When you enter a road or trail race, or start an adventure race, or plan a group or solo event, whether single day or multi-day, do you think about blister management?
There can be many responses to this question. Here are my guesses at the most common three responses.
For many, I’d guess the answer would be no. What happens, happens. They may have a simple first aid kit or blister kit. A bit of tape, maybe a pin and an alcohol wipe.
Others, if participating in an organized event, will count on aid station personnel to have the supplies and knowledge to fix whatever problems develop. They don’t understand that some aid stations do not have the right supplies or medical people, or if they do, they have little to no understanding of how best to treat blisters.
The third bunch takes a full hands-on approach. They have a fully stocked kit and either they or their crew know how to work on feet.
Then there’s the same question put to race directors and event organizers. When you put together the plans for your race, how much thought and planning goes into foot care for the participants?
Again, I think there are three typical responses.
The first is they don’t think about it. It’s either they simply don’t even think about it or they decide to let the runners deal with whatever problems develop.
The second group puts together simple kits of typical first aid equipment and puts them out on tables at the aid stations. Most likely, no one working the aid station knows what to do, or if they do, it’s hit or miss repair. Supplies often are minimal and sometimes not even helpful. I worked an event, a long multi-day race that fell in this category. Runners were hurting.
The third group is wiser. They have medical people and a well-thought out kit. Some, at larger events, have dedicated foot care people.
I need to say here that you don’t have to be a medical person to provide good foot care. I have worked at many events where non-medical people had excellent foot care skills.
You Can Help
So here are my questions for you.
- As a runner or adventure racer, what do you want to see at a race?
- What do you expect to see?
- If the race website and material does not specific what kind of aid or foot care is provide, do you assume it will be there?
Here’s my reason for asking.
A few days before Western States next month, I will be presenting a session about Blister Management at the 2nd Annual Medicine & Science in Ultra-Endurance Sports Conference in Squaw Valley. Plus two hands-on workshops teaching foot care skills.
I have my presentation pretty well planned. I’ve done this long enough and have learned a lot of material and skills. But sometimes I am puzzled at what I see from the race participants. Ill-prepared runners and crews and even some dumb decisions by runners (socks with holes, brand new shoes, serious athletes foot, bad toenails, and more).
My audience will be medical personnel and race directors from many ultras and adventure type races. The aim of my presentation will be to teach them about blister management during a race.
What I need to know is a bit about your expectations about blister management at races as a runner. Send me an email. You can copy in the three questions above and answer all three or as many as you want.
Thanks for your help.
Most of you know how much I like kinesiology tape for taping feet. Over the years, I have used several brands and refined my taping skills. I can tape any part of the foot, and for any blisters or prevention desired.
As I have talked to others who tape, runners or crews, or medical people, I have heard stories of tape not sticking as well as needed. And I have seen first-hand tape coming off – generally because of a lack of skin preparation and taping skill levels.
So I was pleasantly surprised to see an article over at www.theratape.com about How to Get Kinesiology Tape to Stick – the 6 P’s of kinesiology Taping.
When properly applied, kinesiology tape will stick for days through all kinds of conditions. When improperly applied, it may last for less than a day, or in some cases, only a few hours.
The article at Theratape.com identifies three phases to taping: skin preparation, tape preparation and application, and wearing the tape.
Here is a summary of the three phases.
Phase 1: Skin Preparation
- The skin must be completely dry before applying the tape
- The skin needs to be clean
Phase 2: Tape Preparation and Application
- Use good quality tape
- Round the corners
- Don’t touch the adhesive
- Go easy on the stretch
- All strips must end on skin, not on another piece of tape
- Activate the adhesive
Phase 3: Wearing the Tape
- Avoid contact at the ends
This is a very good article and you’ll learn a lot about taping with kinesiology tape. Click of the link to read How to Get Kinesiology Tape to Stick.
What you didn’t read is a few things we have learned when using the tape on feet. The typical use of kinesiology tape is for injuries to muscle and soft tissue, very different than taping feet. Once you put the tape on feet and go running through streams, dust, mud, swamps, and other adverse conditions, things change. There are more stressors on the tape and many times its applied just moments before resuming your adventure.
