My guess is the trainers at the Australia Open were well-trained and good at what they do. Maybe in Chung’s case it was the perfect storm type of situation.

Maybe it’s also time to raise the bar on what athletes should know in regards to foot care and blister prevention and treatment. Many enter a race and expect someone to be there to patch their feet. That’s not fair to race directors and volunteers. Many races are required by law and insurance regulation to have medical people at their event or on stand-by. But that doesn’t mean that know how to patch feet. I have seen excellent patching done by volunteers who have taught themselves.

What do you think?

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.

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