Really Sore Feet and Fleecy Web

October 31, 2015 by · Leave a Comment
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.

Hapla Fleecy Web

Hapla Fleecy Web on very sore feet

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.

Fleecy Web on the foot

Fleecy Web showing application on the side of the foot

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.

Foot Care – Help Yourself and Study Up

October 16, 2015 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Health 

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!

8 Top Tips for Foot Care

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:

  1. Trim nails
  2. Get in shape
  3. Fix calluses
  4. Prep your shoes
  5. Pack camp sandals
  6. Two ways to treat blood under a nail
  7. Wash your socks
  8. Lance right
8 Top Tips for Foot Care

8 Top Tips for Foot Care

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.

Foot Care Preparation for Primal Quest – or Your Next Event

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.

Foot Care Study at the Tahoe Rim Trail 100

July 16, 2015 by · 1 Comment
Filed under: Foot Care, Footcare 

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.

Tahoe Rim Trail Runs

Tahoe Rim Trail Runs

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.

Consequences of Wet Feet at a Dry Western States!  

July 4, 2015 by · 6 Comments
Filed under: blister care, Foot Care, Footcare, Footwear 

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.

Severe results of macerated feet

Severe results of macerated feet

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.

How Important are Gaiters?

Many runners have a love-hate relationship with gaiters.

Some love them and swear by them when running trails. Others never wear them, and dislike them. Which camp do you fall in?

I have regularly promoted the value of gaiters since I made my first homemade set from a pair of old white cotton crew socks. I believe it was one of the first years I ran Western States, maybe in 1985 or 86. I cut the foot out of the socks, leaving the ankle part to pull on my foot and fold over to cover the top of my shoes. I used twist-ties to anchor the socks to the shoes. And – they worked – as primitive as they were.

Then as the years progressed, people with more business sense than I started to make and sell gaiters. Now days, you can get gaiters in a myriad of colors and types.

I still believe in gaiters for trail runners, and in one recent conversation, told a friend that should make them mandatory gear for multi-day trail events.

You have every right to ask why.

Today’s shoes have become increasingly lightweight and many shoes are made with mesh uppers. It’s this mesh that allows all kinds of sand, dust, grit, and dirt into the shoe. These bad things will work their way into your socks and onto your skin. Rubbing and abrasions can occur. If you use any type of lubricant on your feet, the bad stuff will be attracted to the stickiness. The bad stuff can be a contributing factor that can lead to blisters.

A good set of gaiters will cover the tops of the shoes and the toe box to keep bad stuff out.

I’ve included two images of special gaiters that are typically found at the Marathon des Sables (MdS).

Running in sand at the MdS

Running in sand at the MdS






Gaiters at the MdS

Gaiters at the MdS








Here is the link to the myRaceKit for the MdS page that shows two gaiters they support. And a page from their blog that describes the fit and application.

These are highly useful when doing races in the desert, but how about when running trails? I believe the weak point in some gaiters is how they fail to cover the top of the shoe’s upper, thus allowing bad stuff inside.

I have treated many runners’ feet that are filthy with dirt and grit that makes it hard to wash off in order to find, clean, drain, and patch blisters. Blister patches and tape usually does not stick to dirty skin. In addition to making it harder for medical personnel to clean one’s feet, it also means it takes longer, which can affect not only your race, but those behind you that also need their feet worked on.

Back when, I wore homemade gaiters because that’s all there was. Now there are many styles and fabrics to choose from.

If I was going to run a tail race of any length, but especially a 50M or 100M, or multi-day race, I would buy one of the gaiters that attached to the shoe with Velcro and cover the whole shoe.

Still unsure?

Here are two of my blog posts about gaiters.

Blisters and Gaiters – this is by Lisa de Speville and adventure racer and ultrarunner from Soith Africa and her homemade gaiters.

Rough Country Gaiters: a review – this is a review of gaiters and offers commentary by Jay Batchen, who has done the MdS. Here’s a new link to the Rough Country Gaiters mentioned in the post.

In two weeks I will be working foot care at the Michigan Bluff aid station of the Western States 100. Then three weeks later I’ll be doing a foot care study at the Tahoe Rim Trail 100-Mile Run. I’d love to see a few runners wearing a more substantial gaiter.

Common Toenail Question

March 17, 2015 by · Leave a Comment
Filed under: blister care, Footcare, Health, Sports, toenails 

I get questions by email all the time. Toenail questions are quite common, so I thought I’d post this one. Here’s the question.

“I am emailing you because I have a 50K trail race this Saturday and for some reason I am just starting to get pressure from under my large toenail. It is in its early stages and my nail has not turned black yet, but it is starting to be uncomfortable. At what point do I decide to puncture thru my nail and lance the fluid under the nail? Also, if I should be lancing the fluid, what are your thoughts of using a really thin and clean drill bit (turned by hand) to get thru the toenail? I lost a toe nail once before and tried using a really hot paper clip and needle, but I had a hard time getting all the way thru my toe nail. Any help and advice you can give me would be much appreciated… thank you!”

The answer is pretty straightforward.

Draining a blister under a toenail

Draining a blister under a toenail

Can you recall any nailbed trauma? Once fluid is underneath the nail, the pressure becomes painful You’ll know. If you can see the fluid from under the tip of the nail, lance it there. A drill bit works better than a paperclip. Be forewarned that as it goes through the nail, it can go into the soft tissue underneath, so go slowly. Then press on the nail to expel as much of the fluid as possible. Cover with a Band-Aid for now (tape on race day) but don’t plug the hole with ointment, as it will still need to drain for a few days.