Here are my extra tips exclusive to taping feet:
- Use a tape adherent on the skin
- For extra tough cases, run a strip of tape adherent over the edges of the tape/skin
- Apply the tape the day before your run if possible
- Make sure you apply either a thin layer of powder or lubricant over any remaining exposed tape adherent
- Always roll your socks on and off to avoid pulling the tape loose
While you are Threatape.com, check out their line of kinesiology tapes and supplies. Their website offers a lot of information about kinesiology tapes, information about different brands, application instructions, and videos by body part and brand. I have worked with the good folks at Theratape for several years and love their products and service. For medical professionals, they also offer a professional discount.
There is an old Chinese proverb; “Failure results not from the length of the journey or the height of the mountain but the pebble in one’s shoe.”
We have all had it at some point – the pebble that is.
We are running or walking or hiking and feel a small irritant. We think to ourselves that maybe our sock bunched up. But, after a bit, we realize its something else. So we move our foot around a bit or kick it up against a rock or log, or maybe sideways on the ground. The hope is that that kick will move the irritating thing to the side where we won’t feel it.
Sometimes it works for a while. But it always comes back. We are always better off to stop, take off your shoes, and clear whatever the problem is. Even the smallest pebble can cause problems. It can start with a hot spot and develop into a blister. It can cause a hole to develop in the sock. It can tear into the insole’s covering.
So stop and remove it.
I remember a few years back when I was at the Gold Rush Adventure Race and encountered a similar situation. One of the racers came into the transition area and in the process of changing socks, I told her I’d clean out her shoes. The race route had taken runners through muddy areas and some had gone down into her shoes.
As I used my hands to clean inside her shoes, I found very rough hard edges under both heels. I thought it was a defect or tear in the insole. Surprisingly, it was hardened mud that was so hard, it took a lot of pressure to remove it from the insole. This must have hurt through the socks – but the racer had not bothered to clear out her shoes.
In reality, it might be a pebble – or mud. In either case, you are always better off to take a moment and get rid of the irritant.
Of course, I have to recommend gaiters for trail running. They can keep the pebble out in the first place!
One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.
I recently received an email from Rob, asking for some advice. Here’s Rob’s email:
“I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area.
“I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of the donut hole – now a huge blister about the size of a silver dollar and 1/4-inch thick. The camp staff took pictures of the biggest tennis-related blister they had seen.
“I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot.”
This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.
The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.
Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.
This post is from July 2102, but is important for athletes to understand.
If you have followed my blog long enough, you’ll know I have a preference for kinesiology tapes for protective taping before a race and patching blisters during a race.
Over the years I have used many different types of tape – most of which I no longer use. The one tape that has stood the test of time is the kinesiology tape. There are several to choose from including Kinesio Tex, Rock Tape, StrengthTape, and others. Since Kinesio Tex is a trademarked name of a brand of kinesiology tape, we should not use the term Kinesio tape when talking about a different brand than Kinesio Tex. For example, Rock Tape is a kinesiology tape, not Kinesio Rock Tape.
Last year I provided foot care at the Jungle Marathon Amazon and took Leukotape, Rock Tape H20 and StrengthTape. In the end, I stopped using the Leukotape because of the tape residue it left on the skin.
Here’s how I judge tapes:
- I don’t want tape residue on the skin when the tape is removed or comes off
- I don’t want a tape that is coarse
- I don’t want a tape that is thick
- I want a tape with superior adhesive
- I want a tape that will hold in wet conditions
- I want a tape that will conform (at least somewhat) to the shape and curves of the foot and toes
- I want a tape that does not lose it sticking ability or workability in cold or hot conditions
- I want a tape that can be used on all parts of the foot
- I want a tape that is as smooth as possible
The benefits of kinesiology tapes are their stretchiness in length, softness, and smoothness, which allows them to be molded to the shape and curves of the foot and toes. In the image here you can see how the tape has molded to the toes and space between the toes. Imagine trying to patch a blister at the base of the large toe. Most tapes will fail at this because of their inflexibility or thickness, meaning they cannot mold around the toe into the fold at the base of the toe and onto the toe and ball of the foot. Kinesiology tape can do this with no creases or overlaps in the tape.
My favorite kinesiology tapes are Rock Tape H20 and StrengthTape. Both have excellent adhesive stickiness, even in wet conditions. The best application tip for kinesiology tape is to apply it the evening or night before your race. Use a tape adherent and after applying the tape to the skin, rub it for 15-20 seconds to warm the adhesive so it will stick better. Then put on the socks you’ll wear the next day. I have used these tapes in the Amazon Jungle and they stick better than others. Certainly the grit of the sand and dirt in the jungle will compromise the long term stickiness of the tape, but I still think it’s the best tape for wet conditions when a tape adherent is used and the tape is applied correctly and ahead of time.
A helpful website that offers a lot of information about kinesiology tapes and their uses is TheraTape.com. It’s where I get my tapes. In addition to selling most brands of kinesiology tape, the site has information about the kinesiology tapes, brand information, application instructions, and videos. TheraTape provides tapes in single rolls and bulk rolls and in a variety of colors, as well as educational materials if you want to learn more about using the tape. StrengthTape is also sold by ZombieRunner.
Please understand that kinesiology tapes are designed to provide healing benefits to athletes when injured and with inflammatory conditions. The videos do not show patching feet or taping for blisters since that is not what the tape makers promote. Here is a link to learn about kinesiology tape.
TheraTape just released a comparison chart of kinesiology tapes. I have included the chart below, split into two images. Click on each image for a larger view. Here’s the link for the kinesiology tape comparison chart if you want to go directly to the website to see the chart.You can order StrengthTape or Rock Tape H20 or another other kinesiology tape from TheraTape.com or StrengthTape from the ZombieRunner link above.
Connect directly to StrengthTape and Rocktape
- StrengthTape.com has a number of informational videos on their website and is a good way to connect with the company.
- RockTape.com also has a website with lots of good information and videos.
Filed under: blister care, Foot Care, Footwear, Footwear Products
Heel blisters are quite common – although they shouldn’t be.
Today’s post shows one participant’s feet at the 2014 Amazon Jungle Marathon.
If you look closely at this picture, you’ll see two heel blisters, both on the outside of the runner’s feet. The right foot blister is large but is not blood-filled. The blister on the left heel, however, is very large and filled with a large amount of blood.
It’s easy to think these are normal blisters – but their size makes they abnormal.
In my experience, heel blisters are caused by the constant shear when either 1) the heel is moving up and down inside the shoes’ heel, or 2) by the constant movement at the place where the shoe’s insole touches the inside of the shoe. Over the years, the majority of heel blisters have been the latter. One of the characteristics of this “insole/shoe junction” blister is that they often are flat across the bottom. The blister starts at the point where the insole’s edge at the side of the heel touches the inside of the shoe. That’s what makes the flat line at the bottom. Then the blister forms upward as the fluid forms and it grows. Given enough time and movement, you’ll get blood inside.
These are relatively simple to patch. The skin must be cleaned with alcohol wipes, and then the blister can be lanced and drained. Depending on the size of the blister, you’ll need to apply some type of blister patch. The bottom line is that you need to have something over the blister to protect the skin and prevent the top layer of skin from tearing off. For these, I would use strips of kinesiology tape (my preference is either StrengthTape or RockTape H2O) with antibiotic ointment over the blister to keep the tape from sticking to the skin. The larger the blister, the harder these are to patch but it can be done.
You are better off to prevent these blisters in the first place.
Start with the fit. Make sure your shoes hold your heels in place with just a little movement.
Check your shoes and insoles for rough and/or thick edges at the inside and outside of each heel. Side blisters are much more common than the back of the heel. If the insole has a large thick edge, replace them. If the shoe’s fabric is worn into a hole, you are due for new shoes. Under the fabric is generally a plastic edge of the shoe’s heel counter – the plastic that curves around the heel from side to side.