Relieving fluid from underneath a toenail is a simple skill that every runner should know how to perform – just in case. It could be on one of your toes, or the toe of a friend. If you have ever experienced the intense pain of a black toenail with blood or fluid underneath, you’ll appreciate knowing how to fix it.

An Interview with Amy Gasson at the Jungle Marathon Amazon

November 20, 2014 by · 2 Comments
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.

Interview with Amy Gasson at the Jungle Marathon Amazon

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.

Amy Gasson and me

Amy Gasson and me

Thanks Amy for letting me get to know you at the Jungle Marathon Amazon.

Mandatory Gear for Foot Care?  

October 22, 2014 by · 1 Comment
Filed under: blister care, Foot Care, Footcare, Health, Sports 

This post is an editorial about foot care at races – and more importantly, the lack of it.

Last week I returned from my second trip to Brazil to help provide foot care at the Amazon Jungle Marathon. I plan to write a post about the race later, so I won’t go into detail here – but this is the toughest race I have seen. Over the years I have worked many multi-day multi-sport adventure races and multi-day running races. Most of these are six or seven day events. Adventure races are races where the clock doesn’t stop until the team gets to the finish. Running races are typically stage races where each day is a specific mileage and camp changes every day.

Please continue reading – even if you don’t do multi-day races – because this blog post applies to those doing 24-hour races, 100 mile races, and athletes in general.

A Mandatory Gear List

A Mandatory Gear List

These types of races always have a list of mandatory gear. The list is composed of mostly safety items with a mix of medications and first aid stuff. Some of the first aid items can also be used for foot care. The photo shows an example of a first aid mandatory gear list. Here’s the rub though. Most athletes want to minimize, as much as possible, the amount and the weight of the stuff they have to carry. If the list calls for tape, they’ll carry a ½ inch wide very small roll, as few as possible blister patches, 2 or 3 alcohol wipes, 2 Band-Aids – you get the picture. They don’t have the right stuff because the lists are very general and don’t specify exact brands or types of supplies. They don’t have enough because they are not the average athlete and will need more. They only carry what they are required to carry and miss what they need for their feet. And many of these athletes don’t know how to use what they carry.

I have worked many multi-day races and have seen athletes finish a day’s stage and come to medical for every little thing. The medical staff should not have to manage all your foot care. You can manage the small pea-size blister on your toe. If you have hot spots, you can tape over them and check your shoes for seams. There is usually not enough medical staff to care for 100% of each runner’s needs. In addition, the supply of medical equipment is limited and can easily be over taxed by runners wanting everything done for them.

One runner in the Jungle Marathon came to see the medical team every day, telling us what he wanted down to the color of the tape and showing us all the spots on his feet he wanted fixed. We would have had to spend an hour just on him, with a lot of supplies, when he had a medical kit but wanted us to do it for him.

I am becoming more and more convinced that mandatory gear lists should be material specific. The width, length and type of tape should be listed. The number and type of blister patches. Scissors rather then a needle. Specific powder and amount. A specific number and type of tape adherent. And do on. The mandatory gear list needs to be reviewed with the medical director. This applies to runners in any race 50 miles or longer too. While the majority of runners don’t typically carry foot care supplies in a 100-mile run, their crews need to have the supplies.

I also am convinced that runners need to know how to patch their feet. Running a 100-mile race with no knowledge of how to care for one’s feet if and when problems develop is asking for trouble and putting undue burdens on the medical teams. You cannot assume that all medical personnel know how to patch feet – and have the best supplies for doing so.

Earlier this year I worked a multi-day event that had only basic medical supplies at the aid stations. There was virtually nothing that could effectively be used for foot care. The participants were not promised foot care, only first aid and medical personnel. In fact the pre-race materials did not mention foot care. Many aid stations did not allow crew access. The result was runners who were generally not carrying a foot care kit, had no crew access at many aid stations to help with their feet, and no medical personnel trained in or equipped to do foot care – a disaster waiting to happen. I had my complete foot care kit and worked on many runners’ feet. I know several other aid stations happened to have medical people who knew how to do basic foot care. But we each used our own supplies. I can honestly say that without the few of us on the course, the finishing rate would have been less than 30% because the race organizers did not think through the possible problems and build in solutions. Their disclaimer to me was that they had not promised foot care and runners were on their own.

In my opinion, putting on a race of any length requires race organizers to put runner safety as their first concern. Runners pay their money and expect a certain amount of good organization and common sense in return. In what has become a catch-22 situation, many runners genuinely expect there to be medical personnel able to manage emergencies as well as manage their feet. They think “first aid” and “medical personnel” means foot care. In reality, many races make no provision for foot care and take an “Oh well – that’s life” attitude. In fairness to medical personnel, I know anyone doing medical at an aid station will try and help any runner needing it. However they may not have the supplies and / or the training.

The Jungle Marathon had multiple doctors and paramedics, a fully stocked medical cache of basic and emergency supplies including medicines and narcotics, bandages and foot care supplies galore, and a complete set of medical protocols. Each checkpoint was manned by at least two medical personnel with a complete medical kit. Western States has great medical care at the major aid stations. So does Badwater.

In the end, every race lives and dies based on runner perceptions and what they share with their friends. Give them a bad experience; bad or non-existent medical care and / or foot care, and the word will spread.

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