Engo Blister Prevention Patches are perfect for to help prevent these types of blisters. These patches are super slick. Either the small or large oval can be applied to the inside of the shoe and cover the offending edge of the insole/shoe junction. Clean the inside of the shoe and insole first. I work the patch with my fingers to form a curve to fit with area I need to cover. Then remove the backing and apply the center of the patch first and then push the top and bottom of the patch into place. Rub it a bit to assure adherence.
Tonight I finished watching three episodes of the 2014 Spartan Races – two regional races and then the final World Championship. Regional races are about eight miles with 20+ obstacles while the World Championship is about 15 miles with 25+ obstacles.
I know. Some of you are saying. They aren’t the same as a 50-mile or 100-mile race. Ultrarunners are tough and our events are hard. Spartan Races are much shorter.
You are right of course. But. And it’s a huge “but”, Spartan Races have obstacles that I’d bet most ultrarunners could not complete. Carrying a 60-pound sandbag up and down a long grassy hill, the barbed wire roll, rope climbs, the log carry, carrying a five gallon bucket filled with rocks up and down a hill, tire pull, water obstacles, and more. In the World Championships, the sandbag carry was not one but two 60-pound bags carried up and back down a quarter mile black diamond equivalent grassy hill!
At the end of the Spartan Race World Championships, one of the top runners said, “In a triathlon, you sometimes say, ‘Ah shoot, I’ve got a pebble in my shoe – it threw my race off. This is so much beyond pebbles!’” What he’s saying is that what you think is bad in a one race is nothing in another race. Pebbles are the least of your worries in a Spartan Race.
You have to be in the best physical shape of your life for these events. So do your feet. Between the grassy hills, slick with water and mud, the muddy trails and roads, the uphills and downhills over rocky trails and roads, jumping onto and over walls, down cargo nets, and other challenges, your ankles and feet take a beating. You get junk in your shoes, and while no one in the shows complained of blisters, I am certain many of the racers had them. Just watching the shows I could see there would be sprained ankles along with other injuries.
If you can’t complete an obstacle, you have to do 30 burpees. And that’s after you failed at the obstacle. Your heart is racing and breathing is labored, and you are exhausted.
The Spartan Race website has the full series of races for 2015. Check out the website and see if this type of race interests you.
In April 2014, I wrote a review of the Reebok All-Terrain shoe designed for obstacle races like Spartan Races. Check it out here: Reebok All Terrain Shoe.
In addition, Joe Desena, the founder of Spartan Races, has a book Spartan Up! about overcoming obstacles in life, and is starting a podcast also called Spartan Up! You can subscribe at iTunes or Stitcher.
If the challenge of doing a Spartan Race interests you, here’s a code that will save you 10% on any race: SPARTANBLOGGER
Filed under: blister care, Foot Care, Foot Care Products, Sports
I have often mentioned the website BlisterPrevention.com.au as a great source of information on blister care. Rebecca Rushton, manages the website and is on top of developments in the prevention and care of blisters. She’s a podiatrist in Australia – and a friend.
Through research and looking at the mechanism of how blisters form, Rebecca has changed some old theories of what causes blisters. Heat, moisture, and friction were always considered the three contributors of blisters. Further consideration has found that shear is a major factor. Shear and friction combine to cause blister formation.
I want to quote a blog post by Rebecca about Healing Foot Blisters Faster to help you understand more about friction and shear.
“You know friction is responsible for friction blisters. But I bet you think friction is rubbing. It isn’t. Friction is about grip. High friction means two surfaces grip together. Low friction means they don’t … they’re slippery.
“Here’s how friction is responsible for foot blisters … There is high friction in your shoe. There just is. This means your skin grips your sock; and your sock grips your shoe. All three surfaces grip together so your foot doesn’t slide around in your shoe.
But with every step you take, your bones are moving around under the skin. And while the skin is stuck and the bones are moving back and forth. Everything in between is pulled and stretched. This pulling and stretching is what causes blisters.
We call it shear. And it needs high friction to get anywhere near blister-causing.”
With this opening, Rebecca starts to explain the effect of shear and friction on blister formation. She talks about cutting friction levels, especially when a blister develops, and gives examples of six friction reducers. Some of these are better than others.
We have always tried to reduce friction in both preventing blisters and when treating blisters. As Rebecca says, and I support, “Otherwise all that stretching (shear) continues at the blister base while it’s trying to heal. Making it hurt more. And taking longer heal.”
So take a moment and click on the Blister Prevention link and read Rebecca’s full blog post. While you are there, I encourage you to subscribe to her email list.
Many of you have participated in a 50-mile race, a 100-mile race, an adventure race, or some other type of multi-day race. Some multi-day races are non-stop while others are stage races. A lot of these races provide medical care at aid stations – and some also provide foot care.
If you have received foot care aid at these aid stations, you have been helped by the generous people I’ll call the “heroes” of foot care.
The picture shown here is from the Amazon Jungle Marathon this past October. Every one of the 15 members of our medical team helped with foot care. No one said they didn’t want to do feet. You can see the working conditions: sand everywhere, water bottles as footrests, a tarp to protect the runners and our knees (that quickly filled with sand), and supplies strewn all over and shared between medics. What you don’t see are the flies and bugs that were constantly in our faces, and the sweat running down our faces from the humidity. Now keep this up for hours, well into the night.
These are the heroes of foot care.
Most races have them. They volunteer their time and even supplies. They often go to races at their own expense. They work often under adverse and uncomfortable conditions. They want to do the best patch job possible. They are dedicated to getting you back into the race. They want you to have a great race experience. In short, they care.
I’ve been at races that have well-organized foot care services and others that have nothing. Some people providing their services are podiatrists, doctors, nurses, paramedics or EMTs, physical therapists, chiropractors, or other medical specialists. Other times they are simple people who have learned foot care techniques on their own or from someone else.
I know you appreciate these foot care people.
So how can you thank them? Let me share a few ideas.
- Simply say thank you.
- Make sure you have done everything possible to have healthy feet going into the race.
- Trim your toenails short and then file them smooth.
- Reduce calluses as much as possible.
- Wear quality shoes and socks.
- Know how to do your own foot care just in case we aren’t there or there’s a line for our services
- And finally, be patient. Good foot care and blister patching takes more than a minute.
We love helping runners and always welcome your appreciation.
Filed under: blister care, Foot Care, Footcare, Health, Sports, Travel
In early October I had the unique opportunity to return to Brazil and provide foot care to runners at the 10th Annual Jungle Marathon Amazon. The race is more than a marathon. It’s three races in one event set in a stage race format. Every day the race camp moves to a new location as the runners go through the jungle and along the beaches of the Amazon River. There’s a seven day, six stage race and a four day race, that both start at the same time. Then on day four, the single day marathon stage starts.
This year’s race was the toughest of any event I have been a part of. There was single track trails hacked through the jungle, red dirt roads with loose dirt, swamps and streams and rivers, humidity, heat, rain, sand that got everywhere, never ending wet feet and water-logged shoes, bugs and spiders and snakes, jaguar sightings, a lot of bee stings, either cold food or food heated with hot water, jungle and beach camps, carrying all your gear in a backpack, and nine nights in a hammock. Runner’s feet took a beating and as the days progressed, it was harder for them to recover. The cumulative affect of having your feet wet for the majority of every day, became a struggle for many runners. Maceration was a serious problem for everyone, and blisters affected all runners to varying degrees.
After the race ended, I was able to take a a few minutes and interview Amy Gasson, the second place women in the seven day race. Amy was a joy to know and smiled every day with a great positive attitude. Here’s the link to listen to the audio interview. It’s 17 minutes long.
Considering the interview was recorded with a handheld digital recorder, in the lobby of our hotel with all it’s normal background noises, the sound quality is remarkable. There’s a lot we can learn from what Amy shares. She did her homework and prepared well – both physically and her feet. Here’s a photo of Amy and me at the finish line.
Thanks Amy for letting me get to know you at the Jungle Marathon Amazon.